Trends over 15 years in ART in Europe: an analysis of 6 million cycles

Abstract

Study question: Was the European IVF Monitoring (EIM) Consortium, established in 1999 by ESHRE, able to monitor the trend over time of ART in Europe?

Summary answer: The initial aims of the EIM programme (to collect and publish regional European data on census and trends on ART utilization, effectiveness, safety and quality) have been achieved.

What is already known: ART data in Europe have been collected and reported annually in Human Reproduction.

Study design size duration: A retrospective data analysis and summary of the first 15 years of ART activity in Europe (1997-2011) was carried out, using the key figures from the annual ESHRE reports and focusing on how the practice of ART has evolved over the years.

Participants/materials setting method: A total of 5 919 320 ART cycles are reported, including IVF, ICSI, frozen embryo relacment and egg donation, resulting in the birth of more than 1 million infants. A total of 1 548 967 IUIs are also reported, including husband/partner's semen and donor semen cycles. The most relevant and complete data are analysed and discussed.

Main results and the role of chance: With some fluctuations, the number of countries and clinics reporting to EIM increases significantly from 1997 to 2011. A constant increase was also registered in the number of annual cycles reported. Since 2005, the estimation of the EIM coverage on the total European activity was >80%. In countries with 100% of coverage, the mean availability of ART increased from 765 cycles per million inhabitants in 1997 to 1269 cycles per million inhabitants in 2011, and the proportion of ART infants of the total number of infants born in the country increased from 1.3% to 2.4%. The proportion of women aged > 39 years undergoing IVF and ICSI cycles gradually increased. For 12 consecutive years, the proportion of ICSI versus IVF cycles showed a marked increase before reaching a plateau from 2008. The proportion of transfers with three or more embryos decreased constantly and the proportion of SETs increased over the time period. The triplets deliveries were reduced from 3.7% in 1997 to less than 1% since 2005 (0.6% in 2011). The effectiveness (evaluated as clinical pregnancy rate per aspiration and per embryo transfer) increased until 2007, then the figure remained stable. The cumulative percentage of documented pregnancy losses was 17%. No differences have been noted in terms of outcomes in the IUI cycles.

Limitations reasons for caution: The data presented are accumulated from countries with different collection systems, regulations, insurance coverage and different practices. Each year a number of countries have been unable to provide some of the data.

Wider implications of the findings: The first summary of 15 years of the EIM reports offers interesting data on census and trends on ART utilization, safety and quality in Europe. The primary aim of the ESHRE effort in supporting European data collection has been reached. Owing to its importance inside and outside the professional community, European data collection and publication on ART have to be supported and implemented.

Study funding/competing interests: None.

Keywords: 15 year of data collection; ART; ART efficacy; ART safety; Europe; trends.

Figure 1

Availability: number of cycles / million inhabitants in countries where all clinics reported to the national register (100% coverage). The red line represents the mean annual value from all countries; the columns, the maximum value (blue column) and the minimum value (green column) registered each year among the countries.

Figure 2

ART infants: percentage of ART infants of the total infants born in the countries where all clinics reported to the national register (100% coverage). The red line represents the mean annual value from all countries; the columns, the maximum value (blue column) and the minimum value (green column) registered each year among the countries.

Figure 3

Female age: proportion of advanced aged patients of the total number of women undergoing IVF and ICSI cycles each year. Red column: 35–39 years; blue column: 40 years or more year

Figure 4

Techniques: proportion of IVF (light blue column) and ICSI (blue column) cycles performed each year. Reprinted with permissions from Kupka et al. (2016).

Figure 5

Number of embryos transferred: proportion of transfers performed each year with one (blue line), two (red line), three (green line) and more than three embryos (yellow line).

Figure 6

Techniques: the proportion of frozen embryo replacement (FER—light blue column) and egg donation (ED—blue column) of the total cycles.

Figure 7

Effectiveness: annual pregnancy rate (PR) per aspiration in IVF (red line) and ICSI (blue line) cycles.

Figure 8

Effectiveness: annual PR per embryo transfer in IVF (red line) and ICSI (blue line) cycles.

Figure 9

Effectiveness: maximum (blue column) and minimum (green column) PR per embryo transfer registered each year among reporting countries (ICSI plus IVF cycles).

Figure 10

Effectiveness: annual PR per transfer in FER and ED cycles.

Figure 11

Multiple delivery rate: proportion of twin (blue column) and triplets or more (red column) deliveries of the total deliveries.