National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women's and Children's Health, University of New South Wales, Sydney, Australia.
National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women's and Children's Health, University of New South Wales, Sydney, Australia.
Fertil Steril. 2020 Oct;114(4):715-721. doi: 10.1016/j.fertnstert.2020.08.1405.
The health of children born through assisted reproductive technologies (ART) is particularly vulnerable to policy decisions and market forces that play out before they are even conceived. ART treatment is costly, and public and third-party funding varies significantly between and within countries, leading to considerable variation in consumer affordability globally. These relative cost differences affect not only who can afford to access ART treatment, but also how ART is practiced in terms of embryo transfer practices, with less affordable treatment creating a financial incentive to transfer more than one embryo to maximize the pregnancy rates in fewer cycles. One mechanism for reducing the burden of excessive multiple pregnancies is to link insurance coverage to the number of embryos that can be transferred; another is to combine supportive funding with patient and clinician education and public reporting that emphasizes a "complete" ART cycle (all embryo transfers associated with an egg retrieval) and penalizes multiple embryo transfers. Improving funding for fertility services in a way that respects clinician and patient autonomy and allows patients to undertake a sufficient number of cycles to minimize moral hazard improves outcomes for mothers and babies while reducing the long-term economic burden associated with fertility treatments.
通过辅助生殖技术（ART）出生的儿童的健康特别容易受到政策决策和市场力量的影响，而这些决策和力量在他们出生之前就已经在发挥作用。ART 治疗费用高昂，公共和第三方资金在国家之间和内部差异很大，导致全球消费者的负担能力存在相当大的差异。这些相对成本差异不仅影响谁有能力获得 ART 治疗，还影响胚胎转移实践中的 ART 实践，负担能力较低的治疗会产生将多个胚胎转移以在较少周期内最大化妊娠率的经济激励。减少过度多胎妊娠负担的一种机制是将保险范围与可转移胚胎的数量联系起来；另一种机制是将支持性资金与患者和临床医生的教育以及强调“完整”ART 周期（与卵母细胞回收相关的所有胚胎转移）和惩罚多胚胎转移的公共报告结合起来。以尊重临床医生和患者自主权的方式改善生育服务的资金，使患者能够进行足够数量的周期以最小化道德风险，从而改善母婴的结果，同时减轻与生育治疗相关的长期经济负担。
