What can we learn from a decade of promoting safe embryo transfer practices? A comparative analysis of policies and outcomes in the UK and Australia, 2001-2010

Given similar socio-demographic profiles and costs of healthcare, why has Australia been significantly more successful than the UK in reducing the assisted reproductive technology (ART) multiple birth rate? The Australian model of supportive public ART funding, permissive clinical guidelines and an absence of published clinic league tables has enabled Australian fertility specialists to act collectively to achieve rapid and widespread adoption of single embryo transfer (SET). There are striking differences in ART utilization and clinical practice between Australia and the UK. The ART multiple birth rate in Australia is 8 compared with slightly 20 in the UK. The role played by public funding, clinical guidelines, league tables and educational campaigns deserves further evaluation. Parallel time-series analysis was performed on ART treatment and outcome data sourced from the Human Fertilisation and Embryology Authority (HFEA) ART Registry and the Australian and New Zealand Assisted Reproduction Database (ANZARD). Funding arrangements, clinical practice guidelines and key professional and public education campaigns were mapped to trends in clinical practice and ART treatment outcomes between 2001 and 2010. A total of 425 360 and 422 003 autologous treatment cycles undertaken between 2001 and 2010 in the UK and Australia were analysed. From 2001 to 2010, the most striking difference in clinical practice was the increase in SET cycles in Australia from 21 to 70 of cycles, compared with an increase from 8.4 to 31 in the UK. In 20042005, both countries introduced clinical guidelines encouraging safe embryo practices, however, Australia has a history of supportive funding for ART, while the National Health Service has a more restrictive and fragmented approach. While clinical guidelines and education campaigns have an important role to play, funding remains a key element in the promotion of SET. This is a descriptive population study and therefore quantifying the independent effect of differential levels of public funding was not possible. With demand for ART continuing to increase worldwide, it is imperative that we remove barriers that impede safe embryo transfer practices. This analysis highlights the importance of supportive public funding in achieving this goal. No specific funding was received to undertake this study. G.M.C. reports receiving grant support to her institution from the Australian Government, Australian Research Council (ARC) Linkage Grant No LP1002165; ARC Linkage Grant Partner Organisations are IVFAustralia, Melbourne IVF and Queensland Fertility Group. The Fertility Society of Australia (FSA) paid her for 1 week of consultancy work in 2009. Y.A.W. does not report any conflict of interest. M.G.C. reports being a shareholder of IVFAustralia. V.P.H. reports being employed by a grant to his institution from the ARC, Linkage Grant No LP1002165; ARC Linkage Grant Partner Organisations are IVFAustralia, Melbourne IVF and Queensland Fertility Group. E.A.S. reports receiving grant support to her institution from the Australian Government, National Health and Medical Research Council (NHMRC), ARC, National Breast Cancer Foundation, International Vasa Praevia Foundation, the FSA and Australian Institute of Health and Welfare. She is Head of Research, Family Planning NSW. H.I.A. reports being Director of Lister Fertility Clinic, the largest private fertility clinic in UK, and is a member of HFEA. W.L. reports receiving grant support to his institution from the NHMRC, research grants from Merck Sharp Dhome and Swiss Precision Diagnostics. He is a shareholder in IVFAustralia. NA.