ART in Europe, 2016: results generated from European registries by ESHRE†

Abstract

STUDY QUESTION What are the reported data on cycles in ART, IUI and fertility preservation (FP) interventions in 2016 as compared to previous years, as well as the main trends over the years? SUMMARY ANSWER The 20th ESHRE report on ART and IUI shows a progressive increase in reported treatment cycle numbers in Europe, with a decrease in the number of transfers with more than one embryo causing a reduction of multiple delivery rates (DR), as well as higher pregnancy rates and DR after frozen embryo replacement (FER) compared to fresh IVF and ICSI cycles, while the outcomes for IUI cycles remained stable. WHAT IS KNOWN ALREADY Since 1997, ART aggregated data generated by national registries, clinics or professional societies have been collected, analysed by the European IVF-monitoring Consortium (EIM) and reported in 19 manuscripts published in Human Reproduction and Human Reproduction Open. STUDY DESIGN, SIZE, DURATION Yearly collection of European medically assisted reproduction (MAR) data by EIM for ESHRE. The data on treatments performed between 1 January and 31 December 2016 in 40 European countries were provided by either National Registries or registries based on personal initiatives of medical associations and scientific organizations. PARTICIPANTS/MATERIALS, SETTING, METHODS In all, 1347 clinics offering ART services in 40 countries reported a total of 918 159 treatment cycles, involving 156 002 with IVF, 407 222 with ICSI, 248 407 with FER, 27 069 with preimplantation genetic testing, 73 927 with egg donation (ED), 654 with IVM of oocytes and 4878 cycles with frozen oocyte replacement (FOR). European data on IUI using husband/partner’s semen (IUI-H) and donor semen (IUI-D) were reported from 1197 institutions offering IUI in 29 and 24 countries, respectively. A total of 162 948 treatments with IUI-H and 50 467 treatments with IUI-D were included. A total of 13 689 FP interventions from 11 countries including oocyte, ovarian tissue, semen and testicular tissue banking in pre-and postpubertal patients were reported. MAIN RESULTS AND THE ROLE OF CHANCE In 20 countries (18 in 2015) with a total population of approximately 325 million inhabitants, in which all ART clinics reported to the registry, a total of 461 401 treatment cycles were performed, corresponding to a mean of 1410 cycles per million inhabitants (range 82–3088 per million inhabitants). In the 40 reporting countries, after IVF the clinical pregnancy rates (PR) per aspiration and per transfer in 2016 were similar to those observed in 2015 (28.0% and 34.8% vs 28.5% and 34.6%, respectively). After ICSI, the corresponding rates were also similar to those achieved in 2015 (25% and 33.2% vs 26.2% and 33.2%). After FER with own embryos, the PR per thawing is still on the rise, from 29.2% in 2015 to 30.9% in 2016. After ED, the PR per fresh embryo transfer was 49.4% (49.6% in 2015) and per FOR 43.6% (43.4% in 2015). In IVF and ICSI together, the trend towards the transfer of fewer embryos continues with the transfer of 1, 2, 3 and ≥4 embryos in 41.5%, 51.9%, 6.2% and 0.4% of all treatments, respectively (corresponding to 37.7%, 53.9%, 7.9% and 0.5% in 2015). This resulted in a proportion of singleton, twin and triplet DRs of 84.8%, 14.9% and 0.3%, respectively (compared to 83.1%, 16.5% and 0.4%, respectively in 2015). Treatments with FER in 2016 resulted in twin and triplet DR of 11.9% and 0.2%, respectively (vs 12.3% and 0.3% in 2015). After IUI, the DRs remained similar at 8.9% after IUI-H (7.8% in 2015) and at 12.4% after IUI-D (12.0% in 2015). Twin and triplet DRs after IUI-H were 8.8% and 0.3%, respectively (in 2015: 8.9% and 0.5%) and 7.7% and 0.4% after IUI-D (in 2015: 7.3% and 0.6%). The majority of FP interventions included the cryopreservation of ejaculated sperm (n = 7877 from 11 countries) and of oocytes (n = 4907 from eight countries). LIMITATIONS, REASONS FOR CAUTION As the methods of data collection and levels of completeness of reported data vary among European countries, the results should be interpreted with caution. A number of countries failed to provide adequate data about the number of initiated cycles and deliveries. WIDER IMPLICATIONS OF THE FINDINGS The 20th ESHRE report on ART and IUI shows a continuous increase of reported treatment numbers and MAR-derived livebirths in Europe. Being already the largest data collection on MAR in Europe, continuous efforts to stimulate data collection and reporting strive for future quality control of the data, transparency and vigilance in the field of reproductive medicine. STUDY FUNDING/COMPETING INTEREST(S) The study has no external funding and all costs were covered by ESHRE. There are no competing interests.

20 years of the European IVF-monitoring Consortium registry: what have we learned? A comparison with registries from two other regions

“…More European countries have progressively become members of EIM: whereas in 1997 only 18 of all 51 European countries (35.3%) provided data to EIM, the number of participating countries rose to 40 in 2016 (78.4%). As, however, seven (small) European countries do not harbour any known ART institutions, the degree of completeness reached 93.0% in 2016 ( Wyns et al , 2020 ). The number of European countries with complete coverage rose from 10 countries in 1997 to 20 in 2016.…”

“…In 2016, the utilization of ART in Australia and New Zealand reached 2688 ART treatments per million inhabitants (78 185 reported treatments per 29 082 100 inhabitants), in the USA 934 (301 672 reported treatments per 323 100 000 inhabitants), in Europe including all countries participating in the EIM data collection 1220 (918 159 reported treatments per 752 265 824 inhabitants). In 2016, the European countries with complete coverage of all ART treatments reached a utilization level of 1410 (458 404 reported treatments per 325 078 700 inhabitants); in the European countries with incomplete coverage 1076 (459 755 reported treatments per 323 100 000 inhabitants) ( Wyns et al , 2020 ).…”

“…The highest proportion of newborn children after ART is being observed in Australia and New Zealand, reaching 4.1%. The European countries with the highest proportion of newborn children after ART in 2016 were Spain (7.7%) and Austria (6.2%, Wyns et al , 2020 ). In the same year, the European countries with the lowest proportion of children after ART were Lithuania (0.1%) and Serbia (0.2%, Wyns et al , 2020 ).…”

“…European data were extracted manually from the published EIM reports, which contain cross-sectional data sets published annually in Human Reproduction and in Human Reproduction Open ( De Geyter et al , 2020 ; Wyns et al , 2020 ). Only the data sets needed to calculate the proportion of children born after ART and the entire population of neonates in each European country reporting to EIM were calculated from the raw data sets, made available by the ESHRE office.…”

“…Europe currently consists of 51 independent countries with very diverse cultural, political, economic and legal systems, often lacking national data registers dealing with reproduction, rendering the Europe-wide registration of activities in ART difficult. Whereas the first report contained data from 18 countries ( Nygren and Andersen, 2001 ), EIM currently manages the largest global register, dealing with ART reported by 40 European countries ( Wyns et al , 2020 ).…”