title: [Fertility treatments: possibilities for fewer multiple births and lower costs--the 'Umbrella' study].
abstract: Since the 1980s, increasingly more fertility treatments have been performed in the Netherlands. The use of ovarian hyperstimulation during in vitro fertilisation (IVF) and intrauterine insemination (IUI) has contributed to an explosive increase in the number of multiple births. To control the costs of treatment and outcomes, the Minister of Health, Welfare and Sport commissioned research on possible improvements in the performance of fertility treatments in 1999. The results of this research ('Umbrella study'), reported in 2005, suggested that costs and the incidence of multiple births could be reduced if (a) IUI is only performed if the chance of spontaneous pregnancy is less than 30%; (b) the guideline 'Intrauterine insemination' is followed more closely regarding hormonal stimulation; (c) stimulation is used less frequently during IVF; and (d) no more than 1 embryo is placed in the uterus at a time. To achieve these results, all parties involved must revise their policies. In particular, current reimbursement regulations inhibit the implementation of the research results in practice.
authors.affiliation: j.merkus@obgyn.umcn.nl [corrected]
authors.forename: J M W
authors.initials: JM
authors.lastname: Merkus
mesh_terms: D003365:Costs and Cost Analysis; D005260:Female; D005307:Fertilization in Vitro / Q000191:economics; D006801:Humans; D007247:Infertility, Female / Q000628:therapy*; D007315:Insemination, Artificial / Q000191:economics; D009099:Multiple Birth Offspring; D009426:Netherlands; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D011272:Pregnancy, Multiple; D012099:Reproductive Techniques / Q000191:economics* / Q000592:standards