By Gorka Barrenetxea
The second remarkable input of ESHRE meeting was presented during the European and global Assisted Reproductive Technology (ART) monitoring session on Tuesday. First, it is remarkable that ART is increasingly used all over the world. More than 8 million newborns attest to impact of ART among mankind.
But, I found both interesting and shocking the presentation by G. Chambers and colleagues (from Australia) of the paper entitled “Gender inequality and utilization of assisted reproductive technology: an international analysis”. In this paper, the authors showed that countries with less gender inequality have higher rates of ART utilization, regardless of the country’s level of economic and human development. Astonishing.
With an impeccable study design and assessing nothing less than 69 countries the authors demonstrate that after controlling for a country`s level of economic and human development, the higher the gender equality, the higher of ART utilization. The so called “gender equality” includes, for example, the female parliamentary representation, level of male and female education and level of wealth. For instance, an increase of 10% in female parliamentary representation augments ART utilization by a factor of 1,3 (with confidence intervals above the unit: 1,1-1,6). I.e., a 10% increase of females in parliament is translated in a 30% increase of assisted reproduction treatments. Furthermore, a one standard-deviation increase in the educational level (measured as Educational Index) (equivalent to 2.5 additional mean years of schooling) was associated with ART utilization increasing by a factor of 1.9 (95% CI: 1.0-3.5). So, 2.5 additional years of schooling are translated to a 90% increase of treatments. Breathtaking.
Regardless of different causes of infertility, the utilization (and, may be the availability?) of ART is influenced by gender equality and level of education of population.
In other words, gender inequality and low overall educational level is associated with lower ART utilization.
By Gorka Barrenetxea
As usually, the last ESHRE Annual Meeting has been successful both in attendance and scientific level of speakers as well as an opportunity to share experiences and knowledge with colleagues from over the world.
I have been honored with the invitation as a chairman of a scientific session (on biology of oocyte and cumulus complex) and the entire team of Reproducción Bilbao has play an active role by presenting a poster on single embryo transfer policy of our center.
Many topics have been debated but I would like to underline two specific issues of remarkable importance. Let`s go with the first one. The second will be described in a later post.
S. Sunkara (from UK) is one of the most cited author in the assisted reproduction field. Her papers on the number of oocytes considered ideal for IVF success constitute a cornerstone regarding ovarian stimulation targets. Her conference on cumulative live births as the optimal end point has been both clear and clarifying. Traditionally, IVF success has been reported as live birth rate per cycle or per transfer. There “were” a non-lineal relationship between number of achieved oocytes and pregnancy rate. Above 14-15 oocytes there was not an improvement in success rates. Thus, there “were” an ideal number of oocytes to be achieved in each egg retrieval (14-15). Besides, the risk of ovarian hyperstimulation syndrome could be considerable among high responder women. So, the end point was to achieve 14-15 oocytes in each procedure.
However, now things are different. In the XXIst century we have witnessed both, huge improvements in cryopreservation technology and advances in controlled ovarian stimulation procedures by the use of GnRH antagonists as adjuvant therapy and agonists as ovulation triggers. Thus, frozen-thawed embryo transfers are performed increasingly. Thus, cumulative live birth rate, defined as live births resulting from one initiated ART cycle (including fresh and frozen embryo transfers), is a more robust outcome measure of success in ART. In this setting, the achievement of as many oocytes as possible is advisable. Whereas the pregnancy rates did not increase once 14-15 oocytes were obtained (when only fresh cycles were assessed), current evidence shows that by combining fresh and frozen-thawed cycles the more oocytes recovered, the higher the chance of having available embryos to be transferred to achieve one or more pregnancies (after only one ovarian puncture).
The key message would be: “Once technology is available, use it” (of course, looking upon patients` safety).
