P-759 Safety and quality of MAR (medically assisted reproduction) provisions in Spain in response to adaptative regulation during a public health emergency: a national registry analysis
Authors: Vassena R , Cabello Vives Y , Castel Seguí A  B , Herrero García J , Martínez Granados L , Rodríguez García I , Prados Mondejar F , Cueva Sáiz I 
Published: July 2024

Abstract

Study question
Did the level of quality and the safety of MAR treatments change in response to the restrictive medical care regulations during the COVID emergency?

Summary answer
All assessed markers of PMA treatment quality and safety were maintained, indicating a robust quality structure of the Spanish PMA medical system.

What is known already
Acute public health stressors can affect the provision of effective and safe care in specific healthcare areas, as operational constrains are put in place and resource allocation is shifted to emerging areas of need. During 2020, Spain was heavily affected by the COVID pandemic, and the provision of PMA was constrained both in time and scope for several months. Here, we examine the results of these constrains on the quality and safety of PMA treatments performed in the country through the comparative analysis of pre- and post- emergency national data.

Study design, size, duration
This retrospective study includes aggregate registry data from 316 PMA centers in Spain, representing 100% of reported IVF/ICSI treatments in the country. Data refer to treatments performed in 2019, 2020 and 2021.Treatment data were compared on an intention to treat basis (ITT) whenever possible.

Participants/materials, setting, methods
A total of 48.123, 40.453 and 49.734 IVF/ICSI treatments with own oocytes were initiated in 2019, 2020 and 2021 respectively. Oocyte donor stimulation were 15.807, 12.001, and 13.287, respectively. Safety markers analyzed were: oocytes collected (donation), multiple pregnancies and births, complications of treatment requiring hospitalization. Indicators of efficacy were pregnancy and live birth rates, with and without PGT-A, on an ITT basis. Data were compared by ANOVA or t-test. A p &lt; 0.05 was considered significant.

Main results and the role of chance
The ratio between transfers and clinical results in IVF/ICSI cycles with own eggs, according to treatment intention, has remained stable in both pregnancies [34.4-34.8%] and deliveries [24.7-25.7%] between 2019, 2020 and 2021 Births with multiple fetuses were 11.3%, 9.4% and 8.7% respectively. Live births from PGT-A cycles were 22.4% in 2019 and 23.0% in 2020. The results of cycles with donor eggs remained stable in both pregnancies [56.7-58.7%] and deliveries [43.3-44.2%] between 2019, 2020 and 2021. Births with multiple fetuses were 10.7%, 9.8% and 8.2% respectively. Births of higher order than twins were anecdotal. Complications requiring hospital admission have remained at 0.20% - 0.026% of total treatments, with ovarian hyperstimulation and hemorrhages being the most frequent.

Limitations, reasons for caution
The aggregate nature of data did not allow for a more in depth associative analysis.

Wider implications of the findings
The analyzed indicators have remained within the expected ranges, suggesting a low impact of the COVID measures on the operational quality and safety of the TRA units.

Trial registration number
NA