Assisted reproductive technologies in the system of state funding guarantees: clinical results and management challenges

Abstract

Purpose is to conduct a comparative analysis and assessment of the effectiveness of the use of assisted reproductive technologies in Ukraine under state funding under the Medical Guarantees Program and identifying the main management areas for improving the financing system. Materials and Methods. A retrospective cohort study was conducted based on data from electronic medical records (EMR) entered into the electronic health care system (EHСS) on the provision of medical care under the package of the Medical Guarantees Program “Treatment of infertility using assisted reproductive technologies (in vitro fertilization)” during 2024–2025. The information base of the study was 15.035 episodes of medical care created for the treatment of 8.480 women who had started cycles of assisted reproductive technologies. During the study, the following were assessed: – the structure of medical service providers by form of ownership; – features of the patient’s route and registration of electronic referrals; – the structure of patients depending on age and causes of infertility; – structure of applied ART cycles; – pregnancy rate depending on the clinical form of infertility; – effectiveness of different models of ART use; – features of financing of medical services and certain managerial aspects of implementation of the corresponding package. The effectiveness of ART use was assessed by the frequency of occurrence of clinically confirmed pregnancy. The indicator was calculated as the ratio of the number of women in whom after embryo transfer the diagnosis Z32.1 “Pregnancy confirmed” was registered to the total number of women in whose EMZ embryo transfer services were recorded (services 63.0 and/or 63.1, and/or 63.4). Statistical analysis was performed using the Stata 14.0 application package (StataCorp, USA). Quantitative indicators with normal distribution were described by the arithmetic mean (M) and 95% confidence interval (95% CI). For indicators with non-normal distribution, the median (Me) and interquartile range (Q1–Q3) were used. Qualitative indicators were compared using the χ² criterion. The results were presented as absolute values and relative values (%). To assess the relationship between binary clinical signs and the identified factors, multiple logistic regression analysis was used with correction for the age of the patients. The results were presented as odds ratios (OR) and 95% confidence intervals (95% CI). Differences were considered statistically significant at a value of p<0.05. The limitations of the study were possible coding errors in individual medical records in the Unified Health System, incomplete information on individual clinical characteristics of the patients, as well as the lack of data on treatment performed outside the Medical Guarantees Program. Results. A comprehensive analysis of the effectiveness of the use of assisted reproductive technologies in Ukraine with the support of state funding in comparison with other countries was conducted. ART is considered as a component of a comprehensive medical and social system, including clinical, economic and managerial components. A retrospective cohort study included all women who during 2024–2025 started ART cycles and paid providers for services provided under the Medical Guarantees Program, with the calculation of pregnancy rate, live birth rate, complication rate, age-specific efficiency coefficients, which allowed assessing the results of treatment in different groups of patients depending on age, type of infertility and technology used. An assessment of the impact of ART financing on the state budget is shown. Conclusions. Assisted reproductive technologies are an effective method of treating infertility and an important component of modern demographic policy. The analysis confirmed the high effectiveness of the use of ART within the framework of the Medical Guarantees Program, while demonstrating the need to improve approaches to assessing the activities of medical service providers. The results obtained indicate the feasibility of standardizing approaches to registering treatment outcomes in the EHR, introducing risk-adjusted performance indicators and a comprehensive monitoring system that will take into account not only clinical effectiveness, but also indicators of safety, accessibility, and quality of medical care. Further development of the ART financing system should be based on the principles of evidence-based medicine, international practices of performance assessment, and modern digital technologies, which will contribute to increasing the efficiency of budget funds, ensuring fair contracting of medical service providers, and improving the accessibility of infertility treatment in Ukraine.