Key factors of a successful strategy
Andrew Riddle
Medical Director Person Responsible, Nuffield Health Woking Hospital
26 February 2014
#hfeaconference2014
ACE 2014 Oral Presentation
Successful establishment of eSET
criteria with multiple pregnancy
rate reduced to below 5%
How have our blastocyst criteria developed?
Original Criteria
(prior to 2011)
Developing Criteria
(2011-2012)
Current Criteria
(2013 onwards)
<37
All patients ≤40
2 or more TQE on day 2 or 3
9 TQE
5 TQE
1 TQE and multiple average
Increase in blastocyst transfers from
quality embryos
6.4% in 2011 4to
72.1% in 2013
TQE
Previous unsuccessful attempt
when TQE transferred
Long discussion with patient
or
Consider patient history
3 TQE
If >40 consider blastocyst based
on previous history
3
How have our eSET criteria developed?
Original Criteria
Current Criteria
 Consider for any patient <37
 Consider for any patient <41
 TQE to replace
 If the morula or blastocyst is good
 1st cycle
quality
 Any previous pregnancies
 1st or 2nd cycle
 If spare embryos suitable for freezing
 Any previous pregnancies
4
Pregnancy rates eSET vs. DET: Year 4
Patient age
eSET preg.
rate
eSET multiple
preg. rate
DET preg.
rate
DET multiple
preg. rate
Under 35
41.4
1.5
37.9
33.4
35-37
34.8
2.8
33.9
24.9
38-39
31.8
1.3
29.5
23.2
Other
35.1
1.9
28.3
27.0
All ages
38.8
1.6
32.9
29.2
Preg. rates blastocyst eSET vs. DET: Year 4
Patient age
eSET
blastocyst
preg. rate
eSET
multiple preg.
rate
DET
blastocyst
preg. rate
DET multiple
preg. rate
Under 35
44.6
1.6
44.0
40.3
35-37
38.7
2.0
42.0
29.4
38-39
35.7
1.5
38.8
28.7
Other
39.5
2.0
36.3
32.8
All ages
42.3
1.7
40.5
35.2
Overview of National trends
Pre-policy
Year 1
Year 2
Extended
Year 3
Year 4
Proportion of
transfers that
are eSET(%)
4.9
11.3
15.9
19.7
26.1
Proportion of
transfers that
are blastocyst
transfers (%)
13.0
20.6
30.3
38.8
48.2
Multiple
pregnancy rate
(%)
26.6
24.1
21.3
19.5
16.5
Multiple live
birth rate (%)
23.6
21.4
19.2
17.4
15.6?
Overall
pregnancy rate
(%)
30.3
32.1
31.6
32.6
32.9
Clinic data: % eSET fresh cycles
80.0
69.0
70.0
Y1: Jan 2009 to end
60.0
March 2010
50.0
Y2: April 2010 to end
March 2011
40.0
29.4
30.0
20.0
14.5
11.3
26.1
19.7
15.9
13.9
Y3: April 2011 to end
September 2012
Y4: October 2012 to
10.0
end September 2013
0.0
y1
y2
Woking Nuffield
y3
National trend
y4
Clinic data: % blastocyst transfers fresh cycles
80.0
73.0
70.0
Y1: Jan 2009 to end
60.0
March 2010
48.2
50.0
Y2: April 2010 to end
38.8
40.0
March 2011
30.3
30.0
Y3: April 2011 to end
24.5
20.6
September 2012
20.0
10.0
4.2
Y4: October 2012 to
3.4
end September 2013
0.0
Y1
Y2
Woking Nuffield
Y3
National trend
Y4
Clinic data: % CPR, MPR, MBR
45.0
38.2
40.0
Y1: Jan 2009 to end
33.1
35.0
March 2010
30.0
26.2
25.5
25.0
20.0
Y2: April 2010 to end
21.7
20.5
March 2011
18.4
16.3
15.8
15.4
Y3: April 2011 to end
15.0
September 2012
10.0
5.1
5.0
4.1
Y4: October 2012 to
end September 2013
0.0
Y1
Y2
Clin Preg Rate
Y3
MPR
MBR
Y4
Clinic data: CUSUM plot multiple births
Multiple pregnancy rate by
pregnancy, for all IVF, ICSI and
FET cycles
For period: Oct 2012 – Jan 2014 (as of
02/02/14)
Number of births
Year 4 centre performance: funnel plot
Multiple live birth rate by live birth, for all IVF, ICSI and FET cycles
For period: Oct 2012 – Sep 2013 (as of 09/01/14) at 10%
Number of births
Acknowledgements
With Thanks to:
Aimee Hetherington
Rebecca Fabian
Caroline Franklin
All the team at Nuffield Health Woking Hospital
Any questions?
#hfeaconference2014
Discussion
Andrew has replicated the practice in Sweden and achieved almost
identical results in terms of MBR, but with a higher pregnancy rate using
a blastocyst based programme.
Table discussions
 What are the key factors of this successful strategy?
 What did you need to put in place to ensure that the majority of
patients would be able to take part in a blastocyst transfer
programme?
 What proportion of your patients have blastocysts for transfer
 What are the trigger points for review/audit?
Feedback…
Thank you.
#hfeaconference2014