ART in Europe, 2019: results generated from European registries by ESHRE
Authors:   The European IVF Monitoring Consortium (EIM) for the European Society of Human Reproduction and Embryology (ESHRE), Gliozheni Orion , Hambartsoumian Eduard , Strohmer Heinz , Petrovskaya Elena , Tishkevich Oleg , De Neubourg Diane , Bogaerts Kris , Balic Devleta , Antonova Irena , Cvetkova Evelina , Rezabek Karel , Kirk John , Sõritsa Deniss , Gissler Mika , Pelkonen Sari , Mansouri Imene , de Mouzon Jacques , Tandler-Schneider Andreas , Kimmel Markus , Vrachnis Nikos , Urbancsek Janos , Kosztolanyi G , Bjorgvinsson Hilmar , Wingfield Mary , Leyden Joyce , Scaravelli Giulia , de Luca Roberto , Lokshin Vyacheslav , Karibayeva Sholpan , Agloniete Valerija , Bausyte Raminta , Masliukaite Ieva , Schilling Caroline , Calleja-Agius Jean , Moshin Veaceslav , Simic Tatjana Motrenko , Vukicevic Dragana , Smeenk Jesper M J , Petanovski Zoranco , Romundstad Liv Bente , Janicka Anna , Calhaz-Jorge Carlos , Guimaraes Joana Maria Mesquita , e Silva Patricia Duarte , Korsak Vladislav , Vidakovic Snezana , Marsik Ladislav , Kovacic Borut , Saiz Irene Cuevas , Mondéjar Fernando Prados , Bergh Christina , Toitot Sandra , Schneider Mischa , Isikoglu Mete , Balaban Basak , Gryshchenko Mykola , Bridges Elliot , Ewans Amanda , Smeenk Jesper , Wyns Christine , De Geyter Christian , Kupka Markus , Bergh Christina , Cuevas Saiz Irene , De Neubourg Diane , Rezabek Karel , Tandler-Schneider Andreas , Rugescu Ionna , Goossens Veerle 
Published: October 2023

Abstract

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.