ART in Latin America: the Latin American Registry, 2020

Abstract

Research question What was the utilization, effectiveness and safety of assisted reproductive technology (ART) in Latin America during 2020? Design Retrospective collection of multinational data on ART performed by 188 institutions in 16 countries. Results Overall, 87,732 initiated cycles resulted in 12,778 deliveries and 14,582 births. The major contributors were Brazil (46.0%), Mexico (17.0%) and Argentina (16.8%). However, the highest utilization (cycles/million inhabitants) was Uruguay with 558, followed by Argentina with 490 and Panama with 425 cycles/million. Globally, women aged ≥40 years increased to 34% while women ≤34 dropped to 24.7%. After removing freeze-all cycles, the delivery rate per oocyte retrieval was 14.8% for intracytoplasmic sperm injection and 15.6% for IVF. Single-embryo transfer (SET) represented 38.3% of all fresh transfers, with delivery rate per transfer of 20.0%; this increased to 32.4% for elective SET (eSET) and 34.2% for blastocyst eSET, compared with blastocyst elective double embryo transfer (eDET) of 37.9%. However, multiple births increased from 1% in eSET to 30.5% in eDET. Perinatal mortality increased from 7.7‰ in singletons to 24.4‰ in twins and 64.0‰ in triplets. Frozen embryo transfer (FET) represented 66.6% of all transfers, with a delivery rate/transfer of 29.0%, significantly higher than 23.9% after fresh transfers at all ages ( p <0.0001). Preimplantation genetic testing, reported in 8920 cycles, significantly improved delivery rate and decreased miscarriage rates at all ages ( p ≤0.041), including oocyte donation ( p =0.002). Endometriosis was diagnosed in 28.3% of cases. The delivery rate in 5779 women after removal of peritoneal endometriosis was significantly better than tubal and endocrine factors in women aged 35-39 ( p =0.0004) and women aged ≥40 ( p =0.0353). Conclusions Systematic collection and analysis of big data in a south-south cooperation model allow regional growth by implementing evidence-based reproductive decisions.

Corpus luteum and progesterones in embryo transfer cycles: current challenges of different luteal phase support protocols

“…Currently, the need for progesterone supplementation in ART cycles, encompassing fresh and various types of frozen embryo transfer (FET) protocols, is firmly established ( Carp, 2020 ). The latter transfer method’s prevalence is noteworthy, representing 66.6% of all transfers in Latin America ( Zegers-Hochschild et al ., 2023 ) and 56.8% globally ( Adamson et al ., 2018 ).…”

“…As previously discussed, the predominant trend in contemporary embryo transfer cycles revolves around FET cycles. This shift is globally observed, driven by the adoption of diverse freeze-all policies, widespread implementation of measures to mitigate ovarian hyperstimulation, and a rising number of preimplantation genetic tests conducted ( Zegers-Hochschild et al ., 2023 ). Various FET protocols are outlined, typically categorized as artificial cycles (AC) or natural cycles (NC), differing primarily in the presence or absence of a corpus luteum to aid LPS.…”