engleski

Croatian IVF legislation and the effect of restrictions on IVF outcome

The in vitro fertilization (IVF) legislation can directly affect the success of IVF treatment. The illustration and support for these statements can be found in the Italian restrictive law (Law 40/2004) and the effect of its implementation. The aim of this study was to compare data on assisted reproduction treatment and outcome before and after the introduction of this new legislation and give answer to a question on the possible negative effects of restrictive IVF regulation using data from Croatia. Data were analysed retrospectively: the first group consisted of data from patients which underwent IVF/ICSI procedure during period of restrictions (group I) and the second one of data from patients which underwent IVF/ICSI procedure after the new law was enforced (group II).In both groups there were more antagonist cycles (71.9%) than agonist cycles (28.1%) ; but after the new law was enforced there were more antagonist cycles (81.4% for group II compared to 59.5% for group I). Regarding ICSI and IVF procedure ; for ICSI 68.7% in group I vs. 67.4% in group II, and for IVF cycles 31.3% in group I vs. 32.6% in group II. Ratio of ICSI and IVF was similar (χ²=0.598, df=1, p >.01) although we expected more ICSI cycles in group I. During restrictions (in group I, 49.2%) usually three embryos were implemented but after the enforcement of the new law (group II, 63.4%) mostly two embryos were implemented (χ²=77.70, df=2, p < .01). In both groups embryo transfer was usually done on the third day but after the enforcement of the new law much more transfers were done on the fifth day (group II, 23.1%) compared to previous period (group I, 7.1%). During restrictive IVF law there were 28% of twin pregnancies (group I) compared to 12.5% under the new IVF regulation (group II) ; in addition multiple pregnancies (triplets) were 2.81% in group I and 0.96% in group II. In group I there were 9.58% biochemical pregnancies compared to 6.73% in group II ; and there were 4.22% of miscarriages (spontaneous abortions) in group I compared to 12.5% of miscarriages in group II. The percentage of pregnancies did not differ between groups (χ²=0.70, df=1, p>.01) leaving us with a conclusion that the pregnancy rate around 30% was achieved during enforcement of both laws. These results show that IVF regulation affects the treatment and outcomes in ART, and that for some issues in ART restrictive regulations has negative effects. Our findings represent clinical contribution for countries still debating the enforcement of restrictions in ART legislation.

IVF ; law ; pregnancy rate ; national regulation

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