ART in Europe, 2019: results generated from European registries by ESHRE

Smeenk J. Wyns C. De Geyter C. Kupka M. Bergh C. Saiz I.C. De Neubourg D. Rezabek K. Tandler-Schneider A. Rugescu I. Goossens V. Gliozheni O. Hambartsoumian E. Strohmer H. Petrovskaya E. Tishkevich O. Bogaerts K. Balic D. Antonova I. Cvetkova E. Kirk J. Sõritsa D. Gissler M. Pelkonen S. Mansouri I. de Mouzon J. Kimmel M. Vrachnis N. Urbancsek J. Kosztolanyi G. Bjorgvinsson H. Wingfield M. Leyden J. Scaravelli G. de Luca R. Lokshin V. Karibayeva S. Agloniete V. Bausyte R. Masliukaite I. Schilling C. Calleja-Agius J. Moshin V. Simic T.M. Vukicevic D. Petanovski Z. Romundstad L.B. Janicka A. Calhaz-Jorge C. Guimaraes J.M.M. Duarte e Silva P. Korsak V. Vidakovic S. Marsik L. Kovacic B. Mondéjar F.P. Toitot S. Schneider M. Isikoglu M. Balaban B. Gryshchenko M. Bridges E. Ewans A.
1 December 2023 Oxford University Press

Human Reproduction
2023 #38 Issue 12 2321 - 2338 pp.

STUDY QUESTION: What are the data and trends on ART and IUI cycle numbers and their outcomes, and on fertility preservation (FP) interventions, reported in 2019 as compared to previous years? SUMMARY ANSWER: The 23rd ESHRE report highlights the rising ART treatment cycles and children born, alongside a decline in twin deliveries owing to decreasing multiple embryo transfers; fresh IVF or ICSI cycles exhibited higher delivery rates, whereas frozen embryo transfers (FET) showed higher pregnancy rates (PRs), and reported IUI cycles 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 22 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 1 January and 31 December 2019 were provided by either national registries or registries based on initiatives of medical associations and scientific organizations or committed persons in one of the 44 countries that are members of the EIM Consortium. PARTICIPANTS/MATERIALS, SETTING, METHODS: Overall, 1487 clinics offering ART services in 40 countries reported, for the second time, a total of more than 1 million (1 077 813) treatment cycles, including 160 782 with IVF, 427 980 with ICSI, 335 744 with FET, 64 089 with preimplantation genetic testing (PGT), 82 373 with egg donation (ED), 546 with IVM of oocytes, and 6299 cycles with frozen oocyte replacement (FOR). A total of 1169 institutions reported data on IUI cycles using either husband/partner’s semen (IUI-H; n = 147 711) or donor semen (IUI-D; n = 51 651) in 33 and 24 countries, respectively. Eighteen countries reported 24 139 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 21 countries (21 in 2018) in which all ART clinics reported to the registry 476 760 treatment cycles were registered for a total population of approximately 300 million inhabitants, allowing the best estimate of a mean of 1581 cycles performed per million inhabitants (range: 437–3621). Among the reporting countries, for IVF the clinical PRs per aspiration slightly decreased while they remained similar per transfer compared to 2018 (21.8% and 34.6% versus 25.5% and 34.1%, respectively). In ICSI, the corresponding PRs showed similar trends compared to 2018 (20.2% and 33.5%, versus 22.5% and 32.1%) When freeze-all cycles were not considered for the calculations, the clinical PRs per aspiration were 28.5% (28.8% in 2018) and 26.2% (27.3% in 2018) for IVF and ICSI, respectively. After FET with embryos originating from own eggs, the PR per thawing was at 35.1% (versus 33.4% in 2018), and with embryos originating from donated eggs at 43.0% (41.8% in 2018). After ED, the PR per fresh embryo transfer was 50.5% (49.6% in 2018) and per FOR 44.8% (44.9% in 2018). In IVF and ICSI together, the trend toward the transfer of fewer embryos continues with the transfer of 1, 2, 3, and ≥4 embryos in 55.4%, 39.9%, 2.6%, and 0.2% of all treatments, respectively (corresponding to 50.7%, 45.1%, 3.9%, and 0.3% in 2018). This resulted in a reduced proportion of twin delivery rates (DRs) of 11.9% (12.4% in 2018) and a similar triplet DR of 0.3%. Treatments with FET in 2019 resulted in twin and triplet DR of 8.9% and 0.1%, respectively (versus 9.4% and 0.1% in 2018). After IUI, the DRs remained similar at 8.7% after IUI-H (8.8% in 2018) and at 12.1% after IUI-D (12.6% in 2018). Twin and triplet DRs after IUI-H were 8.7% and 0.4% (in 2018: 8.4% and 0.3%) and 6.2% and 0.2% after IUI-D (in 2018: 6.4% and 0.2%), respectively. Eighteen countries (16 in 2018) provided data on FP in a total number of 24 139 interventions (20 994 in 2018). Cryopreservation of ejaculated sperm (n = 11 592 versus n = 10 503 in 2018) and cryopreservation of oocytes (n = 10 784 versus n = 9123 in 2018) were most frequently reported. 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 23rd ESHRE data collection on ART, IUI, and FP interventions shows a continuous increase of reported treatment numbers and MAR-derived livebirths in Europe. Although it is the largest data collection on MAR in Europe, further efforts toward optimization of both the collection and the reporting, 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. # The Author(s) 2023. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology.

data collection , egg donation , fertility preservation , frozen embryo transfer , ICSI , IUI , IVF , registry , surveillance , vigilance

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Elisabeth Twee Steden Ziekenhuis, Tilburg, Netherlands
Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
Reproductive Medicine and Gynecological Endocrinology (RME), University Hospital, University of Basel, Basel, Switzerland
Department of Obstetrics and Gynecology, University Hospital, LMU Munich, Munich, Germany
Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Göteborg University, Göteborg, Sweden
Hospital General Universitario de Valencia, Valencia, Spain
Center for Reproductive Medicine, University of Antwerp, Antwerp University Hospital, Edegem, Belgium
Department of Gynaecology, Obstetrics and Neonatology First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
Fertility Center Berlin, Berlin, Germany
National Transplant Agency, Bukarest, Romania
ESHRE Central Office, Grimbergen, Belgium
Department of Obstetrics & Gynecology, University Hospital for Obstetrics and Gynecology, Bul.B.Curri, Tirana, Albania
Fertility Center, IVF Unit, 4 Tigvan Nets, Yerevan, 375010, Armenia
Dr Obruca & Dr Strohmer Partnerschaft Goldenes Kreuz-Kinderwunschzentrum, Lazarettgasse 16-18, Wien, 1090, Austria
ART Centre “Embryo”, Filimonova 53, Minsk, 220053, Belarus
Centre for Assisted Reproduction “Embryo” Belivpul, Filimonova Str. 53, Minsk, 220114, Belarus
Antwerp University Hospital-UZA, Center for Reproductive Medicine, Drie Eikenstraat 655, Edegem, 2650, Belgium
I-Biostat, Kapucijnenvoer 35 bus 7001, Leuven, 3000, Belgium
Zavod za humanu reprodukciju “Dr Balic”, Kojsino 25, Tuzla, 75000, Bosnia and Herzegovina
ESHRE Certified Clinical Embryologist (2011), Ob/Gyn Hospital Dr Shechterev, 25-31, Hristo Blagoev Strasse, Sofia, 1330, Bulgaria
Executive Agency “Medical Supervision”, 3 Georgi Sofiyski Str, Sofia, 1000, Bulgaria
Department of Gynaecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Czech Republic, Apolinarska 18, Prague, 12000, Czech Republic
Maigaard Fertilitetsklinik, Jens Baggensensvej 88h, Arhus, 8200, Denmark
Tartu University Hospital and Elitre Clinic, Tartu, Estonia
THL National Institute for Health and Welfare, P.O. Box 30, Helsinki, 00271, Finland
Department of Obstetrics and Gynaecology, Oulu University Hospital, Oys, P.O. Box 23, 90029, Finland
Agence de La Biomedicine, 1, avenue du Stade de France, Saint-Denis la Plaine, 93212, France
15-29 rue Guilleminot, Paris, 75014, France
Fertility Center Berlin, Spandauer damm 130, Berlin, 14050, Germany
Deutsches IVF-Register e. V. (D-I-R), Lise-Meitner-Straße 14, Düsseldorf, 40591, Germany
National Authority of Medically Assisted Reproduction, Ploutarxou 3, P.O., Athens, 10675, Greece
First Department of Obstetrics & Gynecology, Semmelweis University, Baross utca 27, Budapest, 1088, Hungary
Department of Medical Genetics and Child Development, University of Pecs, Jozsef A.u, 7., Pecs, 7623, Hungary
IVF Klinikin Reykjavik, Alfheimum 74, Reykjavik, 104, Iceland
Merrion Fertility Clinic, 60 Lower Mount Street, Dublin, D02NH93, Ireland
Istituto Superiore di Sanità, Registro Nazionale della Procreazione Medicalmente Assistita, CNESPS, Viale Regina Elena, 299, 00161, Italy
International Clinical Center for Reproductology “Persona”, Utepova Street 32a, Almaty, 00506, Kazakhstan
Latvian Human Reproduction Society, Apuzes 14, Riga, 1046, Latvia
Vilnius University Hospital Santaros Clinics, Santaros Fertility Center, Simono Staneviciaus 64-69, Vilnius, 07113, Lithuania
Academic Medical Center, Center for Reproductive Medicine, Ijburglaan, Amsterdam, 1086 ZJ, Netherlands
Centre Hospitalier de Luxembourg, Centre de Stérilité et de Médecine de Reproduction, Rue Fiederspiel 2, Luxembourg, 1512, Luxembourg
University of Malta, 12, Mon Nid, Gianni Faure Street, Tarxien, TXN2421, Malta
Repromed Moldova, Center of Mother @ Child protection, State Medical and Pharmaceutical University, “N.Testemitanu”, Bd. Cuza Voda 29/1, Chisinau, Moldova
Human Reproduction Center Budva, Prvomajska 4, Budva, 85310, Montenegro
Hospital “Danilo I”, Humana reprodukcija, Vuka Micunovica bb, Cetinje, 86000, Montenegro
Hospital ReMedika, Nas. Zelezara, Skopje, 1000, North Macedonia
Spiren Fertility Clinic, Nardoskrenten 11, Trondheim, 7032, Norway
VitroLive, Wojska Polskiego 103, Szczecin, 70-483, Poland
CNPMA, Assembleia da Republica, Palacio de Sao Bento, Lisboa, 1249-068, Portugal
Hospital Geral Santo Antonio, Largo Professor Abel Salazar, Porto, 4050-011, Portugal
CNPMA Avenida D. Carlos I, No. 134 4o Piso, Lisboa, 1200-651, Portugal
International Center for Reproductive Medicine, Liniya 11, Building 18B, Vasilievsky Island, St-Petersburg, 199034, Russian Federation
Institute for Obstetrics and Gynecology, Clinical Centre GAK, Visegradska 26, Belgrade, 11000, Serbia
Reprodulcia, Na križovatkách 58, Bratislava, 821 04, Slovakia
Department of Reproductive Medicine and Gynecological Endocrinology, Univerzitetni klinicni center Maribor, Ljubljanska ulica 5, Maribor, 2000, Slovenia
Hospital General Universitario de Valencia, Avenida Tres Cruces, 2, Valencia, 46014, Spain
Hospital de Madrid-Montepríncipe, HM Fertility Center Monteprincipe, C/Montepríncipe 25, Boadilla del Monte, 28660, Spain
Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Bla Straket 6, Göteborg, 413 45, Sweden
FIVNAT Office, c/o SGRM Geschäftsstelle, Postfach, Aarau, 5001, Switzerland
Kinderwunschzentrum Baden, Mellingerstrasse 207, Baden, 5405, Switzerland
Gelecek Tup Bebek Merkezi, Caglayan Mh. Bulent Ecevit Bulvari 167, Antalya, 07070, Turkey
Amerikan Hastanesi-American Hospital, Assisted Reproduction Unit, Güzelbah çe Sok, No. 20, Nisantesi, Istanbul, 34365, Turkey
IVF Clinic Implant Ltd., Academician V.I.Gryshchenko Clinic for Reproductive Medicine, 25 Karl Marx Str., Kharkiv, 61000, Ukraine
Human Fertilization and Embryology Authority (HFEA), 2 Redman Place, E201JQ, London, EC1 Y 8HF, United Kingdom

Elisabeth Twee Steden Ziekenhuis
Cliniques universitaires Saint-Luc
Reproductive Medicine and Gynecological Endocrinology (RME)
Department of Obstetrics and Gynecology
Department of Obstetrics and Gynecology
Hospital General Universitario de Valencia
Center for Reproductive Medicine
Department of Gynaecology
Fertility Center Berlin
National Transplant Agency
ESHRE Central Office
Department of Obstetrics & Gynecology
Fertility Center
Dr Obruca & Dr Strohmer Partnerschaft Goldenes Kreuz-Kinderwunschzentrum
ART Centre “Embryo”
Centre for Assisted Reproduction “Embryo” Belivpul
Antwerp University Hospital-UZA
I-Biostat
Zavod za humanu reprodukciju “Dr Balic”
ESHRE Certified Clinical Embryologist (2011)
Executive Agency “Medical Supervision”
Department of Gynaecology
Maigaard Fertilitetsklinik
Tartu University Hospital and Elitre Clinic
THL National Institute for Health and Welfare
Department of Obstetrics and Gynaecology
Agence de La Biomedicine
15-29 rue Guilleminot
Fertility Center Berlin
Deutsches IVF-Register e. V. (D-I-R)
National Authority of Medically Assisted Reproduction
First Department of Obstetrics & Gynecology
Department of Medical Genetics and Child Development
IVF Klinikin Reykjavik
Merrion Fertility Clinic
Istituto Superiore di Sanità
International Clinical Center for Reproductology “Persona”
Latvian Human Reproduction Society
Vilnius University Hospital Santaros Clinics
Academic Medical Center
Centre Hospitalier de Luxembourg
University of Malta
Repromed Moldova
Human Reproduction Center Budva
Hospital “Danilo I”
Hospital ReMedika
Spiren Fertility Clinic
VitroLive
CNPMA
Hospital Geral Santo Antonio
CNPMA Avenida D. Carlos I
International Center for Reproductive Medicine
Institute for Obstetrics and Gynecology
Reprodulcia
Department of Reproductive Medicine and Gynecological Endocrinology
Hospital General Universitario de Valencia
Hospital de Madrid-Montepríncipe
Department of Obstetrics and Gynaecology
FIVNAT Office
Kinderwunschzentrum Baden
Gelecek Tup Bebek Merkezi
Amerikan Hastanesi-American Hospital
IVF Clinic Implant Ltd.
Human Fertilization and Embryology Authority (HFEA)

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