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1Australian National University, Canberra, Australia
Collection date 2017.
This is an open access article distributed under the terms of the Creative Commons Attribution License (4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background: There is variation in uptake of in vitro fertilisation (IVF) between countries, and Australia has high incidence rates of IVF due to universal public funding. However, it remains unclear whether there is regional variation and, if present, what might cause this.
Objectives: We sought to determine whether regional variations in treatment rates existed and what might influence these.
Methods: The number of cycles of fresh IVF and intrauterine insemination (IUI) for women were obtained for the period 2011 until 2014 in two age groups (25 to 34 years and 35 to 44 years) to calculate incidence rates. Proxy indicators that might influence treatment affordability were: unemployment rates; average weekly total earnings; coverage of private health insurance; and, percentage of women in the highest socioeconomic quintile. Measures of accessibility considered were percentage of the population remote from urban areas and average state population density. Linear regressions were performed using log-transformed ratio of IVF and IUI incidence rates.
Results: Variations were found in IVF uptake between states with greater differences in older women. There was no significant association between IVF procedures and population density or geographic isolation. Economic factors were not associated with IVF uptake.
Conclusion: These findings suggest that factors such as physician preference, clinical practice guidelines, and cryopreservation protocols of ART units might explain the national variation in uptake of IVF.
Figure 1. Age-stratified incidence rate of in vitro fertilisation (IVF) cycles proceeding to oocyte retrieval in women aged 24 to 35 years in Australia (oocyte retrieval procedures per 1000 women per year), 2011 to 2014 inclusive.
Figure 2. Age-stratified incidence rate of in vitro fertilisation (IVF) cycles proceeding to oocyte retrieval in women aged 35 to 44 years in Australia (oocyte retrieval procedures per 1000 women per year), 2011 to 2014 inclusive.
Figure 3. Age-stratified incidence rate of intrauterine insemination (IUI) cycles in women aged 24 to 34 years in Australia (cycles per 1000 women per year), 2011 to 2014 inclusive.
Figure 4. Age-stratified incidence rate of intrauterine insemination (IUI) cycles in women aged 35 to 44 years in Australia (cycles per 1000 women per year), 2011 to 2014 inclusive.
Figure 5. Age-stratified ratio of IVF cycles versus intrauterine insemination IUI cycles in women (a) aged 25 to 34 years and (b) aged 35 to 44 years in Australia, 2011 to 2014 inclusive.
Table 1. Age-stratified incidence rates of in vitro fertilisation cycles proceeding to oocyte retrieval and intrauterine insemination cycles (cycles per 1000 women per year) from 2011 to 2014 for women in two age groups: 25 to 34 years and 35 to 44 years.
Box 1. Proportions, odds ratios (OR) and 95% confidence intervals for preterm birth (stratified by gestation at birth) and caesarean delivery for IVF and non-IVF pregnancies in Australia in 2013. [*χ-square.
