In 2017 and 2018, Lombardy region counted 22 public funded IVF Clinics which treated 11,577 and 11,221 infertile couples respectively. In 2017 15,177 COH, 13,887 retrievals, 10,190 fresh transfers, 5,342 frozen embryo transfers (FER), 299 frozen oocytes (FO) and in 2018 14,968 COH, 13,658 retrievals, 9,770 fresh transfers, 5,996 FER, 284 FO cycles were analyzed.
The mean female age representing a main importance prognostic factor was different among the centers. The mean percentage of women younger than 35 years in 2017 was 28.12% ± 7.57% with a 6.58–39.94% range and although with a different percentage all the centers treated at least 60% of less favorable prognosis patients. Women age was not significantly different in 2018 with a mean female age < 35 years of 27.75% ± 5.37% (range (13.80% − 35.965).
The number of fresh and frozen procedures performed by each Center was different with a mean number of 1,351 ± 1,254 (234–5,175) in 2017 and 1,350 ± 1,275 (223–5,458) in 2018.
In 2017 a total of 29,718 procedures were performed, 4,543 pregnancies, 3,253 deliveries and 3,590 live born babies were obtained. In 2018 14,968 COH, 13,658 retrievals, 9,770 fresh transfers, 5,996 FER, 284 FO for a total of 29,708 procedure were reported and 4,665 pregnancies, with 3,348 deliveries and 3,665 live births were achieved. The number of pregnancies lost to follow up in 2017 were 5.0% in 2017 (227/4.543) with a range of 0 to 67.68% and in 2018 were the 3.4% (160/4,665) with a range of 0 to 45.1%.
The mean delivery rate for fresh retrievals (Table I) was 13.23% ± 5.69 SD in 2017 (range 2.86% − 29.11%) and 19.33% ± 5.80% SD (range 11.82% − 34.98%) in 2018 with a mean improvement of 6.10% ± 4.45 SD (range − 1.66% − 15.13%).
The CDR per oocyte retrieval was 19.86% ± 9.38% (4.43% − 37.88%) in 2017 and 21.32% ± 8.84
(4.24% − 37.11%) in 2018 (Table II). Only a small overall average improvement was observed between mean 2017–2018 performance (1.46% ± 4.03%), with no real differences in best and poor performance centers (Table II).
The cryopreservation incidence (CI) on delivery rate showed a mean of 28.57% ± 19.61% (0%-68.25%) in 2017 and a mean of 32.19% ± 20.07% (0% − 66.34%) in 2018 with a medium increment of 3.62% ± 11.06% between the two years analyzed.
The mean multiple pregnancy delivery rate (MDR) in all 22 IVF Centers was 11.08% ± 5,55% (range 0.00% -22.73%) in 2017 and 10.41% ± 4.99 (range 1.33% − 22.22%), as presented in Table III.
The delta percentage difference between the 2 years was − 0.67% ± 5.09% with a range from − 15.38% to + 10.94%.
The mean cost for delivery was 26,227 ± 14,737 (range 12,480 − 76,725) € in 2017 and 25,018 ± 16,039 (range 12,973 − 86,203) € in 2018 (table IV). Analyzing the 2 years performance we find a mean cost reduction of -1,210 ± 6,327 Euros, with a maximum 2018 cost reduction of 14,694 Euros and a maximum 2018 higher cost of 9,478 Euros with data detailed for each center in Table IV. The overall cost was 66,843,000 Euros excluding induction therapy, luteal phase support, pregnancy, delivery and neonatal care costs for 3,348 deliveries and 3,665 and 66,865,000 € for 3,590 live babies born in 2017.