The trends of assisted reproductive technologies and cost for ovarian stimulation protocols in Ukraine

Abstract

The prevalence of infertility has risen 2.9 times in recent years in Ukraine. The use of assisted reproductive technologies (ART) is needed. The State program for infertility treatment by budget funds was approved in Ukraine since 2004. However, funding for this program is enough only for 500–600 cycles per year, but ART centers conducted more than 27,000 cycles in 2018. This means that many women have to pay out-of-pockets. Our research has shown that between 2000 and 2018, the number of ART clinics and the number of cycles, pregnancies, and children born increased significantly in Ukraine. The rate of ART cycles per 1 million population in Ukraine has increased from 226.9 to 655.3, but it is lower than the WHO recommended rate 800–1000 cycles per 1 million population. Changes in the structure of ART cycles for 2000–2018, the increase of ICSI, and egg donation cycles are shown. It requires an adequate supply by hormonal drugs for ovarian stimulation in ART centers. Since 2004 Ministry of Health of Ukraine annually approved the list of medicines for State program of ART. Only 8 drugs were purchased by the state funds, which amounted for USD 227 438 in 2017, 2018. A retrospective analysis of drug prescriptions in short and long stimulation protocols was performed. The frequency of drug prescriptions according to the ATC-classification based on medical records was determined, all prescriptions were accordance with the requirements of ART treatment standards in Ukraine. The costs of the three hormonal stimulation schemes, which were the most prescribing in ART center, were calculated. It was found that costs for hormonal schemes increased by 22–54% during 2015–2020, it significantly reduces the availability and affordability of ART for the population in Ukraine.