Assisted reproductive technologies in public and private clinics

Abstract

The aim of this study was to analyse the influence of the type of service provided by assisted reproduction clinics. The activities, treatment patterns and results achieved by assisted reproduction centres in Spain were examined, comparing public and private clinics. A retrospective study was carried out using the Assisted Reproductive Technology Register of the Spanish Fertility Society for 2002-2004. The results showed that 74%, 96% and 99% of IVF/intracytoplasmic sperm injection, oocyte donation and preimplantation genetic diagnosis cycles, respectively, were carried out in the private sector. Public clinics performed proportionally more transfers of three embryos than the private clinics (48.1% versus 41.7%). More elective transfers were performed in private clinics. Pregnancy rates per cycle started, per puncture and per transfer were significantly higher among private than public clinics (29.1%, 32.7% and 35.9% versus 25.2%, 28.5% and 32.6%, respectively) (P < 0.05). Implantation rate has risen year on year in both types of clinic and was significantly higher (P < 0.05), every year, among the private clinics. The multiple-pregnancy rate was significantly higher among the private clinics (30.8% versus 26.4%) (P < 0.05). In conclusion, differences exist between public and private clinics as regards to their volume of activity, the range of services offered, clinical practice and results achieved.

Embryologists’ health: a nationwide online questionnaire

“…Because the data for the mailing were provided by ASEBIR, the conclusions drawn may not be applicable to all Spanish embryologists or to other countries. Nevertheless, the fact that the results obtained for some occupational variables (such as type of laboratory: public or private) are similar to those described for Spain in general [45], leads us to believe that our findings could have a high degree of external validity nationwide. However, any extrapolation of these findings to embryologists working in other countries should be performed with caution, because of large differences in the size of laboratories.…”

Assisted Reproduction in Spain, Outcome and Socioeconomic Determinants of Access

“…This study supplements previous research about diverse public ART policies concerning the balance between public and private care, socioeconomic disparities, and differences in outcome [ 12,13,55]. We applied two statistical models on data extracted from the national Spanish Fertility Survey (SFS), conducted in 2018 by the National Statistics Institute (INE).…”

“…Based on the National Activity Registry by the Spanish Fertility Society (SEF) and as analyzed by Romero et al [ 49], we may assume that the quality of care and success rates in public ART clinics in Spain does not fall from the sector's standards [49,53]. It is di cult to determine that private clinics produce a signi cantly better outcome [ 13], since they may handle better prognosis and treat "good" patients with their own eggs and patients of poor embryonic development or low ovarian reserve with donor eggs.…”

“…These reasons may very well be associated with socioeconomics determinants since a favorable nancial situation may "buy" time and reduce stress, although demanding professional career produces "lack of time". (5,110), physical and health impediments (59), preference for adoption or surrogacy (13), religious impediments (10) and unwillingness by the partner ( 22), timed intercourse was applied (11).…”

“…Spanish national health system covers up to three ART cycles for childless couples, up to 40 years for women and 55 for men [ 4]. However, patients spend around one year on average on waiting lists for public clinics [ 25,40], which may delay the potential solution, harm treatment outcomes [ 13], and produce distrust. In practice, about 75% of cycles are elaborated by private clinics, which are also responsible for nearly all donor eggs 3 and PGT (therefore for the majority of reproductive tourism) [ 42,49,54].…”