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

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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 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

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ESHREs publication European 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

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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

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• 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

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EIM 2004. Basis for data collection

• Data from already existing national registers
  (n15)
• Austria, Belgium, Denmark, Finland, France,
  Germany, Hungary, Iceland, Ireland, Netherlands,
  Norway, Portugal, Spain, Sweden, United Kingdom.
• Data collection for the EIM (n14)
• Albania, Bulgaria, Greece, Italy, Latvia,
  Lithuania, Macedonia,, Poland, Russia, Serbia /
  Montenegro, Slovenia, Switzerland, Turkey,
  Ukraine.

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• Quantity and availability

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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
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Proportion of clinics reporting to the EIM, 2004

• All Clinics (n14)
• Austria, Belgium, Denmark, Finland, France,
  Germany, Iceland, Macedonia, Netherlands, Norway,
  Slovenia, Sweden, Switzerland, United Kingdom
• Proportion of clinics (n15)
• Albania, Bulgaria, Greece, Hungary, Ireland,
  Italy, Latvia, Lithuania, Poland, Portugal,
  Russia, Serbia / Montenegro, Spain, Turkey,
  Ukraine,

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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

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Countries with gt 10 000 cycles 2004

• 2004 2003 2002 2001 2000
• France 69746 60 681 59 296
  35 598 56 754
• Germany 60425 102 426 84 819
  71 752 63 005
• Spain 40956 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

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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

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Availability. Number of cycles per 1 mill
inhabitants

• 2004 2003 2002 2001
  2000 1999 1998 1997
• Austria 584 597 -
  - - -
  - -
• Belgium 1974 1462 1241
  1177 - - - -
• Denmark 2128 2008 2106
  1923 1830 1659 1608 1448
• Finland 1747 1421 1463
  1538 1446 1407 1528 1538
• France 1154 978 993
  - 961 882 795
  780
• Germany 803 1243 -
  - - - - -
• Iceland 1208 1378 1224
  1190 1300 1383 1540 1422
• Macedonia 252 186 -
  - - - - -
• Netherlands 942 1086 1008
  955 946 915 889
  897
• Norway 1329 1169 921
  975 971 915 822
  811
• Slovenia 1338 1365 1291
  1119 - - - -
• Sweden 1432 1320 1241
  1133 1038 973 947
  952
• Switzerland 767 769 738
  679 644 586 563
  472
• UK 665 623 625
  591 580 - 595
  583

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Availability. Number of cycles per 1 mill
inhabitants (2004)
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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 -
  - - -
• Denmark 4.2 3.9 4.2 3.9 3.7
  3.2 3.0 2.6
• Finland 2.9 3.2 2.9 2.4 2.3
  2.7 2.8 2.4
• France 1.7 1.5 1.5 - 1.4
  1.4 1.3 1.2
• Germany 1.6 2.6 - - -
  - - -
• Iceland 2.0 2.0 2.9 2.8 3.8
  3.6 3.8 3.5
• Macedonia 0.3 0.2 - - -
  - - -
• Netherlands - - - - -
  - - -
• Norway 2.8 2.5 2.4 2.2 2.1
  1.8 1.7 1.3
• Slovenia 3.4 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 -
• UK 1.6 1.5 1.4 1.1 1.1 -
  1.1 1.0
• Belgium underestimation due to substantial
  loss of follow-up

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Percentage of infants born after ART (2004)
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• Efficacy and trends

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Pregnancy rate per transfer 1997 - 2004

• 2004 2003 2002 2001 2000
  1999 1998 1997
• IVF 30.6 29.6 29.5 29.0 28.4 27.7
  27.0 26.1
• ICSI 30.4 28.7 29.4 28.3 28.7 27.9
  26.8 26.4
• FER 19.2 18.6 18.4 16.4 16.6 15.7
  14.9 15.2
• OD 39.6 37.9 34.9 33.4 32.9 40.0 30.6
  27.1

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Pregnancy rates per transfer. PGD, 2004

• countries 15
• transfers 1849
• pregnancies 789 (42.7)
• deliveries 331 (17.9)

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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 24.4
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
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Pregnancy rates per transfer ICSI - 2004
Latvia 45.5 Denmark 32.6 Norway 27.0
Turkey 44.4 Iceland 31.8 Lithuania 27.0
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 29.1 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
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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

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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 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
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• Quality and trends

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Percentage 3 or 4 embryo transfers. IVF and ICSI,
2004
HIGH gt 50 LOW lt 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
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Number of embryos transferred after IVF and ICSI,
2004The largest countries
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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
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Number of embryos transferred after IVF and ICSI,
2004Central Europe
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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

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Triplet deliveries, IVF and ICSI, 2004

• High, gt 2,5 Low, lt 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

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Percentage singleton, twin, triplet and
quadruplet deliveries. IVF and ICSI, 2004

2004 2003 2002 2001 2000 1999 1998 1997
Singleton 77.2 76.7 75.5 74.5 73.6 73.7 73.7
70.4 Twin 21.7 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
Quadruplet 0.01 0.08 0.04 0.02 0.04 0.1 0.1
0.15
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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

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• Safety and risks

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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

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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
• Germany 8 458 222 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

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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.

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Intrauterine inseminations IUI-H and IUI-D, 2004

• Countries with data on IUI-H (n19)
• Albania Macedonia
• Bulgaria Norway
• Denmark Poland
• France Portugal
• Greece Serbia / Montenegro
• Hungary Slovenia
• Ireland Spain
• Italy Turkey
• Latvia Ukraine
• Lithuania

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IUI-H and IUI-D, 2004

• Cycles Pregnant
• IUI-H lt 40 94 100 11 866 12.6
• IUI-H gt 40 4 288 350
  8.2
• IUI-D lt 40 15 882 2 965 18.7
• IUI-D gt 40 1 710 143 8.2
• All 115 980 15 324 13.2

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Multiple gestations IUI-H and IUI-D, 2004

• All Single Twin
  Triplet
• IUI-H lt 40 11 911 87.0 11.7 1.3
• IUI-H gt 40 347 89.3 10.4
  0.3
• IUI-D lt 40 2 906 88.0 11.1
  0.8
• IUI-D gt 40 140 91.4 7.7
  1.4
• All 15 304 87.3 11.5 1.1

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Conclusions Multiple gestations and IUI

• The number of twin pregnancies after IUI-H in
  women lt 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

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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.