Andrew Riddle, Medical Director Person Responsible, Nuffield
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Transcript Andrew Riddle, Medical Director Person Responsible, Nuffield
Key factors of a successful strategy
Andrew Riddle
Medical Director Person Responsible, Nuffield Health Woking Hospital
26 February 2014
#hfeaconference2014
ACE 2014 Oral Presentation
Successful establishment of eSET
criteria with multiple pregnancy
rate reduced to below 5%
How have our blastocyst criteria developed?
Original Criteria
(prior to 2011)
Developing Criteria
(2011-2012)
Current Criteria
(2013 onwards)
<37
All patients ≤40
2 or more TQE on day 2 or 3
9 TQE
5 TQE
1 TQE and multiple average
Increase in blastocyst transfers from
quality embryos
6.4% in 2011 4to
72.1% in 2013
TQE
Previous unsuccessful attempt
when TQE transferred
Long discussion with patient
or
Consider patient history
3 TQE
If >40 consider blastocyst based
on previous history
3
How have our eSET criteria developed?
Original Criteria
Current Criteria
Consider for any patient <37
Consider for any patient <41
TQE to replace
If the morula or blastocyst is good
1st cycle
quality
Any previous pregnancies
1st or 2nd cycle
If spare embryos suitable for freezing
Any previous pregnancies
4
Pregnancy rates eSET vs. DET: Year 4
Patient age
eSET preg.
rate
eSET multiple
preg. rate
DET preg.
rate
DET multiple
preg. rate
Under 35
41.4
1.5
37.9
33.4
35-37
34.8
2.8
33.9
24.9
38-39
31.8
1.3
29.5
23.2
Other
35.1
1.9
28.3
27.0
All ages
38.8
1.6
32.9
29.2
Preg. rates blastocyst eSET vs. DET: Year 4
Patient age
eSET
blastocyst
preg. rate
eSET
multiple preg.
rate
DET
blastocyst
preg. rate
DET multiple
preg. rate
Under 35
44.6
1.6
44.0
40.3
35-37
38.7
2.0
42.0
29.4
38-39
35.7
1.5
38.8
28.7
Other
39.5
2.0
36.3
32.8
All ages
42.3
1.7
40.5
35.2
Overview of National trends
Pre-policy
Year 1
Year 2
Extended
Year 3
Year 4
Proportion of
transfers that
are eSET(%)
4.9
11.3
15.9
19.7
26.1
Proportion of
transfers that
are blastocyst
transfers (%)
13.0
20.6
30.3
38.8
48.2
Multiple
pregnancy rate
(%)
26.6
24.1
21.3
19.5
16.5
Multiple live
birth rate (%)
23.6
21.4
19.2
17.4
15.6?
Overall
pregnancy rate
(%)
30.3
32.1
31.6
32.6
32.9
Clinic data: % eSET fresh cycles
80.0
69.0
70.0
Y1: Jan 2009 to end
60.0
March 2010
50.0
Y2: April 2010 to end
March 2011
40.0
29.4
30.0
20.0
14.5
11.3
26.1
19.7
15.9
13.9
Y3: April 2011 to end
September 2012
Y4: October 2012 to
10.0
end September 2013
0.0
y1
y2
Woking Nuffield
y3
National trend
y4
Clinic data: % blastocyst transfers fresh cycles
80.0
73.0
70.0
Y1: Jan 2009 to end
60.0
March 2010
48.2
50.0
Y2: April 2010 to end
38.8
40.0
March 2011
30.3
30.0
Y3: April 2011 to end
24.5
20.6
September 2012
20.0
10.0
4.2
Y4: October 2012 to
3.4
end September 2013
0.0
Y1
Y2
Woking Nuffield
Y3
National trend
Y4
Clinic data: % CPR, MPR, MBR
45.0
38.2
40.0
Y1: Jan 2009 to end
33.1
35.0
March 2010
30.0
26.2
25.5
25.0
20.0
Y2: April 2010 to end
21.7
20.5
March 2011
18.4
16.3
15.8
15.4
Y3: April 2011 to end
15.0
September 2012
10.0
5.1
5.0
4.1
Y4: October 2012 to
end September 2013
0.0
Y1
Y2
Clin Preg Rate
Y3
MPR
MBR
Y4
Clinic data: CUSUM plot multiple births
Multiple pregnancy rate by
pregnancy, for all IVF, ICSI and
FET cycles
For period: Oct 2012 – Jan 2014 (as of
02/02/14)
Number of births
Year 4 centre performance: funnel plot
Multiple live birth rate by live birth, for all IVF, ICSI and FET cycles
For period: Oct 2012 – Sep 2013 (as of 09/01/14) at 10%
Number of births
Acknowledgements
With Thanks to:
Aimee Hetherington
Rebecca Fabian
Caroline Franklin
All the team at Nuffield Health Woking Hospital
Any questions?
#hfeaconference2014
Discussion
Andrew has replicated the practice in Sweden and achieved almost
identical results in terms of MBR, but with a higher pregnancy rate using
a blastocyst based programme.
Table discussions
What are the key factors of this successful strategy?
What did you need to put in place to ensure that the majority of
patients would be able to take part in a blastocyst transfer
programme?
What proportion of your patients have blastocysts for transfer
What are the trigger points for review/audit?
Feedback…
Thank you.
#hfeaconference2014