Clinical and logistical aspects of in vitro fertilization treatment: An analysis of a transport IVF programme

In vitro fertilization and cmblYo transfer (IVFIET), the culture of aspirated aGcytcs and spermatozoa in the JaboratOly follO\\ved by transccrvicai embryo transfer, ,vas originally used as a treatment for infertility resulting from impaired fUllction of the fallopian tubes. A few years after the introduction of IVF/ET the indications for treatment included infertility caused by endometriosis, male factors, ovulation disorders and unexplained infertility (1). Although IVF has now become an accepted treatment for infertility, there are still several contentiolls issues in the application of assisted reproductive technologies (ART) (2). It has been argued by World Health Organization authorities that IVF benefits only a small propmtion of infertile couples, that it is expensive, and that it has serious health risks (3). In a WHO repOli from the Regional Office for Europe it was suggested that eligibility for IVF should be limited to wOlllen under 40 years of age, that the nUIllber of treatment cycles per woman should be limited, and that no more than three embryos should be transferred per treatment cycle (4). The increased ineidencc of triplet and higher-order pregnancies caused by ovulation induction and ART (5, 6), its associated increased medical risks (7) and high costs (8) have been reported. Apparently, sOllle health authorities still consider ART controversial. This critical approach stresses the need for IVF programmes to raise their level of accountability. In this thesis, the logistical and some clinical aspects of the IVF treatment as carried out in the transport IVF programme at the Zuiderziekenhuis, Rotterdam, in collaboration with the University Hospital Dijkzigt, Rotterdam, are analyzed. The aims of this thesis are: to determine the efficacy of a decentralized IVF programme with transport and satellite clinics, to fmiher develop criteria for acceptance of patients, to develop a safer treatment strategy avoiding high-order pregnancies, and, where possible, to touch upon the issues mentioned above.

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