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Assisted Reproductive Technology (ART) in Europe, 2004

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Presentation on theme: "Assisted Reproductive Technology (ART) in Europe, 2004"— Presentation transcript:

1 Assisted Reproductive Technology (ART) in Europe, 2004
Assisted Reproductive Technology (ART) in Europe, 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 publication European IVF Monitoring 1997 -
Assisted Reproductive Technology in Europe, 1997, 1998, 1999, 2000, 2001, 2002. Published in Hum. Reprod – 2007. Last publication. Assisted reproductive technology in Europe, 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,

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 data from 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

11 Countries with > 10 000 cycles 2004
France Germany Spain UK Italy Belgium Netherlands Russia Sweden Denmark

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

13 Treatment cycles 2004 ICSI 166 711 ↑ FER 71 997 ↑ (26% of fresh)
IVF ↓ ICSI ↑ FER ↑ (26% of fresh) OD ↑ PGD ↑ 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
Austria Belgium Denmark Finland France Germany Iceland Macedonia Netherlands Norway Slovenia Sweden Switzerland UK

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

16 Percentage of infants born after ART, 1997 to 2004
Austria Belgium * Denmark Finland France Germany Iceland Macedonia Netherlands Norway Slovenia Sweden Switzerland UK * 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
IVF ICSI FER OD

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

21 Pregnancy rates per transfer IVF - 2004
Serbia/Montenegro 100.0 Hungary 33.0 Switzerland 27.9 Turkey 52.4 Macedonia 32.8 Ukraine 27.6 Latvia 40.8 Norway 32.4 France 26.9 Spain 40.0 Portugal 32.2 Finland 26.7 Poland 36.8 Iceland 31.5 Italy 26.0 Greece 36.1 Slovenia 31.1 Albania 24.4 Russia 34.3 Ireland 30.4 Bulgaria Netherlands 33.8 UK 29.3 Belgium 23.5 Sweden 33.5 Germany 28.7 Denmark 33.1 Lithuania 28.2 Austria: no data available Serbia/Montenegro: overestimated, only 2 transfers

22 Pregnancy rates per transfer ICSI - 2004
Latvia 45.5 Denmark 32.6 Norway 27.0 Turkey 44.4 Iceland 31.8 Lithuania Spain 36.7 Slovenia 31.2 France 26.5 Greece 36.5 Sweden 29.6 Switzerland 26.2 Bulgaria 35.9 UK 29.2 Italy 26.1 Serbia/Montenegro 35.5 Ireland 29.1 Albania 24.6 Poland 35.3 Ukraine Belgium 21.5 Netherlands 34.5 Germany 28.4 Macedonia 14.6 Hungary 34.4 Finland 27.8 Russia 33.0 Portugal 27.2 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 “optimal end-points”. The cumulative delivery rates after fresh and FER. Deliveries/ initiated cycle Initiated cycles IVF and ICSI Deliveries, “fresh” Multiple Deliveries fresh FER cycles (thawings) FER deliveries Cumulative Fresh and All multiples Finland 4761 886 118 3434 518 55 18.6% 29.5% 12.3% Sweden 9593 2027 115 3205 498 48 21.1% 26.3% 6.45% UK 30495 6747 1635 7349 1072 172 22.2% 25.6% 23.1%

25 ”Quality” and trends

26 Percentage 3 or 4 embryo transfers. IVF and ICSI, 2004
HIGH > 50% % LOW < 20% Turkey 72.5 Ireland 14.1 Lithuania 71.1 Iceland 12.6 Albania 68.7 Slovenia 12.2 Hungary 64.6 Belgium 9.1 Bulgaria 64.4 UK 5.5 Serbia/Montenegro 62.7 Denmark 5.2 Greece 62.0 Finland 0.3 Ukraine 61.5 Sweden 0.1 Italy 52.4

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

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

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

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

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

32 Number of embryos transferred. IVF and ICSI, 2004 (%)

33 Triplet deliveries, IVF and ICSI, 2004
High, > 2,5% % Low, < 1,0% % Lithuania Slovenia Iceland Ireland Macedonia France 0.5 Bulgaria Finland Hungary Denmark Turkey Norway UK 0.3 Belgium Albania 0.0 Latvia 0.0 Sweden 0.0

34 Percentage singleton, twin, triplet and quadruplet deliveries
Percentage singleton, twin, triplet and quadruplet deliveries. IVF and ICSI, 2004 Singleton Twin Triplet Quadruplet

35 Conclusion. Multiple deliveries
During the 7 year period 1997 – 2004 Decline off the overall muliple delivery rates from 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
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 Poland Bulgaria Russia France Serbia/Montenegro Finland Slovenia Germany Spain Greece Sweden Hungary Switzerland Iceland Turkey Latvia UK Lithuania Ukraine Macedonia

39 Fetal Reduction: A major cause of the low triplet rates
The 748 FR should be related to the 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 IUI-H < 40 94 100 11 866 12.6
Cycles Pregnant % IUI-H < IUI-H > IUI-D < IUI-D > All

42 Multiple gestations IUI-H and IUI-D, 2004
All Single % Twin % Triplet % IUI-H < IUI-H > IUI-D < IUI-D > All

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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