Other important data the European IVF Monitoring group (EIM) on 2008 cycles and the International Committee Monitoring Assisted Reproductive Technologies (ICMART) on 2007 cycles highlighted were Sweden's low rate of multiple births – the lowest in the world – and Spain's 30 % share of egg donations in Europe.
The EIM collected data on frozen oocyte retrieval (FOR) cycles for the first time. Until today, egg freezing is still not offered on a wide scale but can be an option for women who wish to postpone motherhood or are facing cancer therapy to save their lives. Recently, vitrification techniques have offered oocyte survival rates in excess of 90 % and implantation rates per transfer that are comparable with fresh eggs. Scientists still face problems such as poor oocyte survival post-thaw, low fertilisation rates, cytoskeletal damage during vitrification and poor reproducibility of results.
"Of the 19 countries reporting on FOR in 2008, Italy is by far the country with the most cycles using this technology," said Dr. Jacques de Mouzon, chair of the EIM. With 3,284 cycles, Italy is far ahead of Finland (325 cycles), Russia (220) and Spain (199). The reason for Italy's dominance in this area lies in its legislative framework. A law passed in 2004 and overruled in 2009, set a limit of three oocytes to be inseminated per cycle, of which all resulting embryos had to be transferred. Embryo freezing and research on the embryo was outlawed, but not egg freezing. Hence, Italian clinics gained considerable expertise in this area over the last years.
The group also reported that with 4,068 cycles, 30 % of all egg donations (ED) occur in Spain, followed by the Czech Republic (15 %) and Russia (12 %). "Three countries make up almost 60 % of all egg donations in Europe," said Dr. De Mouzon. "Certain clinics in Spain offer wide-ranging egg donation programmes, which may also be the reason why Spain scores so high in terms of frozen oocyte cycles." This fact is mostly due to restrictive laws on ED in many countries, leading to many couples to cross borders to countries with less restrictive laws, which has raised an ethical and public health problem.
During the same scientific session, Dr. Karl Nygren, chair of ICMART, presented global ART data for 2007. "We are particularly pleased to present our data in Stockholm this year, since we can show that Sweden, a pioneer in enforcing single embryo transfer, has the world's lowest multiple birth rate with only 7 % twins and 0.1% of triplets being born after IVF and ICSI." Only Finland and Australia show comparably low rates with 9.3 % and 8.4% of twins, respectively, and almost no triplets. Many countries are still above 20 % for twin deliveries following IVF or ICSI such as for example Spain (23.8 %), Italy (21.2 %) and Germany (21.1 %) as are many Eastern European countries. "We would like to see more countries follow suit to decrease long-term complications for mother and child." The average rate in Europe was 20.6 % for twins and 1.1% for triplets in Europe.
According to data presented by the European IVF Monitoring Group (EIM), 525,640 treatment cycles were reported in 36 European countries. Four more countries reported in 2008 compared to 2007. This compares globally with 148,055 cycles from the US and 61,929 cycles from Australia and New Zealand. "We observed a 9.7 % increase in the number of cycles in Europe from 2007 to 2008, with only 21 more clinics reporting to our database," said Dr. Jacques de Mouzon, chairman of ESHRE's EIM. The delivery rate (DR) per aspiration was 22.1% for IVF and 21.1% for ICSI. DR per transfer was 14.5% for FET and 28.5% for ED. All these rates were relatively stable compared to the previous year, as was the multiple deliveries proportion.
In 30 countries where clinics reported deliveries, 80,284 babies were born. "We believe this to be an underestimate since data on deliveries for Turkey, Poland and some other countries were still missing." There were 124,749 IVF treatments, 280,977 intracytoplasmic sperm injection (ICSI) cycles, 98,288 frozen embryo transfer cycles (FER), 13,609 egg donor cycles (ED), 4,080 FOR, 2,875 preimplantation genetic diagnosis/screening cycles (PGD/PGS) and 1,062 in vitro maturation cycles (IVM).
In terms of ART availability, the largest economies in Europe such as France (5,464 cycles per million women of reproductive age), Italy (4,015), Spain (3,845), the Netherlands (6,382), Germany (4,810) and the UK (4,066) still show much lower availabilities of ART compared to their Nordic neighbours such as Sweden (9,228), Norway (9,287), Denmark (12,712) and Finland (9,291). This is also mirrored in the number of infants born after ART with only 1.7 % in Spain, 2.4 % in the Netherlands, 1.4 % in Germany and 1.9 % in the UK compared to 3.3 % in Sweden, 2.4 % in Norway and 3.0 % in Finland. For Denmark figures were not available yet. Also, 25 countries reported 146,741 IUI-H (with husband's sperm) and 24, 895 IUI-D (donor sperm), with a multiple pregnancy rate (11.1% twin and 0.8 triplet for women aged less than 40 years) not higher than in IVF and ICSI.
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), Assisted Reproduction Technology Success Rates, National Summary and Fertility Clinic Reports, December 2010 at http://www.cdc.gov/art/ART2008/PDF/ART_2008_Full.pdf
AIHW (2010) Australian Institute of Health and Welfare, Assisted Reproduction Technology in Australia and New Zealand 2008. National Perinatal Statistical Unit and Fertility Society of Australia. Assisted Reproduction Technology Series, number 14, at http://www.aihw.gov.au/publication-detail/?id=6442468391&tab=2
Full pdfs of these references are available on request.
Abstract no: Dr. De Mouzon O-208 Wednesday 6 July 2011, 8.30 hrs CEST (Hall A1)
Dr. Nygren O-209 Wednesday 6 July 2011, 8.50 hrs CEST (Hall A1)
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