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