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Assisted Reproductive Technology (ART) in Europe, 2004. Results generated from European registers by ESHRE ESHREs European IVF Monitoring (EIM) A consortium.

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Presentation on theme: "Assisted Reproductive Technology (ART) in Europe, 2004. Results generated from European registers by ESHRE ESHREs European IVF Monitoring (EIM) A consortium."— Presentation transcript:

1 Assisted Reproductive Technology (ART) in Europe, Results generated from European registers by ESHRE ESHREs 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 ESHREs publication European IVF Monitoring Assisted Reproductive Technology in Europe, 1997, 1998, 1999, 2000, 2001, Published in Hum. Reprod – 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 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, Countries Cycles % Increase

11 Countries with > cycles 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 IVF ICSI FER (26% of fresh) OD PGD 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 Austria Belgium 2.4 1* 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 IVF ICSI FER OD

20 Pregnancy rates per transfer. PGD, 2004 countries 15 transfers1849 pregnancies 789 (42.7%) deliveries 331 (17.9%)

21 Pregnancy rates per transfer IVF Serbia/Montenegro100.0Hungary33.0Switzerland27.9 Turkey52.4Macedonia32.8Ukraine27.6 Latvia40.8Norway32.4France26.9 Spain40.0Portugal32.2Finland26.7 Poland36.8Iceland31.5Italy26.0 Greece36.1Slovenia31.1Albania24.4 Russia34.3Ireland30.4Bulgaria24.4 Netherlands33.8UK29.3Belgium23.5 Sweden33.5Germany28.7 Denmark33.1Lithuania28.2 Austria: no data available Serbia/Montenegro: overestimated, only 2 transfers

22 Pregnancy rates per transfer ICSI Latvia45.5Denmark32.6Norway27.0 Turkey44.4Iceland31.8Lithuania27.0 Spain36.7Slovenia31.2France26.5 Greece36.5Sweden29.6Switzerland26.2 Bulgaria35.9UK29.2Italy26.1 Serbia/Montenegro35.5Ireland29.1Albania24.6 Poland35.3Ukraine29.1Belgium21.5 Netherlands34.5Germany28.4Macedonia14.6 Hungary34.4Finland27.8 Russia33.0Portugal27.2 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 cumulative delivery rates after fresh and FER. Deliveries/ initiated cycle Initiated cycles IVF and ICSI Deliveries, fresh cycles IVF and ICSI Multiple Deliveries fresh FER cycles (thawings) Deliveries FER Multiple deliveries FER Deliveries fresh Cumulative Deliveries, Fresh and FER All multiples Finland %29.5%12.3% Sweden %26.3%6.45% UK %25.6%23.1%

25 Quality and trends

26 Percentage 3 or 4 embryo transfers. IVF and ICSI, 2004 HIGH > 50%LOW < 20% Turkey72.5Ireland14.1 Lithuania71.1Iceland12.6 Albania68.7Slovenia12.2 Hungary64.6Belgium9.1 Bulgaria64.4UK5.5 Serbia/Montenegro62.7Denmark5.2 Greece62.0Finland0.3 Ukraine61.5Sweden0.1 Italy52.4

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% % Lithuania10.0 Slovenia 0.7 Iceland 3.8 Ireland 0.5 Macedonia 3.4 France0.5 Bulgaria 3.3 Finland 0.5 Hungary 3.1 Denmark 0.4 Turkey 3.0 Norway 0.3 UK 0.3 Belgium 0.2 Albania0.0 Latvia0.0 Sweden0.0

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

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 stimulation cycles resulted in 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 IrelandSpain Italy Turkey Latvia Ukraine Lithuania

41 IUI-H and IUI-D, 2004 CyclesPregnant % 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 onselected countries.


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