Assisted reproductive technology (ART) in Europe 2019 and development of a strategy of vigilance Preliminary results generated from European registers by the ESHRE EIM consortium

Abstract Study question What are the reported data on cycles in ART, IUI and fertility preservation interventions in 2019 as compared to previous years, as well as the main trends over the years? Summary answer The 23rd ESHRE report on ART and IUI shows a progressive increase in reported treatment cycle numbers in Europe, a small decrease in the number of transfers (IVF + ICSI) with more than one embryo with a trend to decreasing multiple delivery rates, outcomes for IUI cycles are similar to previous years. What is known already Since 1997, ART aggregated data generated by national registries, clinics or professional societies have been collected, analyzed by the European IVF-monitoring Consortium (EIM) and reported in 22 manuscripts published in Human Reproduction and Human Reproduction Open. Study design, size, duration Yearly collection of European medically assisted reproduction (MAR) data by EIM for ESHRE. The data on treatments performed between January 1 and December 31 2019 in 32 European countries were provided by either National Registries or registries based on personal initiatives of medical associations and scientific organizations. Participants/materials, setting, methods In all, 1133 clinics offering ART services in 32 countries reported a total of 784 192 treatment cycles, involving 116 615 with IVF, 285 481 with ICSI, 250 997 with frozen embryo replacement (FER), 55 121 with preimplantation genetic testing (PGT), 71 413 with egg donation (ED), 473 with IVM of oocytes and 4092 cycles with frozen oocyte replacement (FOR). European data on IUI using husband/partner’s semen (IUI-H) and donor semen (IUI-D) were reported from 1033 institutions offering IUI in 25 and 20 countries, respectively. A total of 123 106 treatments with IUI-H and 43 798 treatments with IUI-D were included. A total of 20 400 fertility preservation (FP) interventions from 12 countries including oocyte, ovarian tissue, semen and testicular tissue banking in pre-and post-pubertal patients were reported. Main results and the role of chance In total, 1133 IVF clinics participated (90.0% of registered clinics in the participating countries). Next to these also 1033 IUI units reported their data. In the 32 reporting countries, after IVF the clinical pregnancy rates (PR) per aspiration and per transfer in 2019 were similar to those observed in 2018 (28.5% and 34.7% versus 28.8% and 34.1%, respectively). After ICSI the corresponding rates were also similar to those achieved in 2018 (25.3% en 33.1% versus 27.3% and 32.1%). After FER with own embryos the PR per thawing is still on the rise, from 33.4% in 2018 to 35.0% in 2019. After ED the PR per fresh embryo transfer was 50.1% (49.6% in 2018) and per FOR 44.1% (44.9% in 2018). In IVF and ICSI together, the trend towards the transfer of fewer embryos continues with the transfer of 1, 2, 3 and ≥4 embryos in 61.1%, 36.2%, 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 proportion of singleton, twin and triplet DRs of 89.7%, 10.1% and 0.2%, respectively (compared to 87.4%, 12.4% and 0.2%, respectively in 2018). Treatments with FER in 2019 resulted in twin and triplet DR of 8.3% and 0.1%, respectively (versus 9.4% and 0.1% in 2018). After IUI, the DRs remained similar at 9.5% after IUI-H (8.9% in 2018) and at 12.0% after IUI-D (12.6% in 2018). Twin and triplet DRs after IUI-H were 8.8% and 0.4%, respectively (in 2018: 8.4% and 0.3%) and 6.4% and 0.2% after IUI-D (in 2018: 6.4% and 0.2%). The majority of FP interventions included the cryopreservation of oocytes (n = 9 813 from 10 countries) and of ejaculated sperm (n = 9 521 from 12 countries). Limitations, reasons for caution As the methods of data collection and levels of completeness of reported data vary among European countries, the results should be interpreted with caution. For this abstract some countries were not able to provide adequate data about the number of centers and initiated cycles and deliveries. Wider implications of the findings The 23rd ESHRE report on ART and IUI shows a continuous increase of reported treatment numbers and MAR-derived livebirths in Europe. Being already the largest data collection on MAR in Europe, continuous efforts to stimulate data collection and reporting strive for future quality control and completeness of the data and offer higher transparency and vigilance in the field of reproductive medicine. Trial registration number