ART fact sheet

click here for pdf versions in French, Spanish and Italian

June 2010

Background
• One in six couples worldwide experience some form of infertility problem at least once during their reproductive lifespan. The current prevalence of infertility that lasts for at least 12 months is estimated to be an average of 9% worldwide for women aged 20-44.
• 20-30% of infertility cases are linked to physiological causes in men, 20-35% to physiological causes in women, and 25-40% of cases are due to a joint problem. In 10-20% no cause is found. Infertility is also associated with life-style factors such as smoking, body-weight, stress and age.
• It is estimated that over 3.75 million babies have been born worldwide since the first baby (Louise Brown) was born 32 years ago using ART. In 2002, an estimated 240,000 ART babies were born around the world.
• Most ART treatments take place in women aged between 30 and 39.

Number of cycles / treatments
• Europe leads the world for ART treatment, initiating approximately 54 % of all reported ART cycles.
• In 20061, 458,759 treatment cycles were reported in 32 European countries. This compares globally with 138,198 cycles from the USA and 53,543 cycles from Australia and New Zealand. The number of cycles performed in many developed countries has grown 5-10% per annum over the last 5 years.
• France (65,749 treatment cycles), Germany (54,695), Spain (49,943) and the UK (43,953) make up 56% of all cycles initiated in Europe.
• Other European countries perform a significant number of cycles such as Italy (40,748), Turkey (37,468), Belgium (22,730), Russia (21,274) and The Netherlands (17,770).
• The number of ART cycles performed in Europe in 2006 represented a 9.7% increase on the previous year. This was partly due to the fact that more clinics reported data. Reduction in the reimbursement for ART results in a sharp decline of cycles in Germany between 2003 and 2004 (from 102,000 to 57,000). Number of cycles in 2006 is still low with almost 55,000 cycles.
• In 28 European countries that reported delivery from IVF, ICSI and Fresh Embryo Transfer 87,705 babies were born. The true number of European ART babies is unknown because not all clinics report.
• There were 117,318 regular IVF treatments, 232,844 intracytoplasmic sperm injection (ICSI) cycles, 86,059 frozen embryo transfer cycles (FER), 12,685 egg donor cycles (ED), 6,561 preimplantation genetic diagnosis/screening cycles (PGD/PGS) and 241 in vitro maturation cycles (IVM).
• 22 countries reported data on intra-uterine inseminations (IUI) with 134,261 cycles using partner’s sperm (IUI-H) and 24,339 cycles donor sperm (IUI¬D).

Availability of ART
• For the first time in 2006 the EIM reported on cycle outcome (pregnancies and deliveries) in relation to reproductive age. The Nordic countries tended to have the highest ART availability in terms of cycles per million of women aged 15-45. Denmark had the highest availability at 10,132 cycles per million of women in that category, followed by Belgium (9,383), Finland (7,827), Sweden (7,337) and Iceland (7,088). Austria (2,582), Germany (2,843), Italy (2,993) and the UK (3,039) have comparably low availability of ART treatment.
• The average number of treatment cycles per million inhabitants is 1,127 in Europe. By comparison, there was an average of 463 treatments per million in the USA in 2006.
• The percentage of ART babies were above 3.0% in most Nordic countries, whereas this percentage was between 1.0% and 1.7% in the largest European countries (Germany, France and UK). ART techniques accounted for 4.1% of all children born in Denmark, 3.3% in Belgium and Finland, 3.4% in Iceland, 3.3% in Sweden, 2.8% in Norway, 1.6% in France, 1.7% in the UK and 1.5% in Germany. In Italy only 1.0% of children are conceived with ART. In comparison with 54,656 babies born, the CDC estimates this to be slightly more than 1% of total births in the US2.

Multiple pregnancies
• Large differences exist between European countries in terms of multiple births. However, there is a consistent trend towards transfer of fewer embryos. The overall multiple delivery rate per embryo transfer has declined steadily since 2000 from 26.9% to 20.8% in 2006 (twins at 19.9%, triplets at 0.9%). The multiple delivery rate of 13.8% after frozen embryo transfer compares with 24% in the US.
• The number of embryos transferred in IVF and ICSI cycles varies substantially between countries. The average number of single embryo transfers rose from 20.0% in 2005 to 22.1% in 2006, while dual embryo transfers increased slightly from 56.1% in 2005 to 57.3% in 2006.
• The proportion of three and four embryo transfers continued to decrease, standing at 19.0% and 1.6% respectively in 2006. 12 countries have ceased to transfer four or more embryos; in the remaining countries the proportions ranged from 0.1% (Ireland) to 60.9% (Albania). The proportion of triple embryo transfers ranged from 0% in Sweden to 79.9% in Lithuania. In Italy the number of embryos transferred is one (18.7%), two (30.4%), three (50.9%) and four (0%). The figures probably represent the effect of a law in 2004 which made it compulsory to transfer all embryos, to a maximum of three. These figures may change in future data sets due to a change in legislation in 2009.
• The multiple pregnancy rate after IUI-H in women younger than 40 was 10.6% for twins and 0.6% for triplets. The figures were 8.9% and 0% respectively for women over 40.
• The proportion of triplet deliveries in Europe would have been higher if there had not been 466 cases of foetal reduction, with the largest number of cases being reported from the UK (102), Spain (95), Czech Republic (89) and Ukraine (78). A number of countries did not report foetal reductions; hence the number is probably underestimated.

Pregnancy / delivery rates
• The average pregnancy rate per embryo transfer was 32.4% after IVF, 33.0% after ICSI, 21.6% after FER and 43.5% after ED.
• For IUI in women aged younger than 40, the delivery rate was 9.2% for IUI-H and 13.3% for IUI-D. Over 40, the corresponding rates were 4.4% and 4.1%.

Complications
• Ovarian hyperstimulation syndrome (OHSS) is a complication related to ART. There were 2,753 cases recorded in 26 out of 32 countries reporting on OHSS, making up 0.6% of cycles reported by those countries. The countries with the highest number of OHSS cases were the UK (589), Russia (410) and Turkey (393). Italy, which had the highest number of OHSS cases in 2005 (670) showed a drastic reduction in 2006 (161).

¹ Assisted reproductive technology and intrauterine inseminations in Europe, 2006: results generated from European registers by ESHRE. Human Reproduction, Online publication reference: doi:10.1093/humrep/deq124

² 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, November 2008 at http://www.cdc.gov/ART/ART2006/

AIHW (2008) Australian Institute of Health and Welfare, Assisted Reproduction Technology in Australia and New Zealand 2006. National Perinatal Statistical Unit and Fertility Society of Australia. Assisted Reproduction Technology Series, number 12, at http://www.aihw.gov.au/publications/index.cfm/title/10598

Full pdfs of these references are available on request.

NB: preliminary data for 2007 from ESHRE’s European IVF monitoring consortium and world data for 2003 from the International Committee for Monitoring Assisted Reproductive Technologies (ICMART) will be presented at the ESHRE 2010 meeting on Wednesday 30 June. 8:30-9:30, Hall 8 Room A.