ART in Europe, 2015: 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/hropen/hoz038

Assisted Reproduction · Registries and Reporting

ART in Europe, 2015: 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 February 24, 2020 Human Reproduction Open

DOI 10.1093/hropen/hoz038 PMID 32123753 PMC PMC7038942

RRM Academy Synopsis

European ART treatment cycles rose 9.4% in 2015 across 38 countries

European ART treatment cycles rose 9.4% in 2015, to 849 811 across 38 countries, the 19th annual ESHRE registry report finds. The report pools national registry counts among 1343 reporting institutions. Clinical pregnancy rates in 2015 were slightly lower than in 2014 after IVF and ICSI. The pregnancy rate per thawing after frozen embryo replacement with own embryos was higher.

Key Findings

In 2015, 1343 institutions in 38 countries reported 849 811 treatment cycles, up 9.4% from 776 556 cycles in 2014.
In 2015, clinical pregnancy rates after IVF were 28.5% per aspiration and 34.6% per transfer. After ICSI they were 26.2% and 33.2%. All four were slightly lower than in 2014.
After frozen embryo replacement with own embryos, the pregnancy rate per thawing rose from 27.6% in 2014 to 29.2% in 2015.
Delivery rates after intrauterine insemination (IUI) were 7.8% with partner's semen and 12.0% with donor semen.
Term delivery (37 weeks or later) followed 86.4% of singleton, 44.7% of twin and 7.5% of triplet pregnancies, in data from 18 countries.

Interpretation

The ESHRE report is an annual registry summary of aggregated national counts for treatments started in 2015. The authors state that its content is not externally peer reviewed. All centers reported complete data in 18 of 38 countries (47.4%). Registries in a number of countries gave inadequate data on initiated cycles and deliveries. The authors advise caution and report outcomes per aspiration, transfer or thawing. The unit is the treatment cycle, with no per-couple totals. The authors write that under-reporting leads to overestimation of efficacy and underestimation of safety. A registry shows trends and cannot show why any outcome occurred.

RRM Context

The report counts procedures and their outcomes and lists no causes of infertility. Rising cycle numbers describe how often ART is used. ART bypasses the reproductive system without resolving why conception fails. RRM starts from the cause: evaluating both partners and treating what is found. Restorative care cohorts report outcomes per couple over time, a measure this registry lacks.

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 2015 as compared to previous years?

Summary Answer

The 19th ESHRE report on ART shows a continuing expansion of treatment numbers in Europe, and this increase, the variability in treatment modalities and the rising contribution to the birth rates in most participating countries all point towards the increasing impact of ART on European society.

What Is Known Already

Since 1997, the ART data generated by national registries have been collected, analysed and reported in 18 manuscripts published in Human Reproduction.

Study Design, Size, Duration

Collection of European data by the European IVF-Monitoring Consortium (EIM) for ESHRE. The data for treatments performed between 1 January and 31 December 2015 in 38 European countries were provided by national registries or on a voluntary basis by clinics or professional societies.

Participants/Materials, Setting, Methods

From 1343 institutions in 38 countries offering ART services a total of 849 811 treatment cycles, involving 155 960 with IVF, 385676 with ICSI, 218098 with frozen embryo replacement (FER), 21 041 with preimplantation genetic testing (PGT), 64 477 with egg donation (ED), 265 with IVM and 4294 with FOR were recorded. European data on IUI using husband/partner's semen (IUI-H) and donor semen (IUI-D) were reported from 1352 institutions offering IUI in 25 countries and 21 countries, respectively. A total of 139 050 treatments with IUI-H and 49 001 treatments with IUI-D were included.

Main Results and the Role of Chance

In 18 countries (14 in 2014) with a population of approximately 286 million inhabitants, in which all institutions contributed to their respective national registers, a total of 409 771 treatment cycles were performed, corresponding to 1432 cycles per million inhabitants (range: 727-3068 per million). After IVF the clinical pregnancy rates (PRs) per aspiration and per transfer were slightly lower in 2015 as compared to 2014, at 28.5 and 34.6% versus 29.9 and 35.8%, respectively. After ICSI, the corresponding PR achieved per aspiration and per transfer in 2015 were also slightly lower than those achieved in 2014 (26.2 and 33.2% versus 28.4 and 35.0%, respectively). On the other hand, after FER with own embryos the PR per thawing continued to rise from 27.6% in 2014 to 29.2% in 2015. After ED a slightly lower PR per embryo transfer was achieved: 49.6% per fresh transfer (50.3% in 2014) and 43.4% for FOR (48.7% in 2014). The delivery rates (DRs) after IUI remained stable at 7.8% after IUI-H (8.5% in 2014) and at 12.0% after IUI-D (11.6% in 2014). In IVF and ICSI together, 1, 2, 3 and ≥4 embryos were transferred in 37.7, 53.9, 7.9 and in 0.5% of all treatments, respectively (corresponding to 34.9, 54.5, 9.9 and in 0.7% in 2014). This evolution towards the transfer of fewer embryos in both IVF and ICSI resulted in a proportion of singleton, twin and triplet DR of 83.1, 16.5 and 0.4%, respectively (compared to 82.5, 17.0 and 0.5%, respectively, in 2014). Treatments with FER in 2015 resulted in twin and triplet DR of 12.3 and 0.3%, respectively (versus 12.4 and 0.3% in 2014). Twin and triplet delivery rates after IUI-H were 8.9 and 0.5%, respectively (in 2014: 9.5 and 0.3%), and 7.3 and 0.6% after IUI-D (in 2014: 7.7 and 0.3%).

Limitations, Reasons for Caution

The methods of data collection and reporting vary 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 19th EIM 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 worldwide, detailed information about ongoing developments in the field is provided.

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 32123753 32123753 DOI 10.1093/hropen/hoz038 10.1093/hropen/hoz038 De Geyter et al. 2020, De Geyter 2020

ART in Europe, 2015: results generated from European registries by ESHRE

European ART treatment cycles rose 9.4% in 2015 across 38 countries

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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