Anders Nyboe Andersen

25th annual conference of the European Society of Human Reproduction and  Embryology


 Wednesday 1 July 2009
 
 Amsterdam, The Netherlands: Twin deliveries after assisted reproductive  technology (ART) have fallen below 20% for the first time in Europe according to  the tenth report summarising data on ART in Europe, which was presented at the  25th annual meeting of the European Society of Human Reproduction and Embryology  in Amsterdam today (Wednesday). 
 
 In the year 2006, the most recent year for which figures are available, 19.9% of  all ART deliveries were twins, 0.9% were triplets and, for the first time, there  were no quadruplet deliveries; 79% of all ART deliveries were singletons. Ten  years earlier, in 1997, the first year for which ESHRE started collecting data,  singleton deliveries were 70.4%, twins 25.8%, triplets 3.6% and quadruplets  0.15%.
 
 Professor Anders Nyboe Andersen, chairman of ESHRE’s European IVF

 monitoring  consortium, said: “The good news is that we are continuing to make improvements  in the quality, safety and efficacy of ART. For the first time, European ART  twin deliveries are below 20%. Fewer embryos are being transferred to women’s  wombs but there are better pregnancy rates throughout Europe.
 
 “During the ten years that ESHRE has been monitoring ART in Europe we have seen  a decline in the overall multiple birth rates from 29.5% to 20.8%, and a more  than four-fold reduction in triplet and quadruplet births from 3.7% to 0.9%.  Meanwhile pregnancy rates have continued to improve and in 2006 the average  pregnancy rate per embryo transfer in Europe was 32.8% after IVF, 33.6% after  ICSI*, 21.6% after frozen embryo transfer and 43.5% after oocyte donation. This  compares with 26.1% after IVF, 26.4% after ICSI, 15.2% after frozen embryo  transfer and 27.1% after oocyte donation in 1997.”
 
 However, he pointed out that several countries were still transferring four or  more embryos per ART cycle: in 2006, 1.6% of all transfers involved four or more  embryos per transfer. 
 
 “Foetal reduction remains a major cause of the low triplet rate,” he said. “In  2006, 471 foetal reductions were reported in Europe and this corresponds to 0.8%  of deliveries after the transfer of fresh (as opposed to frozen-thawed) embryos  after IVF or ICSI. Therefore, the 0.9% triplet rate for 2006 is much lower than  it would have been without foetal reduction.”
 
 Certain countries, mainly in Eastern Europe, had a high proportion of three and  four embryo transfers and a similarly high proportion of foetal reductions. For  instance, Bulgaria reported 60.8% three or four embryo transfers after IVF and  ICSI and, of the resulting deliveries, 7.6% involved foetal reduction; Ukraine  reported 60.3% three or four embryo transfers and, of the resulting deliveries,  7.4% involved foetal reduction.
 
 The consortium collected data from 32 countries in 2006. Ninety-two per cent of  all the clinics in these countries (1020 out of 1110) reported data. In 21  countries, 100% of clinics reported data, while a proportion of clinics reported  data in the other 11 countries.
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 Since 2005 there has been a 3% increase in the number of reported cycles, rising  from 419,037 to 429,948 in 2006. The number of cycles in 2006 was more than  double the 1997 figure of 203,225 cycles. Countries carrying out the largest  number of cycles in 2006 were France (65,404 cycles), Germany (54,695), Spain  (50,476) and the UK (44,101). The Netherlands carried out 17,770 cycles.
 
 The availability of ART was highest in Denmark (2,337 cycles per million  inhabitants), Belgium (2,187 per million), Iceland (1,793 per million), Finland  (1,721 per million) and Sweden (1,631). In The Netherlands it was 1,084 cycles  per million and in the UK, 729 cycles per million.
 
 Prof Nyboe Andersen said: “The rise in the use of ICSI in preference to IVF  continues. The number of ICSI cycles rose to 233,823, while IVF cycles dropped  to 116,827. ICSI now accounts for 66.7% of all ART procedures, while standard  IVF accounts for 33.3%. Ten years ago it was exactly the opposite. There is no  obvious reason why this should be so, as the efficacy of ICSI in terms of  pregnancy rates is the same as standard IVF. There are major differences between  countries. Some, like Spain and Turkey, almost exclusively use ICSI, whereas IVF  remains the dominant technology in Scandinavia, The Netherlands and the United  Kingdom. These major differences can only be caused by variations in  professional preferences from one country to another. There is no available  scientific evidence that these high utilisation rates of ICSI are beneficial –  especially considering that this technology is more time-consuming and expensive  and only gives a higher pregnancy rate in couples with severe male infertility.” 
 
 Apart from multiple births, another complication of ART can be ovarian  hyperstimulation syndrome (OHSS). In 2006, 27 of the 32 countries contributed  data on OHSS, and out of 260,764 cycles involving hormonal stimulation in these  countries there were 2,753 cases of OHSS – an incidence of 1.1%, which is  similar to the incidence of 1.2% in 2005. “This suggests that there is no  significant increased use of milder stimulation protocols in Europe at present,”  said Prof Nyboe Andersen.
 
 Professor Jacques de Mouzon, chairman of the International Committee for  Monitoring Assisted Reproductive Technology (ICMART), reported preliminary data  on world ART to the conference on Wednesday morning.
 
 * ICSI: intra-cytoplasmic sperm injection. The injection of a single  spermatozoon (sperm) into the cytoplasm of the oocyte (egg).

Abstract nos: O-206 & O-207 Wednesday 08.30 hrs CEST (Auditorium)

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Articles

Twin deliveries after assisted reproductive technology (ART) have fallen below 20% for the first time in Europe according to the tenth report summarising data on ART in Europe, which was presented at the 25th annual meeting of the European Society of Human Reproduction and Embryology in Amsterdam today (Wednesday).

Anders Nyboe Andersen

Articles

Ten Years of Monitoring ART in Europe sees a Doubling of Cycles and Higher Pregnancy Rates