ART in Europe, 2020: results generated from European registries by ESHRE†

Abstract

Study question: What are the data and trends of ART and IUI cycle numbers and their outcomes, and of fertility preservation (FP) interventions, reported in 2020 as compared to previous years?

Summary answer: This 24th ESHRE report highlights the number of ART treatment cycles and children born over the years, showing a decline in the total number of treatment cycles, when comparing 2020 with 2019, alongside a decline in twin deliveries owing to a decrease in transfers of multiple embryos; however, fresh IVF or ICSI cycles and frozen embryo transfers (FET) showed similar pregnancy rates, and the reported IUI cycle numbers decreased while maintaining stable outcomes.

What is known already: 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 23 manuscripts published in Human Reproduction and Human Reproduction Open.

Study design, size, duration: Data on medically assisted reproduction (MAR) from European countries are collected by EIM for ESHRE each year. The data on treatment cycles performed between January 1 and December 31, 2020, were provided by either national registries or registries based on initiatives of medical associations and scientific organizations or committed persons in the 44 countries that are members of the EIM Consortium.

Participants/materials, setting, methods: Overall, 1440 clinics offering ART services in 41 countries reported 923 318 treatment cycles (-14%; in 2019: 1 077 813), including 135 231 with IVF, 356 408 with ICSI, 305 373 with FET, 57 051 with preimplantation genetic testing (PGT), 64 007 with oocyte donation, 353 with IVM of oocytes, and 4895 cycles using frozen oocytes. A total of 1288 institutions reported data on IUI cycles using either husband/partner's semen (IUI-H; n = 112 663) or donor semen (IUI-D; n = 38 839) in 30 and 21 countries, respectively. Sixteen countries reported 29 566 interventions in pre-and post-pubertal patients for FP, including oocyte, ovarian tissue, semen, and testicular tissue banking.

Main results and the role of chance: In 24 countries (21 in 2019) in which all ART clinics reported to the registry, 356 427 treatment cycles were registered for a total population of approximately 268 million inhabitants in these countries, allowing the best estimate of a mean of 1330 cycles performed per million inhabitants (range: 142-3230). Among the reporting countries, for IVF, the clinical pregnancy rates (PR) per aspiration were similar to that in 2019 (22.1% versus 21.8% in 2019). For ICSI, the corresponding PRs showed similar trends (20.0% in 2020 versus 20.2% in 2019). When freeze-all cycles were excluded from the calculations, the clinical PRs per aspiration were 26.4% (28.5% in 2019) and 25.6% (26.2% in 2019) for IVF and ICSI, respectively. After oocyte donation, the PR per embryo transfer was 51.3% (50.5% in 2019) with freshly donated oocytes and 45.7% (44.8% in 2019) with thawed oocytes. After FET, the PR per thawing was 34.9% (versus 35.1% in 2019). In fresh cycles of both IVF and ICSI, the trend towards the transfer of fewer embryos continued with the transfer of 1, 2, 3, and ≥4 embryos in 57.2%, 37.8%, 4.8%, and 0.2%, of all treatments, respectively (corresponding to 55.4%, 39.9%, 2.6%, and 0.2% in 2019). This resulted in a reduced proportion of twin delivery rates (DRs) of 10.9% (11.9% in 2019) and a similar triplet DR of 0.2%. In FET cycles in 2020, the twin and triplet DRs were 7.9% and 0.1%, respectively (versus 8.9% and 0.1% in 2019). While the number of IUI cycles in 2020 decreased from 2019, the DRs remained stable at 8.8% after IUI-H (8.7% in 2019) and at 12.5% after IUI-D (12.1% in 2019). Twin and triplet DRs after IUI-H were 7.9% and 0.4% (in 2019: 8.7% and 0.4%) and 5.7% % and 0.1% after IUI-D (in 2019: 6.2% and 0.2%), respectively. Data on FP were provided by 16 countries (18 in 2019), reporting a total of 29 566 interventions (24 139 in 2019). Cryopreservation of ejaculated sperm (n = 21 864 versus n = 11 592 in 2019) and cryopreservation of oocytes (n = 6077 versus n = 10 784 in 2019) were the most frequently reported forms of FP.

Limitations, reasons for caution: 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.

Wider implications of the findings: The 24th ESHRE data collection on ART and IUI interventions shows a decrease of reported treatment cycles. A decline was observed when comparing 2020 with 2019, regarding the numbers of MAR treatments and births derived from these treatments in Europe. This break in the trend from prior years could be due to the effects of the COVID pandemic and/or due to the fact that some countries were not able to report. Although it is the largest data collection on MAR in Europe, further efforts to optimize both the collection and the reporting of data, from the perspective of improving surveillance and vigilance in the field of reproductive medicine, are awaited.

Study funding/competing interest(s): The study has received no external funding and all costs are covered by ESHRE. There are no competing interests.

Keywords: ICSI; IUI; IVF; data collection; fertility preservation; frozen embryo transfer; oocyte donation; registry; surveillance; vigilance.