here - eshre

Almost one in five women having IVF in UK is40 or over; but treatments continue to riseThe UK’s latest report on IVF activity for 2010shows that almost 20% of all fresh IVF and ICSIcycles performed in Britain were in women aged 40or over. The figures represent a considerableincrease, having almost doubled over the past 13years, and are thought likely to be replicated inmany other European countries.A recent study from Maastricht foundthat the average age of patientsattending a first consultationincreased from 27.7 years in1985 to 31.4 years in 2008,a rise of almost four yearsin just two decades. Theproportion of women of35 years or older almostquadrupled to 31%.And world datagathered by ICMART for2007 and reported atESHRE’s annual meetinglast year estimated thatalmost 16% of women havingART were over the age of 40.The latest HFEA report puts theaverage age of women in the UK having IVF andICSI (as well as donor insemination) in 2010 at35 years. Twenty years ago, the average age was33.6 years.The report also disclosed that in 2010 a totalof 45,264 women received 57,652 IVF or ICSItreatments, an increase of 5.9% on thenumber of cycles in 2009. This toois consistent with recent year-onyeartrends calculated byESHRE’s EIM Consortiumand by ICMART.The pregnancy ratefrom these UK cycleswas 33.4% per transfer.However, in 200924.9% of live births inpatients aged 18–34years were multiple, arate only marginallylower than the 29.4%multiple rate of 2008.Age range of IVF/ICSI patients in UK clinics in2010, from the HFEA’s latest annual report.Netherlands poised to reduce reimbursed IVF cyclesHolland’s minority government (of liberals and Christian Democrats) has been in power for little more than a year but hasalready announced cost-cutting measures in IVF to the tune of €30 million a year. This, they say, must be achieved byexcluding a second and third cycle from the state’s reimbursement scheme - which would reduce the number of reimbursedIVF cycles in the Netherlands from three to one. In announcing the measures, the government invited those involved topropose alternative ways to raise the €30 million a year.‘We calculated that the additional cost of a twin pregnancy compared to a singleton was around €5000 per pregnancy,’said Hans Evers, from the Academic Hospital of Maastricht. ‘The extra costs involved in the delivery and in the first fourweeks range from €2000 in the case of a healthy twin to €30,000 in the case of a twin with complications, such asprematurity.’ Evers added that the long-term costs submitted to the government were only rough estimates, but rangedfrom €900-7000 per year per child with a minor handicap to €1800-20,000 per year per child with a severe handicap.The Dutch calculations were based on 2009 data; 16,769 IVF treatment cycles were performed, resulting in 4386ongoing pregnancies and 469 twin pregnancies, for a multiple pregnancy rate of 10.7%. Of these twins, 85% were born towomen below 38 years of age.‘Estimating the average lifetime additional costs of a twin at € 75,000,’ explained Evers, ‘we argued that by decreasingthe number of twins to zero by performing single embryo transfer in all women below 38 years, we would save 85% x 469twins x €75,000 per year - that’s €29.9 million. We thought this would meet the government’s requirements, which wouldleave the number of reimbursed cycles at three.’However, despite the logic of the proposal and the clinics’ promise to adopt a strategy of only SETs in all women under38, the Minister of Health was not impressed. The cost savings would be made outside the area of IVF, and many of thecost savings were considered ‘lifetime’, so would not bring an immediate return. The signs are, says Evers, that theNetherlands will now lose its three cycle reimbursement policy in 2013, and become yet another example of how IVFseems the soft option when it comes to cost-cutting in health budgets.Focus on Reproduction January 2012 9