Impact of governmental support to the IVF clinical pregnancy rates: Differences between public and private clinical settings in Kazakhstan - A prospective cohort study

Issanov A. Aimagambetova G. Terzic S. Bapayeva G. Ukybassova T. Baikoshkarova S. Utepova G. Daribay Z. Bekbossinova G. Balykov A. Aldiyarova A. Terzic M.
14 February 2022 BMJ Publishing Group

BMJ Open
2022 #12 Issue 2

Objectives Infertility rates have been increasing in low-income and middle-income countries, including Kazakhstan. The need for accessible and affordable assisted reproductive technologies has become essential for many subfertile women. We aimed to explore whether the public funding and clinical settings are independently associated with in vitro fertilisation (IVF) clinical pregnancy and to determine whether the relationship between IVF clinical pregnancy and clinical settings is modified by payment type. Design A prospective cohort study. Setting Three private and two public IVF clinics located in major cities. Participants Women aged ≥18 seeking first or repeated IVF treatment and agreed to complete a survey were included in the study. Demographical and previous medical history data were collected from a survey, while clinical data from medical records. The total response rate was 14%. Primary and secondary outcome measures Clinical pregnancy was defined as a live intrauterine pregnancy identified by ultrasound scan at 8 gestational weeks. The outcome data were missing for 22% of women. Results Out of 446 women in the study, 68.2% attended private clinics. Two-thirds of women attending public clinics and 13% of women attending private clinics were publicly funded. Private clinics retrieved, on average, a higher number of oocytes (11.5±8.4 vs 8.1±7.2, p<0.001) and transferred more embryos (2.2±2.5 vs 1.4±1.1, p<0.001) and had a statistically significantly higher pregnancy rate compared with public clinics (79.0% vs 29.7%, p<0.001). Publicly funded women had on average a higher number of oocytes retrieved and a statistically significantly higher probability of clinical pregnancy (RR=1.23, 95% CI 1.02 to 1.47) than self-paid women, after adjusting for covariates. There was no statistically significant interaction between clinical setting and payment type. Conclusions Private clinics and public funding were independently associated with higher IVF clinical pregnancy rates. There is also a need to further investigate whether the increase in public funding will influence clinical pregnancy rates.

gynaecology , health policy , obstetrics , public health

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Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan
Department of Biomedical Sciences, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan
Clinical Academic Department of Womens Health, National Research Center of Mother and Child Health, University Medical Center, Nur-Sultan, Kazakhstan
Ecomed IVF Clinic, Nur-Sultan, Kazakhstan
Regional Perinatal Center, Aktobe, Kazakhstan
Department of Obstetrics and Gynecology #2, West Kazakhstan Marat Ospanov State Medical University, Aktubinskaa oblast, Aktobe, Kazakhstan
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States

Department of Medicine
Department of Biomedical Sciences
Clinical Academic Department of Womens Health
Ecomed IVF Clinic
Regional Perinatal Center
Department of Obstetrics and Gynecology #2
Department of Obstetrics

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