SARA 2015 Report Final 02.04.19 · dropped in oocyte donation cycles (from 57% to 42%), the stable...

SARA2015

SOUTH AFRICAN REGISTRY FOR ASSISTED REPRODUCTIVE TECHNOLOGY

2015 REPORT

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Contents

page

Introduction 4

Comments, Definitions and Abbreviations 8

Participating ART Centres 9 Acknowledgements 13

Results

1. Overview and National Coverage

Table 1. Total IVF, ICSI & OD. 14 National coverage: ART cycles. 14 Number of cycles performed per centre. 14

2. IVF

Table 2a. IVF: Procedures and pregnancies by age. 15

Figure 2a. IVF: Distribution (%) of procedures and pregnancies by age. 16

Table 2b. IVF: Number of fresh cleavage-stage embryos/blastocysts transferred by age. 17

3. ICSI

Table 3a. ICSI: Procedures and pregnancies by age. 18

Figure 3a. ICSI: Distribution (%) of procedures by age. 19

Table 3b. ICSI: Number of fresh cleavage-stage embryos/blastocysts transferred by age. 20

4. IVF & ICSI COMBINED DATA

Figure 4a. IVF and ICSI: Distribution of procedures and pregnancies. 21 Figure 4b. IVF and ICSI: Cause of Infertility. 21

Table 4a. IVF and ICSI: Ovarian stimulation. 22

Table 4b. IVF and ICSI: Transfer cycles and pregnancies by age and number of fresh cleavage-stage embryos and blastocysts transferred. 23

Figure 4c. and Table. IVF and ICSI: Distribution of number of cleavage-stage embryos and blastocysts transferred by age. 24

Table 4d. IVF and ICSI: Pregnancy outcome by age. 25

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Figure 4d. IVF and ICSI: Clinical pregnancy outcome 26

5. FROZEN EMBRYO TRANSFER

Table 5a. FET: Procedures and pregnancies by age. 27

Table 5b. FET: Pregnancy outcome by age. 28

6. OOCYTE DONATION

Table 6a. OD: Procedures and pregnancies. 29

Table 6b. OD: Transfer cycles and pregnancies by number of embryos and blastocysts transferred and age. 30

Table 6c. OD: Pregnancy outcome by age of recipient. 31

7. FROZEN EMBRYO TRANSFER: OOCYTE DONATION

Table 7a. FET DONOR: Procedures and pregnancies by age of recipient. 32

Table 7b. FET DONOR: Transfer cycles and pregnancies by number of embryos and age. 33

Table 7c. FET DONOR: Pregnancy outcome by age of recipient. 34

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Introduction

Dear Colleagues, We would like to take the opportunity to congratulate Professor Silke Dyer and all who worked on the SARA 2015 report for an outstanding achievement.

SASREG is committed to provide high-quality care in Reproductive Medicine to all patients in need of treatment. SASREG has setup an accreditation system for fertility clinics in South Africa. Data collection is an essential part of providing patient care. Participation in data collection and participating in SARA is therefore mandatory for being accredited by SASREG.

We are happy to see the increase in participating centres to 16 in 2015 with a total of 5681 aspirations performed. Our main challenges for the future will be to include all ART clinics in this country and to reduce the pregnancies that are lost for follow up.

The data show that the quality of ART services offered in South Africa is comparable to international data. We can be very proud of this achievement. ART is however only available to a small fraction of the South African population and we are far from performing the optimal number of IVF cycles in this country. SASREG will continue to lobby with medical funders and the government to provide financial support for infertile patients to address this problem. Data collection is an essential part in negotiations with all stakeholders.

Professor Dyer has also set up the new regional African data registry for ART (ANARA). Forty ART centres from 13 countries collectively reported on 25,770 cycles undertaken in 2013. This has been published in February 2019 in Reproductive BioMedicine Online.

On behalf of Prof Dyer we would like to thank all participating clinics in this project and supplying the data. Without your continued support this would not be possible.

Sulaiman Heylen, President: SASREG

Danie Botha, Vice President: SASREG

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Dear Colleagues,

It is with great anticipation to have the 7th edition SARA report of our 2015 ART data at last. The SARA team has grown, the collection system has evolved, and support to individual clinics and embryologists has strengthened during the changing milieu of our Registry. The task and challenges are ever growing, and the team has done outstanding work. This is evident in the more accurate results, more clinics reporting and much fewer unknown or lost to follow up data.

Even though we continue to practice the same basic principles, our technologies and clinical approaches change, and thus the nature of data we need to collect. Reporting must follow suit, both on a national and global level. This report will be the last based only on aggregated clinic data moving to the electronic SARA/ANARA cycle by cycle system from 2016 onwards.

The number of aspirations has grown slightly and the new calculation of ART utilization, which also includes frozen cycles, means that the coverage has marginally increased. The proportion of international patients within this numbers is unknown and thus access for South Africans remains low.

One noticeable change is the doubling of total cryopreservation cycles and a 4-fold increase in the frozen embryo transfer (FET) cycles. This was expected due to the optimization of vitrification methods during the period. FET has increased from a quarter to over a third of all transfers. Moreover, although only half of the centres reported on embryo freezing, 50% more embryo freezes where reported. The prospect of seeing more details in future on the different types of cryopreservation cycles from the cycle-based system is exciting. The exclusion of total embryo cryopreservation cycles from the pregnancy rate per aspiration calculation, definitely gives a more accurate view especially to patients looking for expected outcomes.

A valuable benchmark included in this report is the total fertilization failure rate. Interestingly, ICSI was associated with a higher rate when compared to IVF (5% versus 3%). The ICSI data however include fertilization failure in combined IVF /ICSI cycles as these are reported under ICSI.

Despite the increase in blastocyst transfers in both fresh and frozen cycles, the pregnancy rates (PR) of around 30% remained similar to 2014. Double embryo transfer seems the national standard comprising >65% of all non-donor transfers and >80% of donor cycles. Only a very slight decrease in fresh transfers with ³3 embryos is seen. Non-donor and donor FET cycles in 2015 resulted in a higher proportion of singleton pregnancies (80%) compared to non-donor and donor fresh transfers (74% and 62% respectively), a trend similar to 2014. Even though fresh PR remained similar and even dropped in oocyte donation cycles (from 57% to 42%), the stable multiple PR of around 25% and especially 36% in fresh oocyte donation cycles is still a concern and could be reduced; not least because the PR after dual embryo transfer was comparable to the transfer of three and four embryos.

It is always a challenge to recognise true changes in ART results when the treatment options, data collection and reporting structures changes. The most important factor is data quality. Since 2017,

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our Registry data collection has become part of the SASREG accreditation process. This is in recognition of the importance of data and follow up of our patients as essential foundations of documenting quality ART care while providing more accurate benchmarks in future.

A big thank you to every individual and team who worked hard to do their part - whether documenting, collecting, changing, improving, or calculating. These may seem small steps at the time in such a large system, but each step is essential to ensure the quality of our report all the way from national, via regional to the global stage.

I look forward to the 2016 data, entering the new era of more cycle-based data.

Lydia Els-Smit, Chair: SIG Embryology; Accreditation Committee; Executive Committee Member: SASREG

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Dear Friends and Colleagues,

Our 7th SARA report comes, as always, with my deep gratitude to all participating centres who voluntarily shared their data to enable this joint report; a report that makes our work visible, creates an important national bench mark, and reflects our collective stewardship relating to availability, utilization, effectiveness and safety of ART in South Africa.

The report also comes with my sincere apology, as it has taken too long to generate. Each step simply took us too long. The good news is that we have now consolidated the various data processes and we intend to bring out the 2016 report by the middle of 2019. This progress would not have been

possible without the highly capable assistance of Dr Paversan Archary, Ms Liezel Potgieter and Ms Inge Smit who are now part of our ANARA (African Network and Registry for ART) operational team and who assisted me with the processing and reporting of our anonymised data.

Registry reports are dynamic, and we have introduced a few changes compared to our previous reports. Most importantly, we have commenced reporting of deliveries. This decision acknowledges that deliveries and ultimately (singleton) live births per cycle, aspiration or transfer are evidently the most important indicator of ART success. It also reflects our accountability to make our data gaps visible, and pregnancies lost to follow up is by far our biggest gap. Our data do not yet allow us to report on the international indicator of Live Birth Delivery Rate, that is the number of cycles resulting in at least one live baby, as we cannot distinguish singleton and multiple births among the total number of live babies reported. Our cycle-based data collection system will undoubtedly improve the quality of our data in future, in addition to which SARA is seeking to find interventions to reduce the information void regarding pregnancy outcomes. It will however require our collective will to ultimately do so.

The growing practice of freeze all cycles made it necessary to report pregnancy and delivery rates per all aspirations as well as per aspirations minus aspirations that were followed by total embryo freezing. This avoids a misinterpretation of a drop in effectiveness of fresh embryo transfers after conventional IVF and ICSI compared to previous years. We have also initiated reporting FET outcomes by cycles with thawing as well as by embryo transfers with the former being an important laboratory indicator of frozen embryo survival.

To avoid (mis)interpretation from relatively small cycle numbers, we no longer distinguish between embryos and blastocysts by IVF and ICSI but report on this in a single table (Table 4b). Lastly we ensured that all our indicators are now in keeping with the International Glossary for Infertility and Fertility Care (2017). We have thus deleted our previous approach of reporting live birth rates, and our multiple pregnancy rates are reported per ongoing pregnancies or deliveries; and will ultimately be reported as multiple delivery rates once we have narrowed the delivery data gap.

Several findings of our 2015 report as well as trends compared to our 2014 data justify highlighting and Ms Lydia Els-Smit has done so in her part of this introduction.

Thank you to everyone who has contributed to this report and provided care to the patients who underwent ART treatment in 2015.

Silke Dyer, Chair: South African Registry for ART

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Explanatory comments

• Not all centres participated in all tables, therefore the number of centres that submitted data are specified for each table and figure.

• All pregnancies are clinical pregnancies. Biochemical pregnancies are not reported in keeping with international registry practice.

• If both IVF and ICSI were done in the same cycle, the cycle is reported according to which embryo(s) were transferred; if both IVF and ICSI embryos were transferred, the cycle is reported as ICSI.

Definitions:

• Aspirations: The number of cycles resulting in attempted oocyte retrieval irrespective of whether oocytes were retrieved or not.

• Biochemical pregnancy1: A pregnancy diagnosed only by the detection of beta hCG in serum or urine.

• Clinical pregnancy1: A pregnancy diagnosed by ultrasonographic visualization of one or more gestational sacs or definitive clinical signs of pregnancy. In addition to intra-uterine pregnancy, it includes a clinically documented ectopic pregnancy.

• Delivery1: The complete expulsion or extraction from a woman of one or more fetuses, after at least 22 completed weeks of gestational age, irrespective of whether they are live births or stillbirths. A delivery of either a single or multiple newborn is considered as one delivery. If more than one newborn is delivered, it is one delivery with multiple births.

• Delivery Rate1: The number of deliveries expressed per 100 initiated cycles, aspiration cycles, or embryo transfer cycles. It includes deliveries that resulted in the birth of one or more live births and/or stillbirths. The delivery of a singleton, twin or other multiple pregnancy is registered as one delivery.

• Freeze all cycle1: An ART cycle in which, after oocyte aspiration, all oocytes and/or embryos are cryopreserved, and no oocytes and/or embryos are transferred to a woman in that cycle.

• Live Birth1: The complete expulsion or extraction from a woman of a product of fertilization, after at least 22 completed weeks of gestational age or weighing 500g or more; which, after such separation, breathes spontaneously, or shows any other evidence of life. Live births refer to the individual newborn; for example, a twin delivery represents two live births.

• Multiple Pregnancy Rate: Presented in this report as number of multiple pregnancies per all ongoing pregnancies or deliveries.

• Total Fertilization Failure Rate: Presented in this report as the number of cycles with no fertilized oocytes over number of aspirations with one or more oocytes.

Abbreviations:

BT Blastocyst Transfer EPL Early Pregnancy Loss ET Embryo Transfer (fresh) FET Frozen Embryo Transfer GS Gestational Sac OD Oocyte Donation P Pregnancy

1 The International Glossary on Infertility and Fertility Care, 2017. Zegers-Hochschild F. et al, Hum Reprod. 2017;32(9):1786-1801

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PARTICIPATING ART CENTRES

NB: Clinic information largely reflects staffing and institutional structure as of 2015; for updated information please consult the internet, or the respective centre directly.

CAPE FERTILITY CLINIC 209 Library Square, 1 Wilderness Road, Claremont, Cape Town Phone +27 21 674 2088, +27 21 674 2709 Email [email protected]

Website www.capefertility.co.za

Clinicians Dr S Heylen, Dr P Le Roux, Dr N Matebese Embryologists Ms G Raidani, Ms Z Mvinielwa, Mrs H Baker, Mrs Z Williams, Ms E Van Zyl, Nurses Sr K Schwenke, Sr H Clark, Sr L Carter, Sr D Davids, Sr F Rodrigues, Sr E Brenkman, Sr D Groeneveld, Sr I Mulke, Sr S Pakaman Psychologist L Van der Westhuizen

CARE CLINIC 21 Jan Hofmeyr Road, Westville, Durban Phone +27 31 267 7920 Fax +27 31 267 7928 Email [email protected] Website www.careoffice.co.za Clinicians Dr A Ramdeo Embryologists Mr K K Naidoo, Ms S Umarsingh Nurses Sr K Harilall, Sr V Dicks

DRS AEVITAS INCORPORATED Vincent Pallotti Hospital, Park Road, Pinelands - Cape Town Phone +27 21 531 6999 Fax +27 21 531 7919 Email [email protected] Website www.aevitas.co.za Clinicians Prof TF Kruger, Prof TI Siebert, Dr V Hulme Embryologists Mr GM Tinney, Ms N Lans, Ms C Thwaits, Ms Roxy Gentis Nurses Sr S Botha, Sr T Fourie, Sr A Mans, Sr L Zonneveld

DURBAN FERTILITY CLINIC 607 Kingsway Rd, Kingsway Hospital, Amanzimtoti, Durban Phone +27 31 904 3980 Fax +27 31 904 3980 Email [email protected], [email protected], [email protected] Clinicians Dr S Naidu, Dr M Bhana Embryologists Mr NS Moodley

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FEMBRYO FERTILITY CLINIC St Georges Medical Suites, 40A Park Drive, Port Elizabeth Phone +27 41 373 0771 Fax +27 41 374 2006 Email [email protected] Website www.fembryo.co.za Clinicians Dr D Botha Embryologists Dr M Rijsdijk, Mr W Schoeman

GENESIS REPRODUCTIVE CENTRE Suite G20 Kloof Medi-Clinic, 511 Jochemus Street, Erasmuskloof Ext 3, Pretoria Phone +27 12 367 4378 Fax +27 12 367 4378 Email [email protected], [email protected] Clinicians Dr A De Bruin, Dr J Pentz Embryologists Mr J Lourens, Mrs R Van Staden

HART CAPE TOWN FERTILITY CLINIC Christiaan Barnard Chambers, 87 Loop Street, Cape Town Phone +27 21 424 0670 Fax +27 21 424 8343 Email [email protected] Website www.fertilityspecialist.co.za Clinicians Dr S Edelstein, Dr P Dalmeyer Embryologists Ms R Gentis Nurses I Mulke, S Correia

MEDFEM CLINIC Corner Peter Place and Nursery Road, 1st Floor, Bryanston Johannesburg Phone +27 11 540 3440 Fax +27 11 463 1875, +27 86 652 1977 Email [email protected] Website www.medfem.co.za Clinicians Dr Pottow, Dr Van Schouwenburg, Dr Rodrigues, Dr Clark, Dr Divanovic Embryologists Ms E Bosman, Ms V Wolf, Ms E Du Plessis,

Ms B Faber; S De Oliveira (Reznichenko), M Nel Nurses Sr H Sparrow, Sr K Von-Molendorff, Sr H Monerry,

Sr C Van der Merwe; E Magardi; Sr C Cross Clinical Psychologist Dr M Wolf

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NATAL FERTILITY CLINIC 1st Floor, Ingenuity House, 325 Umhlanga Rocks Drive, Durban Phone +27 31 830 3030 Fax 031 830 3043 Email [email protected] Clinicians Dr K Coetzee, Dr JN Hansen Embryologists Ms N Bassa, Dr C Hoogendijk

PRETORIA FERTILITY CENTER Suite M19 Pretoria East Hospital, Pretoria Phone +27 12 998 8854/5 Fax +27 12 998 8856 Email [email protected] Website www.ptafertility.co.za Clinicians Dr MA Trouw Embryologists Ms E Mc Donald, Ms L Venter Nurses Sr L White, Sr R Van Rensburg

REPRODUCTIVE MEDICINE UNIT GROOTE SCHUUR HOSPITAL Groote Schuur Hospital and Faculty of Health Sciences, UCT F Floor, Maternity Centre, Anzio Rd, Cape Town Phone +27 21 6027/6028 Fax +27 21 404 6016 Email [email protected] Clinicians Prof S Dyer, Dr M Patel, Dr M Matjila, Dr L Walmsley, Prof Z van der Spuy Embryologists Mrs M Vienings, Ms L Cindi, Ms B Wager

REPRODUCTIVE AND ENDOCRINE UNIT, STEVE BIKO ACADEMIC HOSPITAL Steve Biko Academic Hospital and University of Pretoria 82290 Level J8, Steve Biko Street, Arcadia, Pretoria Phone +27 12 354 2540 Fax +27 12 354 2557 Email [email protected], [email protected], [email protected] Clinicians Dr LNZ Nene, Dr MA Trouw, Dr A De Bruin, Dr J Biko, Dr H Kruger Dr K Singh Embryologists Prof C Huyser, Mr G Boshoff, Mrs T Ernest, Mr M Baker Nurses Sr T Mathe, Sr MMJ Coetsee, Sr A Moses

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TYGERBERG HOSPITAL FERTILITY CLINIC Department of Obstetrics & Gynaecology, 3rd Floor, Green Avenue, Room 29. Tygerberg Hospital, Francie Van Zijl Drive, Parow, Cape Town Phone +27 21 938 5487 Fax +27 86 471 4827 Email [email protected] Clinicians Dr T Matsaseng, Dr S Norsaka Embryologists Dr ML Windt de Beer, Ms E Erasmus, R Burger, Ms N Nel

SANDTON FERTILITY CENTRE Centre of Advanced Medicine, South Campus, 2nd Floor 13 Scott Street, Waverley, Johannesburg Phone +27 11 883 1776, +27 86 144 2211 Fax +27 11 784 6886 Email [email protected] Website www.sandtonfertility.com Clinicians Dr GH Mohamed, Dr R Patel Embryologists Mr O Ozaturk Nurses Sr I Davids

VITALAB FERTILITY UNIT Inner Circle, 159 Rivonia Road, Morningside, Sandton - Gauteng Phone +27 11 911 4700 Fax +27 11 911 4744 Email [email protected] Website www.vitalab.com Clinicians Dr S Volschenk, Dr MJ Jacobson, Dr L Gobetz; Dr C Venter; Dr Y Unterslak Embryologists J Roos; J Jardim; C Gouveia, M Marais, S Masilela A Sims Nurses Sr E Williams, Sr A Hacking, Sr J Lawrence, Sr V Maseko, Sr C Maema, Sr E Henning

WIJNLAND FERTILITY CLINIC 9 Oewerpark, Die Boord, Stellenbosch Phone +27 21 882 9666 Fax +27 86 566 1701 Email [email protected] Website www.wijnlandfertility.co.za Clinicians Dr J Van Waart, Dr P Dalmeyer, Dr CJ Morrison Embryologists L Els-Smit Nurses A Prins, C Louw, A Hattingh Clinical Psychologist L Van Waart, J Van der Walt

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ACKNOWLEDGEMENTS The SARA Team wishes to specifically acknowledge the following embryologists, sisters and medical officers who submitted the 2015 data on behalf of their ART centres; without their hard work and sustained commitment to our registry, this report could not have been generated:

Ms Nasreen Bassa Natal Fertility Clinic Dr Edolene Bosman & Mrs Sasha De Oliveira Medfem Clinic, Johannesburg

Mrs Lydia Els-Smit Wijnland Fertility Clinic, Stellenbosch

Ms Roxanne Gentis HART Fertility Clinic, Cape Town

Ms Nicole Lans Dr Aevitas Inc, Cape Town

Mr Neville Moodley Durban Fertility Clinic, Durban

Ms Nicole Nel Tygerberg Hospital Fertility Clinic, Cape Town

Mr Ogun Ozaturk Sandton Fertility Centre, Johannesburg

Dr Michelle Rijsdijk Fembryo Fertility Clinic, Port Elizabeth

Ms Jeandri Roos Vitalab Fertility Unit, Johannesburg

Dr Krushmee Singh & Sr Retha Coetsee Reproductive & Endocrine Unit, Pretoria

Ms Shalini Umarsingh Care Clinic, Durban

Mrs Robyn Van Staden Genesis Reproductive Centre, Pretoria

Ms Estee Van Zyl Cape Fertility Clinic, Cape Town

Mrs Linmarié Venter Pretoria Fertility Centre, Pretoria

Mrs Marlize Vienings Reproductive Medicine Unit, Cape Town

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1. OVERVIEW AND NATIONAL COVERAGE Table 1. Total IVF, ICSI and OD. (Sixteen Centres) PROCEDURES AND OUTCOMES n/%

IVF( Conventional IVF & ICSI)

Aspirations 4583 Fresh embryo transfers 3348 Pregnancies 1084 Deliveries 363 Frozen embryo transfers 1765 Pregnancies 545 Deliveries 111

Oocyte donation

Aspirations 1098 Fresh embryo transfers 907 Pregnancies 413 Deliveries 352 Frozen embryo transfers 504 Pregnancies 151 Deliveries 41

Total procedures and outcomes

Aspirations 5681 Fresh embryo transfers 4255 Frozen embryo transfers 2269 Pregnancies 2193 Deliveries 867

NATIONAL COVERAGE: ART CYCLES

Estimated global need for ART: 1500 cycles/million population/year

South African ART Coverage: 7950 cycles1/55 million population/year = 144 cycles/million population/year

Therefore in 2015, 9.6% of ART need in South Africa was met. 1.Total number of cycles performed calculated to include IVF, ICSI & OD aspirations and frozen embryo transfers.

NUMBER OF CYCLES PERFORMED PER CENTRE1

<100 100 -200 200 - 500 500 -1000 >1000

3 4 5 1 3 1Three centres did not report cycles initiated: Aspirations and thaws used as a proxy indicator of cycles performed.

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2. IVF

Table 2a. IVF Procedures and pregnancies by age. (Eleven centres1) IVF <35y 35-39y >39y Total

Cycles initiated2 446 350 150 946 Aspirations 671 497 208 1376

Aspirations with retrieval 664 482 203 1346 Cycles with ≥1 fertilised oocyte 649 468 189 1306 Total fertilisation failure rate 2.3% 2.9% 5.5% 3.0%

Freeze all cycles 168 126 58 352 Freeze all cycles/aspirations 25.3% 26.1% 29.0% 26.2% Fresh embryo transfers 433 293 100 826 Pregnancies 185 99 29 313 PR/aspiration 27.6% 19.9% 13.9% 22.8% PR/aspiration minus freeze all 37.0% 26.7% 19.3% 30.7% PR/fresh ET 42.7% 33.8% 29.0% 37.9% Deliveries3 44 26 7 77 DR/aspiration3 6.5% 5.2% 3.3% 5.6% DR/aspiration minus freeze all3 8.7% 7.0% 4.6% 7.5% DR/fresh ET3 10.1% 8.8% 7.0% 9.3%

1. Four centres did not perform IVF; one centre did not report age-specific data. 2. One centre did not report cycles initiated. 3. Low DR due to pregnancies lost to follow-up.

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Figure 2a. IVF: Distribution (%) of procedures and pregnancies by age. (Eleven centres)

<35y 35-39y >39y

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Table 2b. IVF: Number of fresh cleavage-stage embryos/blastocysts transferred by age. (Eleven centres; Note: Pregnancy rate only calculated for transfers ≥ 100)

IVF <35y 35-39y >39y Total

n PR/ET1 n PR/ET1 n PR/ET1 n PR/ET1

One

Embryo transfers1 84 73 27 184 Pregnancies 27 18 3 48 26.1%

Two

Embryo transfers1 322 196 54 572 Pregnancies 143 44.4% 75 38.3% 17 235 41.1%

Three

Embryo transfers1 24 21 15 60 Pregnancies 14 6 7 27

Four

Embryo transfers1 3 3 4 10 Pregnancies 1 0 2 3 Total

Embryo transfers1 433 293 100 826 Pregnancies 185 42.7% 99 33.8% 29 29.0% 313 37.9%

1.Refers to both cleavage-stage embryos as well as blastocysts. For distinction between cleavage stage embryos and blastocysts, see Table 4b.

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3. ICSI

Table 3a. ICSI: Procedures and pregnancies by age. (Fourteen centres1)

ICSI <35y 35-39y >39y Total

Cycles initiated2 1180 940 575 2695 Aspirations 1377 1085 628 3090 Aspirations with retrieval 1280 1037 560 2877 Cycles with ≥1 fertilized oocyte 1235 991 514 2740 Total fertilisation failure rate 3.5% 4.4% 8.2% 4.8%

Freeze all cycles 194 141 102 437 Freeze all cycles/aspirations 15.1% 13.5% 18.2% 15.1% Fresh embryo transfers 1083 833 418 2334 Pregnancies 392 238 83 713 PR/aspiration 28.5% 21.9% 13.2% 23.1% PR/aspiration minus freeze all 33.1% 25.2% 15.8% 26.9% PR/fresh ET 36.2% 28.6% 19.9% 30.5%

Deliveries 161 94 30 285 DR/aspiration3 11.7% 8.7% 4.8% 9.2% DR/aspiration minus freeze all3 13.6% 10.0% 5.7% 10.7% DR/fresh ET3 14.9% 11.2% 7.2% 12.2%

1Two centres did not report age-specific data. 2One centre did not report cycles initiated. 3 Low DR due to pregnancies lost to follow-up.

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Figure 3a. ICSI: Distribution (%) of procedures and pregnancies by age. (Fourteen centres)

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Table 3b. ICSI: Number of fresh cleavage-stage embryos/blastocysts transferred by age. (Fourteen centres; Note: Pregnancy rate only calculated for transfers ≥ 100)

ICSI <35y 35-39y >39y Total


One


Two


Three


Four


Total

Total transfers1 1083 833 418 2334 Pregnancies 392 36.2% 238 28.6% 83 19.9% 713 30.5%

1Refers to both cleavage-stage embryos as well as blastocysts. For distinction between cleavage stage embryos and blastocysts, see Table 4b.

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4. IVF & ICSI: COMBINED DATA

Figure 4a. IVF and ICSI: Distribution of procedures and pregnancies. (Fourteen centres)

NB: Four centres did not perform IVF.

Figure 4b. IVF and ICSI: Cause of infertility. (Eleven centres)

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Table 4a. IVF and ICSI: Ovarian stimulation. (Eleven centres)

IVF ICSI Total Total (%)

Agonist 170 490 660 24.7% Antagonist 260 1514 1774 66.4% Gonadotropins only 7 3 10 0.4% Clomiphene Citrate & Gonadotropins 77 121 198 7.4% Others 5 24 29 1.1% Total 519 2152 2671 100%

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Table 4b. IVF and ICSI: Transfer cycles and pregnancies (in brackets) by age and number of fresh cleavage stage embryos/blastocysts transferred. (Fourteen centres1)

IVF & ICSI <35y 35-39y >39y Total

TF(P) PR TF(P) PR TF(P) PR TF(P) PR

One

Embryo transfers 99(21) 92(8) 74(5) 265(34) 12.8% Blastocyst transfers 180(68) 37.8% 150(45) 30.0% 70(9) 400(122) 30.5% Total transfers 279(89) 31.9% 242(53) 21.9% 144(14) 9.7% 665(156) 23.5%

Two

Embryo transfers 195(45) 23.1% 185(39) 21.1% 76(13) 456(97) 21.3% Blastocyst transfers 934(393) 42.1% 558(203) 36.4% 180(51) 28.3% 1672(647) 38.7% Total transfers 1129(438) 38.8% 742(242) 32.6% 256(64) 25.0% 2128(744) 35.0%

Three

Embryo transfers 41(15) 56(12) 46(11) 143(38) 26.6% Blastocyst transfers 60(33) 64(21) 35(13) 159(67) 42.1% Total transfers 101(48) 47.5% 120(33) 27.5% 81(24) 302(105) 34.8%

Four

Embryo transfers 6(1) 15(7) 29(9) 50(17) Blastocyst transfers 1(1) 6(2) 8(1) 15(4) Total transfers 7(2) 21(9) 37(10) 65(21)

Total

Embryo transfers 341(82) 24.0% 348(66) 19.0% 225(38) 16.9% 914(186) 20.4% Blastocyst transfers 1175(495) 42.1% 778(271) 34.8% 293(74) 25.3% 2246(840) 37.4% Total transfers 1516(577) 38.1% 1126(377) 29.9% 518(112) 21.6% 3160(1026) 32.5%

Means & Pregnancy Rates

Mean no. embryos2 1.9 2.0 2.1 2.0 Mean no. blastocysts2 1.9 1.9 1.9 1.9 PR/embryo transfer 24.0% 19.0% 16.9% 20.4% PR/blastocyst transfer 42.1% 34.8% 25.3% 37.4% PR/Total 38.1% 29.9% 21.6% 32.5%

1Two centres did not report age specific data. 2Mean number of embryos/blastocysts replaced per transfer. NB: PR only calculated if TF>100.

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Figure 4c and Table. IVF and ICSI: Distribution of number of cleavage-stage embryos and blastocysts transferred by age. (Fourteen centres)

onetwothreefour

<35y 35-39y >39y

ET1 (n=341) BT (n=1175) ET1 (n=348) BT (n =778) ET1 (n=225) BT (n=294)

One 29.0% 15.3% 26.4% 19.3% 32.9% 23.8%

Two 57.2% 79.5% 53.2% 71.7% 33.8% 61.2%

Three 12.0% 5.1% 16.1% 8.2% 20.4% 12.2%

Four 1.8% 0.1% 4.3% 0.8% 12.9% 2.7%

1. ET in this figure refers to cleavage stage embryos only.

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Table 4d. IVF and ICSI: Pregnancy outcome by age. (Twelve centres1)

IVF & ICSI <35y 35-39y >39y Total

n % n % n % n %

Transfer cycles 1423 1087 467 3115 Pregnancies 538 331 104 1010

Early pregnancy loss

Intra-uterine loss <22w 75 57 34 175 Ectopic pregnancy 3 5 1 9 EPL rate (per all pregnancies) 14.5% 18.7% 33.7% 18.2%

Ongoing pregnancy or delivery

Ongoing pregnancy 233 136 23 392 Delivery 205 120 37 362 Total 438 256 60 754 Singletons 321 73.3% 184 72.7% 49 83.1% 554 73.9% Twins 111 25.3% 65 25.7% 10 16.9% 186 24.8% Triplets/more 6 1.4% 4 1.6% 0 0.0% 10 1.3%

Multiple pregnancy rate 26.7% 27.3% 16.9% 26.1%

Unknown number of fetuses 22 3.8% 11 3.3% 2 1.9% 35 3.5%

Live births

Singletons 148 94 33 254 Twins 89 57 11 130 Triplets/more 12 9 0 9 Total new-borns 249 125 44 393

1Four centres did not report pregnancy outcome.

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Figure 4d. IVF and ICSI: Clinical pregnancy outcome. (Twelve centres)

Early pregnancy lossClinical pregnancy lost to follow-upSingleton pregnancy or deliverySingleton pregnancy or deliveryTwin pregnancy or delivery

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5. FROZEN EMBRYO TRANSFER

Table 5a. FET: Procedures and pregnancies by age. (Fourteen centres)

FET NON DONOR <35y 35-39y >39y Total

Aspirations resulting in embryo freezing1 657 656 119 1432 Cycles initiated2 473 287 185 945 Cycles with thawing3 881 522 266 1669 Frozen embryo transfers4 853 513 254 1620 FET/thaws 96.8% 98.3% 95.5% 97.1% Clinical pregnancies 292 166 56 514 Mean no. embryos transferred4 1.8 1.7 1.7 1.8 PR/thaw cycle 33.1% 31.8% 24.8% 30.8% PR/FET 34.2% 32.6% 21.7% 31.7% Deliveries 60 35 16 111 DR/thaw cycle 6.8% 6.7% 6.0% 6.7% DR/FET 7.0% 6.8% 6.3% 6.9% 1Six centres did not report aspirations resulting in freezing. 2Three centres did not report cycles initiated. 3One centre did not report cycles with thaws. 4Comprises both embryo and blastocyst transfers; 97.5% were blastocyst transfers.

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Table 5b. FET: Pregnancy outcome by age. (Thirteen centres)

FET NON DONOR <35y 35-39y >39y Total

n % n % n % n %



IUP loss <22w 35 22 13 70 Ectopic pregnancy 4 2 0 6 EPL rate (per all) 13.4% 14.5% 25.0% 14.8%





Live births


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6. OOCYTE DONATION

Table 6a. OD: Procedures and pregnancies. (Fifteen centres)

OD Fresh – Donors n/%

Cycles initiated1 893 Aspirations 1036 Cycles with embryo freezing 703 Cycles with all embryos frozen 179 OD Fresh - Recipients <35y 35–39y >39y Total

Fresh embryo transfers2 96 180 613 8892 Pregnancies after fresh ET2 44 81 272 3972 PR/ET 45.8% 45.0% 44.3% 44.7%

Ongoing pregnancies and deliveries 36 58 200 294 DR/ET 37.5% 32.2% 32.6% 33.0%

1Three centres did not report cycles initiated. 2One centre included Freeze-thawed Oocyte (OD) Transfers and Pregnancies in Fresh OD.

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Table 6b. OD: Transfer cycles and pregnancies by number of embryos/blastocysts transferred and age of recipient. (Fifteen centres)

OD FRESH <35y 35-39y >39y Total


One


Two

Embryo transfers1 74 148 517 739 Pregnancies 35 62 41.9% 234 45.3% 335 45.3%

Three


Four


Total

Total transfers1 96 180 613 889 Pregnancies 44 81 45.0% 272 44.3% 397 44.7%

1Refers to both cleavage-stage embryos as well as blastocysts. NB: Pregnancy rate only calculated for transfers ≥ 100.

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Table 6c. OD fresh: Pregnancy outcome by age of recipient. (Thirteen Centres)

OD Fresh <35y 35-39y >39y Total

n % n % n % n %



IUP loss <22w 1 14 45 59 Ectopic pregnancy 0 0 5 5 EPL Rate (per all) 2.6% 18.4% 19.1% 17.3%





Live births


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7. FROZEN EMBRYO TRANSFER: OOCYTE DONATION

Table 7a. FET DONOR: Procedures and pregnancies by age of recipient. (Thirteen centres)

Recipient <35y 35 – 39y >39y Total

Cycles initiated 13 50 193 256

Cycles with thawing 48 100 320 468

Cycles with transfer 47 98 313 458

FET/thaws 97.9% 98.0% 97.8% 97.8%

Clinical pregnancies 18 32 84 134

Mean no. of embryos transferred1 1.8 1.8 1.8 1.8

PR/thaw cycle 37.5% 32.0% 26.2% 28.6%

PR/FET 38.2% 32.6% 26.8% 29.2%

Deliveries 3 9 29 41

DR/thaw cycle 6.4% 9.0% 9.1% 8.8%

DR/FET 6.5% 9.2% 9.2% 9.0%

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Table 7b. FET DONOR: Transfer cycles and pregnancies by number of embryos transferred and age of recipient. (Thirteen centres)

FET DONOR <35y 35-39y >39y Total


One


Two

Embryo transfers1 29 66 210 305 Pregnancies 9 24 58 27.6% 91 29.8%

Three


Four


Total

Total transfers1 47 98 313 458 Pregnancies 18 32 84 26.8% 134 29.2%

1Refers to both cleavage-stage embryos as well as blastocysts. NB: Pregnancy rate only calculated for transfers ≥ 100.

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Table 7c. FET DONOR: Pregnancy outcome by age of recipient. (Twelve centres)

FET DONOR <35y 35-39y >39y Total

n % n % n % n %



IUP loss <22w 2 4 9 15 Ectopic pregnancy 0 0 0 0 EPL rate (per all) 11.1% 12.9% 10.7% 11.3%





Live births

Singletons 2 8 25 35 Twins 0 0 7 7 Triplets/more 0 0 0 0 Total Neonates 2 8 32 42

SARA 2015 Report Final 02.04.19 · dropped in oocyte donation cycles (from 57% to 42%), the stable...

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