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Assisted Reproductive Technology (ART) in Europe, 2004. Results generated from European registers by ESHRE

Assisted Reproductive Technology (ART) in Europe, 2004. Results generated from European registers by ESHRE. ESHRE’s European IVF Monitoring (EIM) A consortium of representatives for National Registers Karl G. Nygren, Chairman Anders Nyboe Andersen, Co-ordinator

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Assisted Reproductive Technology (ART) in Europe, 2004. Results generated from European registers by ESHRE

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  1. Assisted Reproductive Technology (ART) in Europe, 2004. Results generated from European registers by ESHRE ESHRE’s European IVF Monitoring (EIM) A consortium of representatives for National Registers Karl G. Nygren, Chairman Anders Nyboe Andersen, Co-ordinator Luca Gianaroli, Ricardo Felberbaum and Jacques de Mouzon, members Veerle Goossens, ESHRE Central Office

  2. ESHRE’s publicationEuropean IVF Monitoring 1997 - • Assisted Reproductive Technology in Europe, 1997, 1998, 1999, 2000, 2001, 2002. • Published in Hum. Reprod. 2001 – 2007. • Last publication. • Assisted reproductive technology in Europe, 2003. Results generated from European registers by ESHRE (2007) A.Nyboe Andersen, V.Goossens, L.Gianaroli, R.Felberbaum, J.de Mouzon and K.G.Nygren. Hum. Reprod., 22, 1513-1525

  3. The European IVF Monitoring (EIM) The EIM is basically a summary of data from already existing National Registers. Contain data on • Quantity, including ”availability” • Efficacy • Quality • Risks • Trends

  4. EIM Why?

  5. Should we summarise data that are so different? It should be stressed that data should be looked at from individual countries and compared between countries, rather than concluding that “In Europe ART ……”

  6. EIM 2004. Basis for data collection • Data from already existing national registers (n=15) Austria,Belgium, Denmark, Finland, France, Germany, Hungary, Iceland, Ireland, Netherlands, Norway, Portugal, Spain, Sweden, United Kingdom. • Data collection for the EIM (n=14) Albania,Bulgaria, Greece, Italy, Latvia, Lithuania, Macedonia,, Poland, Russia, Serbia / Montenegro, Slovenia, Switzerland, Turkey, Ukraine.

  7. Quantity and availability

  8. 29 countries in 2004 Albania Iceland Russia Austria Ireland Serbia / Montenegro Belgium Italy Slovenia Bulgaria Latvia Spain Denmark Lithuania Sweden Finland Macedonia Switzerland France Netherlands Turkey Germany Norway UK Greece Poland Ukraine Hungary Portugal No datafrom the Czech Republic, Croatia, and Slovakia New countries 2004: Albania and Turkey

  9. Proportion of clinics reporting to the EIM, 2004 • All Clinics (n=14) Austria,Belgium,Denmark, Finland, France, Germany, Iceland, Macedonia, Netherlands, Norway, Slovenia, Sweden, Switzerland, United Kingdom • Proportion of clinics (n=15) Albania,Bulgaria, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Poland, Portugal, Russia, Serbia / Montenegro, Spain, Turkey, Ukraine,

  10. EIM, 1997 - 2004 Countries Cycles % Increase 1997 18 203 225 1998 18 232 225 + 14 1999 21 249 624 + 10 2000 22 275 187 + 10 2001 23 289 690 + 5 2002 25 324 238 + 12 2003 28 365 103 + 13 2004 29 370 963 + 2

  11. Countries with > 10 000 cycles 2004 2004 2003 2002 2001 2000 France 69746 60 681 59 296 35 598 56 754 Germany 60425102 426 84 819 71 752 63 005 Spain40956 17 011 15 030 13 720 14 519 UK 40101 37 348 37 083 35 012 34 634 Italy 26099 25 877 18 948 18 673 19 835 Belgium 20426 15 594 12 827 12 558 11 829 Netherlands 15366 17 649 16 273 15 335 15 062 Russia 14838 10 819 8 667 7 665 6 363 Sweden 12871 11 736 11 081 10 082 9 205 Denmark 11518 10 893 11 321 10 305 9 682

  12. Reduction in oocyte aspirations after change in ART re-imbursements in Germany, 2004

  13. Treatment cycles 2004 IVF 114 512 ↓ ICSI 166 711 ↑ FER 71 997 ↑ (26% of fresh) OD 10 334 ↑ PGD 2 051 ↑ 2004 IVF / ICSI: 41.0 vs 59.0 % 2003 IVF / ICSI: 45.0 vs 55.0 % 2002 IVF / ICSI: 47.6 vs 52.4 % 2001 IVF / ICSI: 51.8 vs 48.2 % 2000 IVF / ICSI: 55.9 vs 44.1 % 1999 IVF / ICSI: 56,6 vs 43,4 %

  14. Availability. Number of cycles per 1 mill inhabitants 2004 2003 2002 2001 2000 1999 1998 1997 Austria 584 597 - - - - - - Belgium1974 14621241 1177 - - - - Denmark 2128 2008 2106 1923 1830 1659 1608 1448 Finland1747 1421 1463 1538 1446 1407 1528 1538 France1154978993 - 961 882 795 780 Germany 8031243- - - - - - Iceland1208 1378 1224 1190 1300 1383 1540 1422 Macedonia 252186- - - - - - Netherlands 942 1086 1008 955 946 915 889 897 Norway1329 1169 921 975 971 915 822 811 Slovenia1338 1365 1291 1119 - - - - Sweden1432 1320 1241 1133 1038 973 947 952 Switzerland 767 769 738 679 644 586 563 472 UK665 623 625 591 580 - 595 583

  15. Availability.Number of cycles per 1 mill inhabitants (2004)

  16. Percentage of infants born after ART, 1997 to 2004 2004 2003 2002 2001 2000 1999 1998 1997 Austria 0.4 - - - - - - - Belgium 2.4 1* 2.1 1.5 - - - - Denmark4.2 3.9 4.2 3.9 3.7 3.2 3.0 2.6 Finland2.9 3.2 2.9 2.4 2.3 2.7 2.8 2.4 France1.7 1.5 1.5 - 1.4 1.4 1.3 1.2 Germany 1.6 2.6 - - - - - - Iceland2.0 2.0 2.9 2.8 3.8 3.6 3.8 3.5 Macedonia 0.3 0.2 - - - - - - Netherlands - - - - - - - - Norway2.8 2.5 2.4 2.2 2.1 1.8 1.7 1.3 Slovenia3.4 2.9 3.5 3.2 3.0 - - - Sweden 2.9 2.9 2.8 2.8 2.5 2.6 2.4 2.3 Switzerland 1.4 1.5 1.4 1.0 1.0 0.7 0.5 - UK1.6 1.5 1.4 1.1 1.1 - 1.1 1.0 * Belgium: underestimation due to substantial ”loss of follow-up”

  17. Percentage of infants born after ART (2004)

  18. Efficacy and trends

  19. Pregnancy rate per transfer 1997 - 2004 2004 2003 2002 2001 2000 1999 1998 1997 IVF30.6 29.6 29.5 29.0 28.4 27.7 27.0 26.1 ICSI30.4 28.7 29.4 28.3 28.7 27.9 26.8 26.4 FER19.2 18.6 18.4 16.4 16.6 15.7 14.9 15.2 OD39.6 37.9 34.9 33.4 32.9 40.0 30.6 27.1

  20. Pregnancy rates per transfer. PGD, 2004 countries 15 transfers 1849 pregnancies 789 (42.7%) deliveries 331 (17.9%)

  21. Pregnancy rates per transfer IVF - 2004 Austria: no data available Serbia/Montenegro: overestimated, only 2 transfers

  22. Pregnancy rates per transfer ICSI - 2004 Austria: no data available

  23. Conclusion. Efficacy – pregnancies/ transfer During the 7 year period 1997 – 2004 Despite the transfer of less and less embryos a gradual increase: 26 to 30%, IVF/ICSI 15 to 19%, FER 27 to 40%, ED

  24. The “optimal end-points”. The cumulative delivery rates after fresh and FER. Deliveries/ initiated cycle

  25. ”Quality” and trends

  26. Percentage 3 or 4 embryo transfers. IVF and ICSI, 2004

  27. Number of embryos transferred after IVF and ICSI, 2004The largest countries

  28. Number of embryos transferred after IVF and ICSI, 2004The Nordic countries

  29. Number of embryos transferred after IVF and ICSI, 2004Southern Europe

  30. Number of embryos transferred after IVF and ICSI, 2004Eastern Europe

  31. Number of embryos transferred after IVF and ICSI, 2004Central Europe

  32. Number of embryos transferred. IVF and ICSI, 2004(%) 2004 2003 2002 2001 2000 1999 1998 1997 1 19.2 15.7 13.7 12.0 12.1 11.9 11.5 11.5 2 55.4 55.9 54.8 51.7 46.7 39.2 37.2 35.7 3 22.1 24.9 26.9 30.8 33.3 39.6 42.0 38.4 4 3.3 3.5 4.7 5.5 6.8 9.3 9.4 14.2

  33. Triplet deliveries, IVF and ICSI, 2004 High, > 2,5%%Low, < 1,0% % Lithuania 10.0 Slovenia 0.7 Iceland 3.8 Ireland 0.5 Macedonia 3.4 France 0.5 Bulgaria 3.3 Finland 0.5 Hungary 3.1 Denmark 0.4 Turkey 3.0 Norway 0.3 UK 0.3 Belgium 0.2 Albania 0.0 Latvia 0.0 Sweden 0.0

  34. Percentage singleton, twin, triplet and quadruplet deliveries. IVF and ICSI, 2004 2004 2003 2002 2001 2000 1999 1998 1997 Singleton77.2 76.7 75.5 74.5 73.6 73.7 73.7 70.4 Twin21.7 22.0 23.2 24.0 24.4 24.0 23.9 25.8 Triplet 1.0 1.1 1.3 1.5 2.0 2.2 2.3 3.6 Quadruplet0.01 0.08 0.04 0.02 0.04 0.1 0.1 0.15

  35. Conclusion. Multiple deliveries During the 7 year period 1997 – 2004 • Decline off the overall muliple delivery rates from 29.5 to 22.7% • A 3-fold reduction in triplet delivery rates from 3.6 to 1.0%

  36. Safety and risks

  37. OHSS, 2004 • Data from 25 of the 29 contributing countries • 326 351 stimulation cycles resulted in 2 858 cases of OHSS • The incidence was 0.9%

  38. Fetal reduction (FR), 2004 In 21 countries, 748 fetal reductions were reported Deliveries FR % Deliveries FR % Albania 10 0 0.0 Poland 970 0 0.0 Bulgaria 218 2 0.9 Russia 2 518 47 1.9 France 10 387 106 1.0 Serbia/Montenegro 0 3 0.0 Finland 1 410 0 0.0 Slovenia 522 2 0.2 Germany8 458 222 2.6 Spain 5 668 83 1.5 Greece 1 514 84 5.5 Sweden 2 545 0 0.0 Hungary 671 15 2.2 Switzerland 845 0 0.0 Iceland 64 0 0.0 Turkey 575 77 13.4 Latvia 27 0 0.0 UK 8 338 92 1.1 Lithuania 10 0 0.0 Ukraine 354 9 2.5 Macedonia 59 6 10.2

  39. Fetal Reduction: A major cause of the low triplet rates • The 748 FR should be related to the 45.148 reported deliveries after ”fresh transfer” • This correspond to 1.7% of deliveries after ”fresh transfer”, so the 1.0% triplet rates after IVF/ICSI is lower than it would be without FR.

  40. Intrauterine inseminations IUI-H and IUI-D, 2004 Countries with data on IUI-H (n=19) Albania Macedonia Bulgaria Norway Denmark Poland France Portugal Greece Serbia / Montenegro Hungary Slovenia Ireland Spain Italy Turkey Latvia Ukraine Lithuania

  41. IUI-H and IUI-D, 2004 Cycles Pregnant % IUI-H < 40 94 100 11 866 12.6 IUI-H > 40 4 288 350 8.2 IUI-D < 40 15 882 2 965 18.7 IUI-D > 40 1 710 143 8.2 All 115 980 15 324 13.2

  42. Multiple gestations IUI-H and IUI-D, 2004 All Single % Twin % Triplet % IUI-H < 40 11 911 87.0 11.7 1.3 IUI-H > 40 347 89.3 10.4 0.3 IUI-D < 40 2 906 88.0 11.1 0.8 IUI-D > 40 140 91.4 7.7 1.4 All 15 304 87.3 11.5 1.1

  43. Conclusions Multiple gestations and IUI • The number of twin pregnancies after IUI-H in women < 40 (11.7%) is half the rates than the twin delivery rates after IVF and ICSI (21.6%) • The triplet pregnancy rates after IUI-H were similar to IVF/ICSI

  44. Future developments • New cycle based statutory registers being established around Europe • Better coverage – complete coverage • Gradual evolution of a common European consensus on core-data-sets • An infant follow-up database based on selected countries.

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