ART in Europe, 2014: results generated from European registries by ESHRE

De Geyter C; Calhaz-Jorge C; Kupka MS; Wyns C; Mocanu E; Motrenko T; Scaravelli G; Smeenk J; Vidakovic S; Goossens V; European IVF-monitoring Consortium (EIM); European Society of Human Reproduction and Embryology (ESHRE)

doi:10.1093/humrep/dey242

Assisted Reproduction · Registries and Reporting

ART in Europe, 2014: results generated from European registries by ESHRE

De Geyter C, Calhaz-Jorge C, Kupka MS, Wyns C, Mocanu E, Motrenko T, Scaravelli G, Smeenk J, Vidakovic S, Goossens V, European IVF-monitoring Consortium (EIM), European Society of Human Reproduction and Embryology (ESHRE)

Published September 2018 Human Reproduction, 33(9), 1586-1601

DOI 10.1093/humrep/dey242 PMID 30032255

RRM Academy Synopsis

European ART registries recorded 776 556 cycles in 2014

European registries recorded 776 556 ART cycles in 2014 and 170 163 infants born after ART. The European IVF-monitoring Consortium collected yearly totals for ESHRE from registries in 39 countries. The report presents cycle counts, embryo transfers, outcomes and complications.

Key Findings

ICSI was the most common technique with 362 285 cycles (46.6%), and frozen embryo replacement cycles exceeded the 146 148 conventional IVF cycles for the first time.
Reported cycles rose 13.1% from 686 271 in 2013 to 776 556 in 2014, and the authors attribute much of the rise to Spain, whose registry now reports nearly complete data.
Infants born after ART in 2014 numbered 170 163, or 2.1% of all children born in Europe, and the share may vary by country from 0.2% in Serbia to 6.4% in Denmark.
Single-embryo transfers made up 34.9% of IVF and ICSI transfers in 2014, up from 31.4% in 2013, and deliveries after IVF and ICSI were 17.0% twins and 0.5% triplets.
Ovarian hyperstimulation syndrome was the most frequent reported complication (2040 cases, 0.3% of reported cycles), and singleton preterm deliveries per embryo transfer rose from 0.96% in 2006 to 1.79% in 2014.

Interpretation

The report is a cross-sectional survey of yearly totals from national registries and some clinics or societies. Only 14 countries had every clinic report complete data. The authors write that unreported cycles may overstate success rates and that unreported adverse events overstate safety. IVF and ICSI outcomes are counted per aspiration because data on initiated cycles were incomplete. The authors call the reports purely descriptive, with cumulative analysis possible only within one year. The report has no comparison group of untreated couples. The ESHRE Executive Committee approved it, and its section has no external peer review.

RRM Context

IVF bypasses the reproductive system and leaves the reason conception failed unresolved. The registry tables list cycles and outcomes without a diagnosis for any couple. Restorative reproductive medicine begins with an evaluation of both partners to find the underlying cause. It then treats that condition.

Our editorial summary of this paper, not the article's abstract.

Abstract

Study Question

What are the European trends and developments in ART and IUI in 2014 as compared to previous years?

Summary Answer

The 18th ESHRE report on ART shows a continuing expansion of both treatment numbers in Europe and more variability in treatment modalities resulting in a rising contribution to the birth rates in most participating countries.

What Is Known Already

Since 1997, ART data generated by national registries have been collected, analysed by the European IVF-monitoring (EIM) Consortium and reported in 17 manuscripts published in Human Reproduction.

Study Design, Size, Duration

Continuous collection of European data by the EIM for ESHRE. The data for treatments performed in 2014 between 1 January and 31 December in 39 European countries were provided by national registries or on a voluntary basis by clinics or professional societies.

Participants/Materials, Setting, Methods

From 39 countries and 1279 institutions offering ART services, a total of 776 556 treatment cycles, involving 146 148 with IVF, 362 285 with ICSI, 192 027 with frozen embryo replacement (FER), 15 894 with PGT, 56 516 with egg donation (ED), 292 with IVM and 3404 with frozen oocyte replacement (FOR) were reported. European data on IUI using husband/partner's semen (IUI-H) and donor semen (IUI-D) were reported from 1364 institutions offering IUI in 26 countries and 21 countries, respectively. A total of 120 789 treatments with IUI-H and 49 163 treatments with IUI-D were included.

Main Results and the Role of Chance

In 14 countries (17 in 2013), where all institutions contributed to their respective national registers, a total of 291 235 treatment cycles were performed in a population of ~208 million inhabitants, corresponding to 1925 cycles per million inhabitants (range: 423-2978 per million inhabitants). After treatment with IVF the clinical pregnancy rates (PR) per aspiration and per transfer were marginally higher in 2014 than in 2013, at 29.9 and 35.8% versus 29.6 and 34.5%, respectively. After treatment with ICSI the PR per aspiration and per transfer were also higher than those achieved in 2013 (28.4 and 35.0% versus 27.8 and 32.9%, respectively). After FER with own embryos the PR continued to rise, from 27.0% in 2013 to 27.6% in 2014. After ED a similar trend was observed with PR reaching 50.3% per fresh transfer (49.8% in 2013) and 48.7% for FOR (46.4% in 2013). The delivery rates (DR) after IUI remained stable at 8.5% after IUI-H (8.6% in 2013) and at 11.6% after IUI-D (11.1% in 2013). In IVF and ICSI together, 1, 2, 3 and ≥4 embryos were transferred in 34.9, 54.5, 9.9 and in 0.7% of all treatments, respectively (corresponding to 31.4%, 56.3, 11.5% and 1% in 2013). This evolution in embryo transfer strategy in both IVF and ICSI resulted in a singleton, twin and triplet DR of 82.5, 17.0 and 0.5%, respectively (compared to 82.0, 17.5 and 0.5%, respectively, in 2013). Treatments with FER in 2014 resulted in a twin and triplet DR of 12.4 and 0.3%, respectively (versus 12.5 and 0.3% in 2013). Twin and triplet DR after IUI were 9.5 and 0.3%, respectively, after IUI-H (in 2013:9.5 and 0.6%) and 7.7 and 0.3% after IUI-D (in 2013: 7.5 and 0.3%).

LIMITATION, REASONS FOR CAUTION: The method of data collection and reporting varies among European countries. The EIM receives aggregated data from various countries with variable levels of completeness. Registries from a number of countries have failed to provide adequate data about the number of initiated cycles and deliveries. As long as incomplete data are provided, the results should be interpreted with caution.

Wider Implications of the Findings

The 18th ESHRE report on ART shows a continuing expansion of treatment numbers in Europe. The number of treatments reported, the variability in treatment modalities and the rising contribution to the birth rates in most participating countries point towards the increasing impact of ART on reproduction in Europe. Being the largest data collection on ART, the report gives detailed information about ongoing developments in the field.

Study Funding/Competing Interests

The study has no external funding and all costs are covered by ESHRE. There are no competing interests.

Topics

Assisted Reproduction Registries and Reporting National Registry Data

Assisted Reproduction › Registries and Reporting › National Registry Data

Christian De Geyter, Carlos Calhaz-Jorge, Christine Wyns, Edgar Mocanu, Veerle Goossens

C Geyter, C Calhaz-Jorge, Chris Wyns, C Wyns, E Mocanu, V Goossens

PMID 30032255 30032255 DOI 10.1093/humrep/dey242 10.1093/humrep/dey242 De Geyter et al. 2018, De Geyter 2018

ART in Europe, 2014: results generated from European registries by ESHRE

European ART registries recorded 776 556 cycles in 2014

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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