P-731 Into a green (r)evolution in fertility centers: a forerunner experience
Authors: Ronchetti C , Albani E , Cirillo F , Messa M , Di Lascio L , Fanchiotti R , Caniglia F , Alshatali A , Teng M , Dezzani A , Lettieri E , Levi-Setti P  E 
Published: July 2024

Abstract

Study question
Is it possible to redefine an everyday clinical routine at the fertility centers in order to reduce the environmental impact?

Summary answer
A fundamental improvement in the reduction of waste is the elimination of all unnecessary disposable tools, especially during embryo transfer.

What is known already
Pollution and related climate changes have a major impact on global health. While the mission of healthcare systems is to guarantee health among people, emissions from the health care setting significantly contribute to climate change. Recent publications have called for an emergency action to reduce the healthcare environmental footprint. The International Federation of Gynaecology and Obstetrics (FIGO) states that the current climate crisis implies an imminent health risk even to reproductive health. An immediately reduceable source of greenhouse emissions could reside in inappropriate and avoidable tests, procedures, tools and treatments used in clinical practice.

Study design, size, duration
This is a retrospective observational study in which all outpatient, surgical and laboratory procedures, that are part of the daily clinical routine at our fertility center, were analysed during a one-week period and evaluated to be strictly necessary or not. In particular, as for surgical activity, in the mentioned week, all embryo transfer (ET) and oocyte retrieval (OR) waste production was analysed.

Participants/materials, setting, methods
During the week of 18-24 September 2023, waste production from 80 ETs and 56 ORs procedures was analysed. The environmental impact of all unnecessary tests, procedures and tools was assessed in terms of energy-, time- and money-saving, waste production and potential harm to the patients. In particular, the amount of packaging unnecessarily produced each week was weighed.

Main results and the role of chance
In consideration of the high number of procedures performed at our fertility center, the amount of waste related to the surgical activity was estimated as too high. Regarding ETs, the estimated total waste for a single procedure is 0.6692 kg, 0.5749 kg being product waste, 0.0943 kg being packaging waste. Concerning ORs, the estimated total waste for a single procedure is 0.7563 kg, 0.6495 kg being product waste, 0.1068 kg being packaging waste. This waste can be reduced by eliminating extra-packaging for the ET and OR set (from «one pack for each item» to «all in one»). A significant role in environmental pollution is also played by plastic surgical drapes and physician’s coats, used to cover patients and operators to guarantee both protection and comfort. These plastic garments have several drawbacks, including difficult or unfeasible sterilisation as well as their disposable use, huge environmental impact and cost in their manufacture. A proposed solution is to avoid the use of unnecessary disposable tools, such as the plastic sterile physician’s coat, 2 out of 3 plastic sterile cloths to cover the patients and the plastic syringe during the embryo transfer.

Limitations, reasons for caution
The main limitation of the proposed solution is healthcare workers’ compliance. In fact, their willingness to participate in eventual future educational events and procedural changes is unknown. Another limitation is that it is not clear whether the removal of unnecessary facilities will lead to a real reduction in environmental damage.

Wider implications of the findings
Eliminating unnecessary materials during surgery seems to have a huge positive impact on waste reduction. Our future plan is to lead a prospective study to compare waste management, production and recycling differentiation of a selected week after the procedural changes and awareness-raising events with the already assessed week.

Trial registration number
Not applicable