Access to assisted reproduction services and infertility treatment in Belgium in the context of the European countries

Abstract

The major complication of assisted reproductive technologies is the increased incidence of multiple pregnancies. Multiple pregnancies are associated with higher morbidity and mortality rates related to a higher incidence of prematurity and (very) low-birth-weight babies. The epidemic of iatrogenic multiple births has increased the incidence of maternal, perinatal and childhood morbidity and mortality. Healthcare cost of infertility treatment did increase significantly and this may lead to social and political concern. For in vitro fertilization, reducing the number of embryos transferred and the use of natural cycle IVF will decrease the number of multiple gestations. For non-IVF ovarian stimulation, a strict ovarian stimulation protocol aiming at mono-ovulation should be followed. The Belgian project to prevent multiple pregnancies was started in July 2003. A reimbursement of ART-related laboratory activities was linked to a transfer policy aiming at substantial multiple pregnancy reduction. It's a nice example of efficient forward looking health economics through responsabilisation. The first results indicate an increase of the number of IVF cycles by more than 30% and a more than 50% reduction of twin pregnancies. The next step will be the prevention of multiple pregnancies associated with non-IVF ovarian stimulation.