Equity in the use of IVF in Finland in the late 1990s

Abstract

Aims: The purpose of this study was to describe equity in the use of in vitro fertilization (IVF; including micro-injections and frozen-embryo transfers), and compare its use with that of other assisted reproduction technologies (other ARTs; including ovulation inductions with or without inseminations). Methods: The women who received IVF (n=9, 175) and other ARTs (n=10,254) between 1996 and 1998 were identified from the reimbursement records of the Social Insurance Institution (SII) covering all Finns. Population controls, matched by age and municipality, were selected for IVF women (n=9,175). Information concerning background characteristics came from the Central Population Register and the SII's reimbursement files. The sector (public vs. private) was defined using prescribing physicians' codes. IVF use was studied by the proportions of women treated and the frequency of treatment. Results: The age-standardized IVF incidence per thousand 20-to-49-year-old women was 8.8 in urban and 7.3 in rural areas, but the use of other ARTs did not vary correspondingly (9.2, 9.3). The regional incidence of IVF and other ARTs varied considerably. In the private sector, women in the highest socioeconomic position were over-represented (29% private, 18% public, 16% controls). During the mean 1.5 years of the study period, the IVF women had somewhat more treatment cycles in the private than in the public sector (mean 3.3, 2.7), and those in the highest socioeconomic position had more cycles than others (3.5, 3.2); the frequency was not age-dependent. In the public sector the number of cycles did not differ by socioeconomic group (mean 2.7 - 2.8 per woman), and women aged 25 to 39 had more cycles than others. Conclusion: There were socioeconomic differences in use of IVF services, but they were small because of the equitable use of public services.