title: Public health implications of a North American publicly funded in vitro fertilization program; lessons to learn.
abstract: OBJECTIVE
  A retrospective study was conducted to determine trends in practice and outcomes that occurred since the implementation of the publicly funded in vitro fertilization (IVF) and single embryo transfer (SET) program in Quebec, in August, 2010.
  
  
  METHODS
  Data presented was extracted from an advisory report by the Health and Welfare Commissioner, and from a report by the Ministry of Health and Social Services published in June 2014 and October 2013, respectively. This data is publicly available, and was collected from all six private and three public-assisted reproduction centers in Quebec providing IVF services. Data pertains to all IVF cycles performed from the 2009-2010 to 2012-2013 fiscal years.
  
  
  RESULTS
  SET was performed in 71 % of cycles in 2012. The number of children born from IVF was 1057 in 2009-2010 and 1723 in 2012-2013 (p < 0.0001). Multiple birth rates from IVF were 24 % in 2009-2010 (before the program began) and 9.45 % in 2012-2013 (p < 0.0001). The proportions of IVF babies that were premature, that were the result of multiple births, or that required neonatal intensive care unit admission (NICU) all decreased by 35.5 % (p < 0.0001), 55 % (p < 0.0001), and 37 % (p < 0.0001), respectively, from 2009-2010 to 2012-2013. The cost per NICU admission for an IVF baby increased from $19,990 to $28,418 from 2009-2010 to 2011-2012.
  
  
  CONCLUSIONS
  This first North American publicly funded IVF program with a SET policy shows that such a program contributes substantially to number of births. It has also succeeded in increasing access to treatment and decreasing perinatal morbidity by decreasing multiple birth rates from IVF. A substantial increase in global public health care costs occurred as well.
authors.affiliation: Reproductive Centre, McGill University Health Centre, 687 Pine Avenue West, Montreal, QC, H3A 2B4, Canada. talya07@gmail.com.
authors.forename: Talya
authors.initials: T
authors.lastname: Shaulov
authors.affiliation: Department of Obstetrics and Gynecology, University of Montreal Hospital Centre, 1058 rue Saint-Denis, Montreal, QC, H2X 3J4, Canada.
authors.forename: Serge
authors.initials: S
authors.lastname: Belisle
authors.affiliation: Reproductive Centre, McGill University Health Centre, 687 Pine Avenue West, Montreal, QC, H3A 2B4, Canada.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Dahan
mesh_terms: D001723:Birth Rate; D047108:Embryonic Development; D005260:Female; D005306:Fertilization / Q000502:physiology*; D005307:Fertilization in Vitro / Q000191:economics* / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D009656:North America; D011247:Pregnancy; D011256:Pregnancy Outcome; D011634:Public Health / Q000379:methods*; D056826:Single Embryo Transfer / Q000191:economics* / Q000706:statistics & numerical data*
keywords: In vitro fertilization; Neonatal outcomes; Public funding; Single embryo transfer