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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

Quality of systematic reviews: Oxman and Guyatt index of scientific quality for systematic reviews.
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Related In: Results  -  Collection

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Fig3: Quality of systematic reviews: Oxman and Guyatt index of scientific quality for systematic reviews.

Mentions: Results of quality assessment for the systematic reviews are presented in Additional file 5: Table S5 and Figure 3. In general, most of the systematic reviews were of high quality, regardless of whether meta-analyses had been performed. All provided details of their search strategy, which was comprehensive, and nearly all clearly described their study inclusion criteria. Aside from one review that excluded studies with 0% incidence of a primary outcome, no clear bias in study selection was found. The most common weakness of the reviews was failure to perform or report a validity assessment of included studies (12/33). However, where validity was assessed, appropriate criteria were used. Of reviews with meta-analyses (24/33), all recorded methods used to combine outcomes data, and all were appropriate. Comparing studies that pooled data with those that did not, there was variation in the degree of clinical heterogeneity deemed too much to pool. Conclusions drawn in all reviews were consistent with the data they collected and reported.Figure 3


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)

Quality of systematic reviews: Oxman and Guyatt index of scientific quality for systematic reviews.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig3: Quality of systematic reviews: Oxman and Guyatt index of scientific quality for systematic reviews.
Mentions: Results of quality assessment for the systematic reviews are presented in Additional file 5: Table S5 and Figure 3. In general, most of the systematic reviews were of high quality, regardless of whether meta-analyses had been performed. All provided details of their search strategy, which was comprehensive, and nearly all clearly described their study inclusion criteria. Aside from one review that excluded studies with 0% incidence of a primary outcome, no clear bias in study selection was found. The most common weakness of the reviews was failure to perform or report a validity assessment of included studies (12/33). However, where validity was assessed, appropriate criteria were used. Of reviews with meta-analyses (24/33), all recorded methods used to combine outcomes data, and all were appropriate. Comparing studies that pooled data with those that did not, there was variation in the degree of clinical heterogeneity deemed too much to pool. Conclusions drawn in all reviews were consistent with the data they collected and reported.Figure 3

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