Willingness to pay and conjoint analysis to determine women's preferences for ovarian stimulating hormones in the treatment of infertility in Spain.

BACKGROUND: Despite many advances in assisted reproductive techniques (ART), little is known about preferences for technological developments of women undergoing fertility treatments. The aims of this study were to investigate the preferences of infertile women undergoing ART for controlled ovarian stimulation (COS) treatments; to determine the utility values ascribed to different attributes of COS treatments; and to estimate women's willingness to pay (WTP) for COS. METHODS: A representative sample of ambulatory patients ready to receive, or receiving, COS therapies for infertility were recruited from seven specialized private centres in six autonomous communities in Spain. Descriptive, inferential and conjoint analyses (CA) were used to elicit preferences and WTP. Attributes and levels of COS treatments were identified by literature review and two focus groups with experts and patients. WTP valuations were derived by a combination of double-bounded (closed-ended) and open questions and contingent ranking methods. RESULTS: In total, 160 patients [mean (standard deviation; SD) age: 35.8 (4.2) years] were interviewed. Over half of the participants (55.0%) had a high level of education (university degree), most (78.8%) were married and half (50.0%) had an estimated net income of >€1502 per month and had paid a mean (SD) €1194.17 (€778.29) for their most recent hormonal treatment. The most frequent causes of infertility were related to sperm abnormalities (50.3%). In 30.6% of cases, there were two causes of infertility. The maximum WTP for COS treatment was €800 (median) per cycle; 35.5% were willing to pay an additional €101-€300 for a 1-2% effectiveness gain in the treatment. Utility values (CA) showed that effectiveness was the most valued attribute (39.82), followed by costs (18.74), safety (17.75) and information sharing with physicians (14.93). CONCLUSIONS: WTP for COS therapies exceeds current cost. Additional WTP exists for 1-2% effectiveness improvement. Effectiveness and costs were the most important determinants of preferences, followed by safety and information sharing with physicians.

Comparison of IVF cycles reported in a voluntary ART registry with a mandatory registry in Spain.

BACKGROUND: Monitoring assisted reproductive technology (ART) is essential to evaluate the performance of fertility treatment and its impact on birth rates. In Europe, there are two kinds of ART registers: voluntary and mandatory. The validity of register data is very important with respect to the quality of register-based observational studies. The aim of this paper is to determine the degree of agreement between voluntary and mandatory ART registers. METHODS: The two sources for the data compared in this study (referring to 2005 and 2006) were FIVCAT.NET (an official compulsory Assisted Reproduction Registry within the Health Ministry of the Regional Government of Catalonia, to which all authorized clinics, both public and private, performing assisted reproduction in the region are obliged to report) and the register of the Spanish Fertility Society (SEF), to which data are provided on a voluntary basis. The SEF register data were divided into two groups: (i) data from clinics in Catalonia (SEF-CAT); (ii) data from the rest of Spain, excluding Catalonia (SEF-wCAT). The techniques compared were IVF cycle using patients' own eggs (IVF cycle) versus donor egg cycles. RESULTS: For IVF cycles, the voluntary ART register reflected 77.2% of those on the official one, but the corresponding figure was only 34.4% with respect to donated eggs. The variables analysed in the IVF cycle (insemination technique used, patients' age, number of embryos transferred, pregnancy rates, multiple pregnancies and deliveries) were similar in the three groups studied. However, we observed significant differences in donor egg cycles with regard to the insemination technique used, pregnancy rates and multiple pregnancies between the voluntary and the official register. CONCLUSIONS: Data from the voluntary ART register for IVF cycles are valid, but those for donor egg cycles are not. Further study is necessary to determine the reasons for this difference.

Impact of the Spanish Fertility Society guidelines on the number of embryos to transfer.

The multiple pregnancy rate in assisted reproduction treatment cycles depends, fundamentally, on the number of embryos transferred. It is essential that patients and professionals should have good practical guidelines on the best number of embryos to be transferred in each cycle in order to obtain high pregnancy rates with minimal risk of multiple pregnancies. This study analysed the impact made by the Spanish Fertility Society (SEF) guidelines on the number of embryos to be transferred, as regards the policies adopted at clinics in Spain and the resulting financial repercussions. Data were collected from the assisted reproduction treatment register of the SEF and compared over three periods of time: 2002-2003, with no legal regulation and no SEF guidelines; 2004, with only legal regulation; and 2005-2006, with legal regulation and SEF guidelines. The acceptance of SEF guidelines varies according to the IVF technique. The guidelines have led to a reduction in multiple pregnancy rates, especially concerning triplets, in patients' own-egg and with donor-egg cycles. Even without full implantation, these results validate the clinical utility of the SEF guidelines. They constitute a useful tool to reduce the incidence of the principal adverse effect of treatment cycles: multiple pregnancies. The multiple pregnancy rate in assisted reproduction cycles depends fundamentally on the number of embryos transferred. It is essential that patients and professionals should have good practical guidelines on the best number of embryos to be transferred in each cycle in order to obtain high pregnancy rates with minimal risk of multiple pregnancies. The purpose of this study was to analyse the impact made by the Spanish Fertility Society (SEF) guidelines on the number of embryos to be transferred, as regards the policies adopted at clinics in Spain, and the resulting financial repercussions. Data were collected from the assisted reproduction register of the SEF and compared over three periods of time: 2002-2003, when there was no legal regulation and no SEF guidelines; 2004, when there was only legal regulation; and 2005-2006, when there was legal regulation and SEF guidelines. The degree of acceptance of SEF guidelines varies according to the IVF technique employed. The guidelines have led to a reduction in multiple pregnancy rates, especially concerning triplets, using patients' own eggs and with donor eggs. The reduction in the financial cost of deliveries achieved in the years 2005-2006 ranged from 890,187 to 18,593,242 euros, and the incremental cost per percentage point of multiple pregnancy avoided is 2,989,613 euros. In conclusion, even without full implementation, these results validate the clinical utility of the SEF guidelines. They constitute a useful tool to reduce the incidence of the principal adverse effect of assisted reproduction cycles, namely multiple pregnancies.

Assisted reproductive technologies in public and private clinics.

The aim of this study was to analyse the influence of the type of service provided by assisted reproduction clinics. The activities, treatment patterns and results achieved by assisted reproduction centres in Spain were examined, comparing public and private clinics. A retrospective study was carried out using the Assisted Reproductive Technology Register of the Spanish Fertility Society for 2002-2004. The results showed that 74%, 96% and 99% of IVF/intracytoplasmic sperm injection, oocyte donation and preimplantation genetic diagnosis cycles, respectively, were carried out in the private sector. Public clinics performed proportionally more transfers of three embryos than the private clinics (48.1% versus 41.7%). More elective transfers were performed in private clinics. Pregnancy rates per cycle started, per puncture and per transfer were significantly higher among private than public clinics (29.1%, 32.7% and 35.9% versus 25.2%, 28.5% and 32.6%, respectively) (P < 0.05). Implantation rate has risen year on year in both types of clinic and was significantly higher (P < 0.05), every year, among the private clinics. The multiple-pregnancy rate was significantly higher among the private clinics (30.8% versus 26.4%) (P < 0.05). In conclusion, differences exist between public and private clinics as regards to their volume of activity, the range of services offered, clinical practice and results achieved.

Diferencias de morbilidad obstétrica y perinatal entre la población autóctona y magrebí / Differences in obstetric morbidity and the perinatal period between the autochtonous and the Moroccan populations

Nuestro propósito es conocer si existen diferencias en el grado de control del embarazo, morbilidad obstétrica y resultado perinatal entre las gestantes magrebíes y autóctonas, así como discutir la necesidad de implantar medidas específicas, ya que el porcentaje de mujeres inmigrantes crece de forma importante en nuestro entorno. Para ello estudiamos las 115 gestantes magrebíes que parieron en nuestro centro en el año 2000 y una muestra igual de población autóctona, recogiendo los datos a partir de la historia clínica. Se estudian paralelamente todos los neonatos magrebíes y autóctonos ingresados en el año 2000 a partir del registro de altas del servicio de pediatría. Se realiza un análisis estadístico aplicando la prueba de la *2. Encontramos diferencias significativas, por lo que respecta a las magrebíes, en su mayor paridad y distribución por edad, en su menor grado de control de la gestación, menor número de analíticas realizadas, mayor positividad frente al estreptococo B, menor número de ecografías realizadas en los períodos protocolizados, mayor número de obesas y de incremento insuficiente de peso durante la gestación, mayor número de registros de enfermedad médica y obstétrica, menor necesidad de analgesia durante el parto, diferencia en el peso del recién nacido entre percentiles y mayor número de ingresos neonatales por riesgo de infección. En conclusión, siendo necesario llevar a cabo medidas para favorecer la integración del colectivo de inmigrantes y mejorar su control gestacional, existen determinados aspectos de su morbilidad no modificables (AU)

Tumoraciones de pared abdominal como diagnóstico diferencial con masas anexiales. A propósito de dos casos / Tumorations of the abdominal wall, with a differential diagnosis of adnexial massess. Two case studies

Relatamos dos casos en que, bajo la sospecha de masa pélvica de origen ginecológico, se identifican dos tumoraciones de pared abdominal. Resaltamos la dificultad que existe para orientar estas otras posibilidades diagnósticas, a causa de su baja frecuencia (AU)