What are the data and trends on ART and IUI cycle numbers and their outcomes, and
on fertility preservation (FP) interventions, reported in 2019 as compared to previous
years?The 23rd ESHRE report highlights the rising ART treatment cycles and children
born, alongside a decline in twin deliveries owing to decreasing multiple embryo transfers;
fresh IVF or ICSI cycles exhibited higher delivery rates, whereas frozen embryo transfers
(FET) showed higher pregnancy rates (PRs), and reported IUI cycles decreased while
maintaining stable outcomes.ART aggregated data generated by national registries,
clinics, or professional societies have been gathered and analyzed by the European
IVF-Monitoring (EIM) Consortium since 1997 and reported in a total of 22 manuscripts
published in Human Reproduction and Human Reproduction Open.Data on medically assisted
reproduction (MAR) from European countries are collected by EIM for ESHRE each year.
The data on treatment cycles performed between 1 January and 31 December 2019 were
provided by either national registries or registries based on initiatives of medical
associations and scientific organizations or committed persons in one of the 44 countries
that are members of the EIM Consortium.Overall, 1487 clinics offering ART services
in 40 countries reported, for the second time, a total of more than 1 million (1 077
813) treatment cycles, including 160 782 with IVF, 427 980 with ICSI, 335 744 with
FET, 64 089 with preimplantation genetic testing (PGT), 82 373 with egg donation (ED),
546 with IVM of oocytes, and 6299 cycles with frozen oocyte replacement (FOR). A total
of 1169 institutions reported data on IUI cycles using either husband/partner's semen
(IUI-H; n = 147 711) or donor semen (IUI-D; n = 51 651) in 33 and 24 countries, respectively.
Eighteen countries reported 24 139 interventions in pre- and post-pubertal patients
for FP, including oocyte, ovarian tissue, semen, and testicular tissue banking.In
21 countries (21 in 2018) in which all ART clinics reported to the registry 476 760
treatment cycles were registered for a total population of approximately 300 million
inhabitants, allowing the best estimate of a mean of 1581 cycles performed per million
inhabitants (range: 437-3621). Among the reporting countries, for IVF the clinical
PRs per aspiration slightly decreased while they remained similar per transfer compared
to 2018 (21.8% and 34.6% versus 25.5% and 34.1%, respectively). In ICSI, the corresponding
PRs showed similar trends compared to 2018 (20.2% and 33.5%, versus 22.5% and 32.1%)
When freeze-all cycles were not considered for the calculations, the clinical PRs
per aspiration were 28.5% (28.8% in 2018) and 26.2% (27.3% in 2018) for IVF and ICSI,
respectively. After FET with embryos originating from own eggs, the PR per thawing
was at 35.1% (versus 33.4% in 2018), and with embryos originating from donated eggs
at 43.0% (41.8% in 2018). After ED, the PR per fresh embryo transfer was 50.5% (49.6%
in 2018) and per FOR 44.8% (44.9% in 2018). In IVF and ICSI together, the trend toward
the transfer of fewer embryos continues with the transfer of 1, 2, 3, and ≥4 embryos
in 55.4%, 39.9%, 2.6%, and 0.2% of all treatments, respectively (corresponding to
50.7%, 45.1%, 3.9%, and 0.3% in 2018). This resulted in a reduced proportion of twin
delivery rates (DRs) of 11.9% (12.4% in 2018) and a similar triplet DR of 0.3%. Treatments
with FET in 2019 resulted in twin and triplet DR of 8.9% and 0.1%, respectively (versus
9.4% and 0.1% in 2018). After IUI, the DRs remained similar at 8.7% after IUI-H (8.8%
in 2018) and at 12.1% after IUI-D (12.6% in 2018). Twin and triplet DRs after IUI-H
were 8.7% and 0.4% (in 2018: 8.4% and 0.3%) and 6.2% and 0.2% after IUI-D (in 2018:
6.4% and 0.2%), respectively. Eighteen countries (16 in 2018) provided data on FP
in a total number of 24 139 interventions (20 994 in 2018). Cryopreservation of ejaculated
sperm (n = 11 592 versus n = 10 503 in 2018) and cryopreservation of oocytes (n =
10 784 versus n = 9123 in 2018) were most frequently reported.Caution with the interpretation
of results should remain as data collection systems and completeness of reporting
vary among European countries. Some countries were unable to deliver data about the
number of initiated cycles and/or deliveries.The 23rd ESHRE data collection on ART,
IUI, and FP interventions shows a continuous increase of reported treatment numbers
and MAR-derived livebirths in Europe. Although it is the largest data collection on
MAR in Europe, further efforts toward optimization of both the collection and the
reporting, from the perspective of improving surveillance and vigilance in the field
of reproductive medicine, are awaited.The study has received no external funding and
all costs are covered by ESHRE. There are no competing interests.
