In-depth analysis of the demographic landscape and clinical outcomes of assisted reproductive technologies in Türkiye: a comprehensive survey for the years 2020 and 2021

Abstract

Objective: To investigate patient characteristics and outcomes of assisted reproductive technology (ART) cycles conducted in Türkiye during the coronavirus disease-2019 (COVID-19) pandemic (2020-2021).

Material and methods: ART centers in Türkiye were invited to participate in this survey. The questionnaire focused on patient demographics and performance outcomes and was sent to center directors via anonymous Qualtrics™ links.

Results: The survey was sent to 167 centers and data were collected from 15 centers in 2020 and 24 centers in 2021. The clinical pregnancy rate from intrauterine insemination (IUI) procedures remained similar, with 15.1% in 2020 (1,245 IUI cycles) and 14.5% in 2021 (2,023 IUI cycles), while successful delivery rates were 12.5% and 11.5%, respectively. For ART treatments, the clinical pregnancy rate from fresh embryo transfers increased from 45.1% in 2020 (3,119 transfers) to 50.4% in 2021 (8832 transfers), with similar live birth rates, 34.2% vs. 34.4%. Frozen embryo transfers resulted in clinical pregnancy rates of 47.8% in 2020 (2,498 transfers) and 51.9% in 2021 (12,015 transfers), with live birth rates rising from 39.8% to 42.7%. Preimplantation genetic testing cycles resulted in clinical pregnancy rates of 64.2% in 2020 (271 transfers) and 60.8% in 2021 (2,102 transfers), with live birth rates of 53.5% and 48.2%, respectively. Regarding techniques for fertility preservation in females, 11 prepubertal and 61 postpubertal ovarian tissue cryopreservation procedures were reported, alongside 1,346 cycles performed within the same period. In males, 144 post-pubertal testicular tissue, 871 epididymal and 2,480 ejaculated sperm cryopreservations were reported. During the two years, six ovarian tissue transplantations followed by ART were performed, with 96 women using cryopreserved oocytes. In addition, 40 testicular tissue, 298 epididymal, and 238 ejaculated sperm samples were used for ART purposes.

Conclusion: This survey provides a comprehensive overview of ART practices in Türkiye for 2020 and 2021, establishing a long-term, nationallevel analysis while highlighting the challenges posed by the COVID-19 pandemic. The longitudinal analysis established a foundation for future annual reports and offers critical insights into emerging trends over these two years.

Keywords: Assisted reproduction techniques; data collection; in-vitro fertilization; medically assisted reproduction; registry.

Figure 1

ART applications, trends and clinical outcomes in fresh cycles over a two-year period (all numbers are presented as rates). ^aRates are based on all fresh embryo transfer cycles. ^bCalculated as the total number of clinical pregnancies divided by the total number of transfers for each category (e.g., clinical pregnancy rate for SETs in 2020 = number of clinical pregnancies from fresh SETs/total fresh SETs) SET: Single embryo transfer, ART: Assisted reproductive technology

Figure 2

ART applications, trends and clinical outcomes in frozen cycles over a two-year period (all numbers are presented as rates). ^aRates are based on all frozen embryo transfer cycles. ^bCalculated as the total number of clinical pregnancies divided by the total number of transfers for each category (e.g., clinical pregnancy rate for SETs in 2020 = number of clinical pregnancies from frozen SETs/total fresh SETs) SET: Single embryo transfer, ART: Assisted reproductive technology

Figure 3

Trend shifts in transfer characteristics and results between 2019 and 2021. ^aRates are based on all embryo transfer cycles. ^bRates are based on all deliveries. ART: Assisted reproductive technology, PGT: Preimplantation genetic test, LBR: Live birth rate, ET: Embryo transfer