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Global socioeconomic and cultural factors affecting the number of embryos transferred

Global socioeconomic and cultural factors affecting the number of embryos transferred. Fernando Zegers-Hochschild, MD

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Global socioeconomic and cultural factors affecting the number of embryos transferred

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  1. Global socioeconomic and cultural factors affecting the number of embryos transferred Fernando Zegers-Hochschild, MD ICMART Symposium: “Global socioeconomic, cultural and regulatory differences that affect the number of embryos transferred” ASRM, San Francisco 2008

  2. Regional contribution of ART cycles to the World Report (2004) N = 764,628 Middle East 6.5% Latin America 3.0% Australia & New Zealand 5.2% ICMART, World Report 2004. * Corresponds to aspiration cycles in IVF, ICSI & GIFT and transfer cycles in FET & OD.

  3. 1st Hypothesis Socioeconomic factors influence access to ART

  4. Number of ART Cycles according to Public/Private Health Expenditure (2004) United Nations Statistics Division

  5. Out-of-pocket expenditure as % of Private health expenditure (2004) United Nations Statistics Division

  6. Access Is “ART cycles/million Inhabitants” a good marker of availability? It does not consider the age distribution of the population and the willingness to become pregnant

  7. Number of births and age of female Spontaneous Pregnancy - The Netherlands 17500 15000 12500 10000 7500 5000 2500 1965-9 1975-9 1995-9 2001-5 Births 20 25 30 35 40 45 50 Age of the female partner (years) N=1000 births / period Central Statistics Bureau of the Netherlands

  8. Number of births and age of Female Spontaneous pregnancy - Chile Number of births Age of Female N=1000 births / year Instituto Nacional de Estadísticas (INE)

  9. Number of ART cycles performed in one year Female population aged 25 through 40 (10% infertility prevalence) x (30% ART) Estimated Need for ART Cycles x 100%

  10. Access to ART* (women aged 25-40) 100 78.9 56.0 50.5 40.9 23.7 21.3 16.4 8.4 6.6 2.4 2.1 0.9 0.8 (*) ICMART, World Report

  11. 2nd Hypothesis Demographic factors influence access to ART

  12. Access to ART (2004) according to:age of female population and fertility rate US Census Bureau/International Data Base (IDB) / UN Statistics Division

  13. Socioeconomic and demographic factors determine access to ART Countries with • HIGH median age of the female population • LOW median age of the female population • LOW population growth • HIGH population growth SOCIETY needs access to ART INDIVIDUAL needs access to ART

  14. Is fertility a national priority? How does it compete with other health issues?

  15. Under-5 mortality rate US Census Bureau/International Data Base (IDB) / Nations Statistics Division

  16. Fertility rate becomes a priority once other vital health issues have been solved

  17. 3rd Hypothesis Cultural and religious factors influence access to ART

  18. Cultural and religious factors influence access to ART Religious authority Moral decisions Principles Evidence and consequence Catholic / Islamic Protestant / Jewish

  19. Socioeconomic, demographic & religious factors influence access to ART Does access to ART determine HOW it is performed?

  20. Number of embryos transferred and multiplicity • Proportion of ICSI vs IVF • Embryo Cryopreservation

  21. Number of embryos transferred per region, IVF & ICSI (2004) x= 3.10 x= 2.9 x= 2.2 ICMART, World Report 2004.

  22. Factors influencing the number of transferred embryos (2004)

  23. Conclusion • Cultural, Socio-economic and demographic factors influence: • who has access to ART, • when they have access to ART, and • how ART is performed.

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