Issue link: https://maltatoday.uberflip.com/i/1468438
maltatoday | SUNDAY • 22 MAY 2022 3 NEWS Fresh transfers 2017 Fresh transfers 2016 Fresh transfers 2015 Total 185 Total 153 Total 144 Not pregnant 142 76.8% Not pregnant 114 74.5% Not pregnant 95 66% Miscarriage 7 3.8% Miscarriage 5 3.3% Miscarriage 19 13.2% Live Birth 8 4.3% Live Birth 5 3.3% Live Birth 13 9% Expected 28 15.1% Expected 29 19.0% Expected 17 11.8% Fresh transfers 2018 Frozen transfers 2018 Total 182 Total 2 Not pregnant 141 77.5% Not pregnant 2 100% Miscarriage 7 3.8% Miscarriage 0 Live Birth 14 7.7% Live Birth 0 Expected 20 11% Expected 0 Fresh transfers 2019 Frozen transfers 2019 Total 54 Total 23 Not pregnant 41 75.9% Not pregnant 14 60.9% Miscarriage 3 5.6% Miscarriage 2 8.7% Live Birth 1 1.9% Live Birth 0 0.0 Expected 9 16.7% Expected 7 30.4% Fresh transfers 2020 Frozen transfers 2020 Total 47 Total 59 Not pregnant 39 83% Not pregnant 44 74.6% Miscarriage 0 0.0 Miscarriage 3 5.1% Live Birth 4 8.5% Live Birth 4 6.8% Expected 4 8.5% Expected 8 13.6% 2019: Repeal of ban on embryo freezing Pregnancy rate combining live births, expected, and miscarriages in fresh transfers 2020 17% 2019 24.1% 2018 22.5% 2017 23.2% 2016 25.5% Outcome of treatment cycles SOURCE: EPA data for the EPA apart from paying licence fees. For every single clinical process that takes place by government doctors, Cherubino also gets paid: for example, it is paid €1,500 for each embryo that gets frozen. Cherubino's fees are charged across each step of the IVF service: a standard service fee of €1,900, then €800 to freeze the surplus eggs, an additional €1,500 for each embryo frozen, again €1,500 to thaw the frozen embryos, and €900 to transfer them. In a normal cycle, five eggs will get fertilised and perhaps produce three good quality embryos. Cherubino will be paid €1,900, and €800 to freeze surplus eggs harvested from the mother, but also €1,900 to freeze one embryo – only a maximum of two embryos are implanted at a time. But what happens when the risk of OHSS interrupts a fresh transfer of embryos? Now the cost climbs to €1,900 for service provision and €800 for the freezing of surplus eggs; the freezing of three embryos is at €4,500, thawing them will cost €1,500 – twice, given that only two embryos at a time can be implanted – and a thawed cycle for €900: €11,100. These are fees which are over and above the human resource cost financed by the State, which spent in total €1.43 mil- lion on the IVF programme in 2020, €1.6 million in 2021, and in 2022, is expected to spend €2.5 million. And ultimately the measure of success for the government IVF programme are the pregnancy rates and live births from the fresh and frozen embryo trans- fers. Contract expires, but PPP is retained: why? The Cherubino PPP at Mater Dei was inexplicably allowed to continue its operation since 2020 without a proper contract. The health authorities did not explain why. The initial concession first granted in 2014 has expired since then, a state of affairs that however does not affect its licensing by the Superintend- ence which issued licences for Cherubino in April 2015, 2017, 2020, and finally in April 2022 – but only for seven months. This short licensing period ap- pears to be the prologue to the end of Cherubino's PPP at Ma- ter Dei, which has announced a transition plan for the hospi- tal to regain control of the IVF clinic. But part the reason also lies in an important document issued back in April 2020 when Cheru- bino was last licensed: a market consultation calling for the up- grade of the Mater Dei clinic "by moving to a new fully li- cenced clinic outside of MDH." The document shows the in- tention of the health authorities to upgrade the MDH clinic's dated equipment, and to pro- vide the same services from "a bigger, fully functional and li- censed facility". But apart from moving out of Mater Dei's under-performing facility, the health authorities' awareness of the Mater Dei limitations of were made clear enough: because the document requested interested parties to show how they could "guar- antee… minimal near to zero OHSS cases"; and then "reduce to zero the waiting list" by per- forming more weekly fertility cycles, and even "guarantee success of IVF cycles, wherein the interested party will only be paid for successful cycles car- ried out. Cycles that are unsuc- cessful will not be paid for." What the ministry wanted, was not a repeat of the Cheru- bino PPP. Cherubino fees paid by Mater Dei as part of PPP Service for fresh cycle €1,900 Service for thawed cycle €900 Freezing of eggs (24 months) €800 Freezing per embryo €1,500 Sperm banking (24 months) €400 Surgical extraction of sperm €400 Thawing of sperms €250 Frozen embryo transfer €1,500 2015-2020 rate of treatment outcomes Annual cost of government IVF 2022 (projected) €2.5 milion 2021 (estimated) €1.6 million 2020 (actual) €1.43 million