ART in Europe 2000: ESHRE Report #4

Article Conference Coveragefrom the 19th Annual Meeting of ESHRE - Madrid, Spain

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Hans van der Slikke, MD, PhD: “It is July 2003 and we are in Madrid at the ESHRE conference and next to me, again, I welcome Karl Nygren. You are the representative of the European IVF Monitoring Consortium and we want to hear an update on IVF in Europe. You will talk now about the year 2000?”

Associate Professor Karl-Gsta Nygren, MD PhD: “Yes these treatments started then. This is the fourth report, so we now have a series of information over these four years, so we can start following trends more than before.”

Hans van der Slikke, MD, PhD: “We’re curious; what are the differences? Are we making some progress in terms of preventing multiple pregnancies?”

Associate Professor Karl-Gsta Nygren, MD PhD: “Yes, we are; and this is of course then the key issue. That is the raison d’tre almost for doing all of this. We are making progress, slowly maybe, but definitely and the trend is steady. The trend is that the number of triplets is going down substantially. It’s half the proportion now, compared to four years ago. The quadruplets and more have actually disappeared, they don’t exist anymore. But the twins are only starting to show a decline but we will come to that within the next couple of years I think.”

Hans van der Slikke, MD, PhD: “I think they will come later.”

Associate Professor Karl-Gsta Nygren, MD PhD: “Yes and it’s only natural of course because this is a transition in a dynamic situation, so it won’t be changed overnight. It is a very, very positive trend that goes on, that shows that people are accepting that their risk of multiple pregnancies is a substantial one and that it is being taking care of”

Hans van der Slikke, MD, PhD: “It is substantial indeed because you are talking about a decrease from 4% to 2%. When talking about 4% how many pregnancies are there? You are reporting on how many cycles?”

Associate Professor Karl-Gsta Nygren, MD PhD: “The whole register encompasses for that year (2000) 275,000 cycles. We do half a million cycles globally each year. Europe does about 60% of those and actually we calculated the number of children born so far in the world and we estimate that to be about 1.4 million children today.”

Hans van der Slikke, MD, PhD: “That’s a lot. You had a kind of stratifying in Europe. The difference in percentage of children born by IVF in the different countries?”

Associate Professor Karl-Gsta Nygren, MD PhD: “Yes, we don’t have that information for all countries but we have it in some countries. On the top of the list is Denmark where almost 4% of all children today are born as the result of IVF. That’s a very high figure. Of all countries, the UK has 1%, Sweden (my country) has 2-2.5% but in Denmark it’s nearly 4%. We estimate that that will rise to about 5%, before it will saturate and level off.”

Hans van der Slikke, MD, PhD: “So this may reflect the number of cycles per inhabitant of the country?”

Associate Professor Karl-Gsta Nygren, MD PhD: “Per million, yes. In Denmark it is 1,800 interventions per million. In the UK that’s 500, in the United States, that’s 200. The difference in availability between Denmark and the USA is nearly ten fold, and that’s fantastic. You would have thought it would be the other way around. The driver behind the difference is money. The availability means resources. It could mean acceptance by society but it IS accepted in the States by law and everything, so the only explanation left is the resources: the money.”

Hans van der Slikke, MD, PhD: “Talking about resources, do you think this plays a role in some countries having difficulty in reducing the number of multiple pregnancies?”

Associate Professor Karl-Gsta Nygren, MD PhD: “Yes, there is definitely a connection because this is a dilemma. The reason for the high multiple pregnancy rates is to make your money worth your while, to reach your goal for the family as fast as possible, which usually is to have two to three children. If you have them at once, it’s OK. So this is palatable to some if they don’t realise how dangerous it actually is. So this is the dilemma - many couples start off saying, “Oh we would love to have triplets” but they don’t realise, I think, what that means. So the doctors have to take responsibility I think to actually persuade people that this is not a good idea. You can have as many children as you want, but one at a time. One at a time!”

Hans van der Slikke, MD, PhD: “What’s your comment about the Belgian situation? You heard that from yesterday, actually, they started to reimburse IVF on the condition that in the first cycle only one embryo would be transferred.”

Associate Professor Karl-Gsta Nygren, MD PhD: “I think it makes very good sense, it’s very good news indeed because in some other countries in Europe we have bad news. In Italy they are going to have a very restrictive law possibly that forbids many things. In Norway they have also a very restrictive situation so it’s different in different countries. But on the whole I think Europe is accepting and actually doing these kinds of interventions more than any other region in the world.

Belgium is a very nice example to show that the message has reached the people who make decisions. We are very happy about that. It makes good sense. It means that they have listened to what we have to say and that they are going in a generous direction to really reimburse quite a lot of treatments. We are very happy about that; very happy indeed. In a way, they have transceptors now in Belgium."

Hans van der Slikke, MD, PhD: “I think that we can only convince the government people, who make these decisions, if we have a monitoring system like you have in Europe.”

Associate Professor Karl-Gsta Nygren, MD PhD: “Absolutely. The importance of this is growing. If you had gone back ten years ago and I would have had this conference here, there would be two people in the audience. Now it’s full. Everybody needs this. The media want to report it. Because it is very important, financially and also concerning the safety of what we are doing, because it is not absolutely safe. We have risks but we have now identified the risks. 

We know what the risks are and how big they are and whether we can do anything about it or not. And multiple pregnancies dominate totally. We know that this is a major driver behind the risks. We know that we can curb it. We know how to handle it. So my prediction is that within five to six years we would hopefully have more or less solved this problem and then that these procedures would be even more safe than they are today and then they would be more acceptable, so the use of this technique undoubtedly will increase in Europe.”

Hans van der Slikke, MD, PhD: “Thank you very much again and I look forward to our interview next year.”

Associate Professor Karl-Gsta Nygren, MD PhD: “Thank you very much.”

Press Release: Europe's healthcare systems support trend for quality and quantity in ART

2003 JUL 31 - ( & -- Europe's systems for healthcare are generally more able to support couples seeking fertility treatment than anywhere else in the world, experts told the annual meeting of the European Society of Human Reproduction and Embryology on July 2, 2003. 

Professor Karl Nygren and Dr. Anders Nyboe Andersen, authors of the fourth ESHRE report on ART in Europe, told the conference that although there is wide variation among individual European countries, and in particular between the Nordic countries and the southern European countries, Europe performs about 60% of all assisted reproductive techniques (ART) treatments in the world and ART is available to more couples in Europe than anywhere else. 

Out of just under 500,000 ART treatment cycles performed worldwide in 2000, 275,187 cycles were carried out in 21 European countries reporting these data. The availability of fertility treatment for couples has steadily increased in Europe over the past 4 years. 

According to Nygren, associate professor of Obstetrics and Gynecology at Sofiahemmet Hospital in Stockholm, "Denmark is way ahead of everyone else with 1,826 cycles per million of the population performed in 2000. Out of all the children born in Denmark that year, 3.7% were ART babies. By comparison, in the USA there were approximately 250 cycles per million of the population performed. Europe appears to have embraced ART socially, ethically, and legally, and has incorporated it into its healthcare systems in a way that has made fertility treatment more easily available than anywhere else in the world." 

Nygren and Andersen, head of the Fertility Clinic at the Rigshospitalet at Copenhagen University Hospital, Denmark, presented the ESHRE report for the year 2000-the most recent figures available. It contains data from 21 European countries and over 500 clinics. In 1997 there were about 200,000 treatment cycles in Europe and in 2000 this had increased to 275,187: a 37% increase. 

As in previous years, three countries performed more than 50% of all treatment cycles in Europe: Germany performed 63,005, France, 56,754, and the U.K., 34,634. In Spain, the host country for the conference, 14,519 treatment cycles were reported in 2000. The majority of treatments were IVF (55.8%), and intracytoplasmic sperm injection (ICSI; 44.1%). 

There was considerable variation, though, and in Spain, Poland, and Belgium, for instance, the majority of treatments were ICSI (63%). Switzerland had the highest proportion of ICSI treatments at 68%. 

Out of the 10 countries reporting data from all their clinics, fertility treatment was available to the highest proportion of the population in Denmark where there were 1,826 treatment cycles per million of the population. The Nordic countries and  Slovenia top the list in terms of availability, with Denmark followed by Finland (1,440 cycles), Slovenia (1,199), Sweden (1,034), Iceland (1,020), Norway (986), Netherlands (966), France (965), Switzerland (654) and the UK (585).  "We think that Denmark has nearly reached saturation point, with hardly anyone who wants fertility treatment having to wait," said Andersen. 

Not only are the numbers of treatment cycles increasing, but also the numbers of embryos transferred in one cycle is declining, thus reducing the chances of multiple pregnancies that can be risky for both mothers and their babies. For instance, in 1997 three or more embryos were transferred in 52.6% of treatments. But in 2000 the proportion of transfers involving three or more embryos had dropped to 39.9%. 

Here, too, there were wide variations among European countries. Greece had the highest proportion of transfers of three or more embryos at 74.1%, Hungary had 73.3%, Ukraine 72.5%, Spain 68.5%, and Russia 68%, compared with Sweden at 3.8%, Finland 6.1%, and Denmark 8.3%. In the U.K., the proportion of transfers involving three embryos was 33.8% and there were no transfers of four or more embryos. 

The proportion of IVF and ICSI treatments that result in the birth of a single child rose from 70.4% in 1997 to 74% in 2000, while the proportion of twin deliveries dropped from 25.8% to 24%, triplets from 3.6% to 2%, and quadruplets from 0.15% to 0.04%. 

"It is good news that the proportion of multiple deliveries continues to decline," said Andersen. "However some European countries still transfer three or more embryos with a resulting higher number of multiple births. For instance, the average proportion of twin and triplet deliveries in 2000 in Europe was 26% after IVF or ICSI, yet in Spain nearly 32% of deliveries were twins or triplets and in the Ukraine this figure was 36.3." 

"Overall," Nygren concluded, "this report shows a continuing trend in Europe of quantity and quality in Europe. ART is increasingly available to couples and the efficacy of the technique is improving."

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