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#hfeaconference2014 26 February 2014 Andrew Riddle Medical Director Person Responsible, Nuffield Health Woking Hospital Key factors of a successful strategy.

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Presentation on theme: "#hfeaconference2014 26 February 2014 Andrew Riddle Medical Director Person Responsible, Nuffield Health Woking Hospital Key factors of a successful strategy."— Presentation transcript:

1 #hfeaconference February 2014 Andrew Riddle Medical Director Person Responsible, Nuffield Health Woking Hospital Key factors of a successful strategy

2 ACE 2014 Oral Presentation Successful establishment of eSET criteria with multiple pregnancy rate reduced to below 5%

3 Original Criteria (prior to 2011) Developing Criteria ( ) Current Criteria (2013 onwards) <37All patients ≤402 or more TQE on day 2 or 3 9 TQE5 TQE1 TQE and multiple average quality embryos Previous unsuccessful attempt when TQE transferred 4 TQEor Consider patient history Long discussion with patient3 TQEIf >40 consider blastocyst based on previous history 3 How have our blastocyst criteria developed? Increase in blastocyst transfers from 6.4% in 2011 to 72.1% in 2013

4 How have our eSET criteria developed? 4 Original Criteria Consider for any patient <37 TQE to replace 1st cycle Any previous pregnancies If spare embryos suitable for freezing Current Criteria Consider for any patient <41 If the morula or blastocyst is good quality 1st or 2nd cycle Any previous pregnancies

5 Pregnancy rates eSET vs. DET: Year 4 Patient ageeSET preg. rate eSET multiple preg. rate DET preg. rate DET multiple preg. rate Under Other All ages

6 Preg. rates blastocyst eSET vs. DET: Year 4 Patient ageeSET blastocyst preg. rate eSET multiple preg. rate DET blastocyst preg. rate DET multiple preg. rate Under Other All ages

7 Overview of National trends Pre-policyYear 1Year 2Extended Year 3 Year 4 Proportion of transfers that are eSET(%) Proportion of transfers that are blastocyst transfers (%) Multiple pregnancy rate (%) Multiple live birth rate (%) ? Overall pregnancy rate (%)

8 Clinic data: % eSET fresh cycles Y1: Jan 2009 to end March 2010 Y2: April 2010 to end March 2011 Y3: April 2011 to end September 2012 Y4: October 2012 to end September 2013

9 Clinic data: % blastocyst transfers fresh cycles Y1: Jan 2009 to end March 2010 Y2: April 2010 to end March 2011 Y3: April 2011 to end September 2012 Y4: October 2012 to end September 2013

10 Clinic data: % CPR, MPR, MBR Y1: Jan 2009 to end March 2010 Y2: April 2010 to end March 2011 Y3: April 2011 to end September 2012 Y4: October 2012 to end September 2013

11 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

12 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

13 With Thanks to: Aimee Hetherington Rebecca Fabian Caroline Franklin All the team at Nuffield Health Woking Hospital Acknowledgements

14 Any questions? #hfeaconference2014

15 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… Discussion

16 Thank you. #hfeaconference2014


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