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Assisted reproductive technologies (ARTs): evaluation of evidence to support public policy development.

Nardelli AA, Stafinski T, Motan T, Klein K, Menon D - Reprod Health (2014)

Bottom Line: IVF was shown to offer significant benefits over no treatment and IUI in achieving pregnancy and live birth among couples with endometriosis or unexplained infertility.Frozen and blastocyst-stage embryo transfers were as effective as fresh and cleavage-stage embryo transfers, respectively.Frozen embryo transfer had fewer adverse events during pregnancy and delivery than fresh embryo transfer, and was at least as safe in terms of infant outcomes.

View Article: PubMed Central - PubMed

Affiliation: Health Technology and Policy Unit, School of Public Health, Department of Public Health Sciences, University of Alberta, Room 3021 Research Transition Facility, 8308 114 Street, Edmonton, Alberta T6G 2 V2, Canada. alexan@ualberta.ca.

ABSTRACT
Over the years, IVF/ICSI protocols have continued to evolve with efforts to improve outcomes. As a result, treatment success may be related to certain procedural factors, including number of embryos transferred and stage at which they are transferred. This review aims to assess the safety and effectiveness of IVF/ICSI in comparison to spontaneous conception and less invasive ARTs and the impact of procedure-related factors on the outcomes of IVF/ICSI in order to support the development of local clinical and policy guidance. Following Cochrane Collaboration guidelines and the PRISMA statement, a comprehensive systematic review of literature examining the impact of procedural characteristics on the safety or effectiveness of IVF/ICSI from 2007 to date was performed. 33 systematic reviews and 3 primary studies evaluating the impact of procedural differences, IVF/ICSI in comparison to less invasive ARTs, and ARTs in comparison to spontaneous conception were found. IVF was shown to offer significant benefits over no treatment and IUI in achieving pregnancy and live birth among couples with endometriosis or unexplained infertility. Frozen and blastocyst-stage embryo transfers were as effective as fresh and cleavage-stage embryo transfers, respectively. In comparison to single embryo transfer, double embryo transfer significantly increased pregnancy, live birth and multiple pregnancy/birth rates. IVF/ICSI was associated with more complications during pregnancy and delivery, and in infants compared to naturally conceived pregnancies, particularly when multiple embryo transfer was used. Frozen embryo transfer had fewer adverse events during pregnancy and delivery than fresh embryo transfer, and was at least as safe in terms of infant outcomes. The potential complications of IVF/ICSI may be minimized through procedural choices, but such choices often impact effectiveness. Thus, in developing clinical and policy guidance around IVF/ICSI, the risk-benefit trade-offs patients and providers are willing to accept must be carefully considered.

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Related in: MedlinePlus

PRISMA flowchart of literature search results and study selection for safety and clinical effectiveness review: systematic reviews.
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Fig1: PRISMA flowchart of literature search results and study selection for safety and clinical effectiveness review: systematic reviews.

Mentions: 1,733 discrete citations were identified through the literature search for systematic reviews, of which 79 potentially relevant systematic reviews were selected for full review (Figure 1). Thirty-three met the inclusion criteria. The search for additional primary studies yielded 4,614 discrete citations (Figure 2). Three potentially relevant studies were selected for full review, all of which met the inclusion criteria. Excluded studies and their reasons for exclusion are presented in Additional file 2: Table S2. Methodological characteristics and outcomes of each included study are summarized in Additional file 3: Table S3, Additional file 4: Table S4, Additional file 5: Table S5; Additional file 6: Table S6, Additional file 7: Table S7, Additional file 8: Table S8, Additional file 9: Table S9, Additional file 10: Table S10, Additional file 11: Table S11, Additional file 12: Table S12, Additional file 13: Table S13, Additional file 14: Table S14, Additional file 15: Table S15 and Additional file 16: Table S16.Figure 1


Assisted reproductive technologies (ARTs): evaluation of evidence to support public policy development.

Nardelli AA, Stafinski T, Motan T, Klein K, Menon D - Reprod Health (2014)

PRISMA flowchart of literature search results and study selection for safety and clinical effectiveness review: systematic reviews.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4233043&req=5

Fig1: PRISMA flowchart of literature search results and study selection for safety and clinical effectiveness review: systematic reviews.
Mentions: 1,733 discrete citations were identified through the literature search for systematic reviews, of which 79 potentially relevant systematic reviews were selected for full review (Figure 1). Thirty-three met the inclusion criteria. The search for additional primary studies yielded 4,614 discrete citations (Figure 2). Three potentially relevant studies were selected for full review, all of which met the inclusion criteria. Excluded studies and their reasons for exclusion are presented in Additional file 2: Table S2. Methodological characteristics and outcomes of each included study are summarized in Additional file 3: Table S3, Additional file 4: Table S4, Additional file 5: Table S5; Additional file 6: Table S6, Additional file 7: Table S7, Additional file 8: Table S8, Additional file 9: Table S9, Additional file 10: Table S10, Additional file 11: Table S11, Additional file 12: Table S12, Additional file 13: Table S13, Additional file 14: Table S14, Additional file 15: Table S15 and Additional file 16: Table S16.Figure 1

Bottom Line: IVF was shown to offer significant benefits over no treatment and IUI in achieving pregnancy and live birth among couples with endometriosis or unexplained infertility.Frozen and blastocyst-stage embryo transfers were as effective as fresh and cleavage-stage embryo transfers, respectively.Frozen embryo transfer had fewer adverse events during pregnancy and delivery than fresh embryo transfer, and was at least as safe in terms of infant outcomes.

View Article: PubMed Central - PubMed

Affiliation: Health Technology and Policy Unit, School of Public Health, Department of Public Health Sciences, University of Alberta, Room 3021 Research Transition Facility, 8308 114 Street, Edmonton, Alberta T6G 2 V2, Canada. alexan@ualberta.ca.

ABSTRACT
Over the years, IVF/ICSI protocols have continued to evolve with efforts to improve outcomes. As a result, treatment success may be related to certain procedural factors, including number of embryos transferred and stage at which they are transferred. This review aims to assess the safety and effectiveness of IVF/ICSI in comparison to spontaneous conception and less invasive ARTs and the impact of procedure-related factors on the outcomes of IVF/ICSI in order to support the development of local clinical and policy guidance. Following Cochrane Collaboration guidelines and the PRISMA statement, a comprehensive systematic review of literature examining the impact of procedural characteristics on the safety or effectiveness of IVF/ICSI from 2007 to date was performed. 33 systematic reviews and 3 primary studies evaluating the impact of procedural differences, IVF/ICSI in comparison to less invasive ARTs, and ARTs in comparison to spontaneous conception were found. IVF was shown to offer significant benefits over no treatment and IUI in achieving pregnancy and live birth among couples with endometriosis or unexplained infertility. Frozen and blastocyst-stage embryo transfers were as effective as fresh and cleavage-stage embryo transfers, respectively. In comparison to single embryo transfer, double embryo transfer significantly increased pregnancy, live birth and multiple pregnancy/birth rates. IVF/ICSI was associated with more complications during pregnancy and delivery, and in infants compared to naturally conceived pregnancies, particularly when multiple embryo transfer was used. Frozen embryo transfer had fewer adverse events during pregnancy and delivery than fresh embryo transfer, and was at least as safe in terms of infant outcomes. The potential complications of IVF/ICSI may be minimized through procedural choices, but such choices often impact effectiveness. Thus, in developing clinical and policy guidance around IVF/ICSI, the risk-benefit trade-offs patients and providers are willing to accept must be carefully considered.

Show MeSH
Related in: MedlinePlus