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Global Reporting And ESHRE Reporting

Global Reporting And ESHRE Reporting . Jacques de Mouzon EIM elect Chairman ICMART coordinator and INSERM U822, Le Kremlin-Bicêtre, France. Introduction (1) ICMART. IWGROAR created 1989 : Cambridge meeting 15 countries with national registries ICMART 2002-2008

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Global Reporting And ESHRE Reporting

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  1. Global Reporting And ESHRE Reporting Jacques de Mouzon EIM elect Chairman ICMART coordinator and INSERM U822, Le Kremlin-Bicêtre, France

  2. Introduction (1) ICMART IWGROAR created 1989 : Cambridge meeting 15 countries with national registries ICMART 2002-2008 International Committee for Monitoring Assisted Reproduction Organization • Regional Basis • 4 long term organized regions Europe (EIM, ESHRE), North America, Latin America, Australia-New Zealand • 1 recently organized : Middle East (Cairo meeting, 2003) • Still to be organized : Asia, Africa : individual countries • Nine reports (every other year)

  3. Introduction (2) EIM • European In vitro fertilization Monitoring • Assisted Reproductive Technology in Europe, • Annual reports for activity 1997 to 2004. • Published in Hum. Reprod. 2001 – 2008.

  4. International Reports Organization The EIM is basically a summary of data from already existing National Registers. ICMART is based upon regional reports Both contain data on • Quantity, including ”availability” • Efficacy • Quality • Risks Both allow for trends analyses

  5. World report 2003, EIM report 2004 • Register Performance: WorldCoverage • ART availability: Regional differences • Main ART results: Regional differences • Discussion and conclusions

  6. World register performance Coverage

  7. World report coverage history

  8. World report 2003: Countries/region

  9. EIM: 29 countries in 2004 AlbaniaIceland Russia Austria Ireland Serbia / Montenegro Belgium Italy Slovenia Bulgaria Latvia Spain Denmark Lithuania Sweden Finland MacedoniaSwitzerland FranceNetherlandsTurkey GermanyNorwayUK Greece Poland Ukraine Hungary Portugal New countries 2004: Albania and Turkey

  10. 2003 ART World activity • Missing centers in participating countries • Hypothesis: Similar activity : report = 74 % of cycles • tLower activity : report = 85 % of cycles) • Missing countries • Europe, Latin America and Middle East: small countries • Africa : Mainly small activity, but almost all missing • Asia : Large countries missing : China, Indonesia,.. • 54 participating countries with population 3 billion represents 80 - 90 % of World activity • Total ICMART report : 60 % - 76 % of World activity • Estimate all countries, all cycles: 1.1 million

  11. ART availability, 2003

  12. Regional contribution of ART cycles to the World Report (2003) N = 667,711 Middle East 5.0% Latin America 2.9% Australia & New Zealand 5.0% Asia 12.5% * Corresponds to aspiration cycles in IVF, ICSI & GIFT and transfer cycles in FET & OD.

  13. Evolution of ART Cycles by Region

  14. Countries with > 10 000 cycles Europe, 2004 2004 2003 2002 2001 2000 France 69746 60 681 59 296 35 598 56 754 Germany 60425102 426 84 819 71 752 63 005 Spain40956 17 011 15 030 13 720 14 519 UK 40101 37 348 37 083 35 012 34 634 Italy 26099 25 877 18 948 18 673 19 835 Belgium 20426 15 594 12 827 12 558 11 829 Netherlands 15366 17 649 16 273 15 335 15 062 Russia 14838 10 819 8 667 7 665 6 363 Sweden 12871 11 736 11 081 10 082 9 205 Denmark 11518 10 893 11 321 10 305 9 682

  15. Availability : Cycles / million inhabitants World 2003

  16. Availability : Neonates /1000World 2003

  17. Availability according to national birth rate, World 2003

  18. Efficacy

  19. Global results, World 2003 • 667,771 initiated cycles, 135,186 deliveries delivery rates • 461,784 OPU • 201,878 IVF 20.4 % • 259,513 ICSI 22.2% • 391 GIFT 19.9 % • 112,932 Thaws 15.6% • 2,578 PGD 14.1 % • 22,795 Egg donations 36.6 %

  20. Trends in procedure distribution Aspirations, FET, Egg donation World 2003

  21. Trends in procedure distribution Aspirations, World 2003

  22. Procedure distribution According to Region (2003) *excludes Israel

  23. Women aged ≥40 according to region (IVF + ICSI, 2003)

  24. ART World cumulative results: pregnancies, deliveries and babies Percentage per initiated cycle Cumulative : addition of FET pregnancies to « fresh » pregnancies

  25. Pregnancy rate per transfer Europe, 1997 - 2004 2004 2003 2002 2001 2000 1999 1998 1997 IVF30.6 29.6 29.5 29.0 28.4 27.7 27.0 26.1 ICSI30.4 28.7 29.4 28.3 28.7 27.9 26.8 26.4 FER19.2 18.6 18.4 16.4 16.6 15.7 14.9 15.2 OD39.6 37.9 34.9 33.4 32.9 40.0 30.6 27.1

  26. Delivery rates by OPU according to region (IVF & ICSI, 2003)

  27. Heterogeneity among countriesDelivery rates, World 2003 OPU (cumulative) FET (per thawing) • < 15 % 5 <10 % 16 • 15-19 % 9 10-15 % 13 • 20-24 % 15 15-20 % 9 • 25-29% 15 20-25 % 5 • 30-34 % 8 ≥ 25% 11 • ≥ 35 % 0

  28. Pregnancy rates per transfer, IVF Europe 2004 Austria: no data available Serbia/Montenegro: overestimated, only 2 transfers

  29. Pregnancy rates per transfer ICSI Europe 2004 Austria: no data available

  30. Safety, regions, trends,

  31. Number of transferred embryos per region, 1998 - 2003

  32. Transfers of 3 and ≥ 4 embryos per region, 1998 - 2003

  33. Number of embryos transferred. IVF and ICSI, Europe 2004(%) 2004 2003 2002 2001 2000 1999 1998 1997 1 19.2 15.7 13.7 12.0 12.1 11.9 11.5 11.5 2 55.4 55.9 54.8 51.7 46.7 39.2 37.2 35.7 3 22.1 24.9 26.9 30.8 33.3 39.6 42.0 38.4 4 3.3 3.5 4.7 5.5 6.8 9.3 9.4 14.2

  34. Cumulative delivery rate and twin pregnancies per region, 1998 - 2003

  35. Triplet pregnancies per region, 1998 - 2003

  36. Singleton, twin, triplet and quadruplet deliveries (%). IVF and ICSI, Europe 2004 2004 2003 2002 2001 2000 1999 1998 1997 Singleton77.2 76.7 75.5 74.5 73.6 73.7 73.7 70.4 Twin21.7 22.0 23.2 24.0 24.4 24.0 23.9 25.8 Triplet 1.0 1.1 1.3 1.5 2.0 2.2 2.3 3.6 Quadruplet0.01 0.08 0.04 0.02 0.04 0.1 0.1 0.15

  37. Triplet deliveries, IVF and ICSI, by country, Europe 2004 High, > 2,5%%Low, < 1,0% % Lithuania 10.0 Slovenia 0.7 Iceland 3.8 Ireland 0.5 Macedonia 3.4 France 0.5 Bulgaria 3.3 Finland 0.5 Hungary 3.1 Denmark 0.4 Turkey 3.0 Norway 0.3 UK 0.3 Belgium 0.2 Albania 0.0 Latvia 0.0 Sweden 0.0

  38. Results and percentage of transfers with ≥ 4 embryos % of transfers ≥ 4 embryos

  39. OHSS, EIM 2004 • Data from 25 of the 29 contributing countries • 326 351 stimulation cycles resulted in 2 858 cases of OHSS • The incidence was 0.9%

  40. Fetal reduction, EIM 2004 In 21 countries, 748 fetal reductions were reported Deliveries FR % Deliveries FR % Albania 10 0 0.0 Poland 970 0 0.0 Bulgaria 218 2 0.9 Russia 2 518 47 1.9 France 10 387 106 1.0 Serbia/Montenegro 0 3 0.0 Finland 1 410 0 0.0 Slovenia 522 2 0.2 German 8 458 222 2.6 Spain 5 668 83 1.5 Greece 1 514 84 5.5 Sweden 2 545 0 0.0 Hungary 671 15 2.2 Switzerland 845 0 0.0 Iceland 64 0 0.0 Turkey 575 77 13.4 Latvia 27 0 0.0 UK 8 338 92 1.1 Lithuania 10 0 0.0 kraine 354 9 2.5 Macedonia 59 6 10.2

  41. Intrauterine inseminations (IUI-H + IUI-D), EIM 2004 Countries with data on IUI-H (n=19) Albania Macedonia Bulgaria Norway Denmark Poland France Portugal Greece Serbia / Montenegro Hungary Slovenia Ireland Spain Italy Turkey Latvia Ukraine Lithuania

  42. Intrauterine inseminations, Europe 2004 • Cycles 115 980 • Pregnancies 13.2 % • Singleton 87.3 % • Twins 11.5 % • Triplets 1.1 %

  43. Conclusion

  44. Conclusion • 667,000 cycles reported (+10%): 1.1 million worldwide • 152,000 babies reported (+26%): 235,000 World • 3.3 millions since the beginning • 56% ICSI (+1.5), 15% women>40 (+2%), • Number of transferred embryos: 2.6 (-0,2) • 20.1 % Delivery rate (+1%), 23.4% cumulative • Huge differences in availability, practice and results among countries and regions

  45. Why To Collect International Data? • “…..the publication of performance data has been associated with an improvement in health outcomes.” (1) (1) Marshall MN et al. JAMA. 2000 Apr 12;283(14):1866-74

  46. ART World Report 2003 • Registers : Regional Organisations • EUROPE : ESHRE:Austria, Belgium, Bulgaria, Croatia, Denmark, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Macedonia, Netherlands, Norway, Poland, Portugal, Russia, Slovenia, Spain, Sweden, Switzerland, Ukraine , UK • AUSTRALIA -NEW ZEALAND : Australia, New Zealand • LATIN AMERICA : Argentina, Bolivia, Brazil, Chile, Colombia, Dominican Republic, Ecuador, Guatemala, Mexico, Peru, Uruguay, Venezuela • NORTH AMERICA : Canada, USA • MIDDLE_EAST: MEFS: Egypt, Jordan, Lebanon, Saudi Arabia, Tunisia • Registers : National Level : • Israel,India, Japan, Korea, Taiwan

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