SARA 2012
SOUTH AFRICAN REGISTER OF ASSISTED REPRODUCTIVE TECHNIQUES
1
CONTENTS
TITLE
PAGE
Introduction
3
General
5
Participating ART Centres
7-9
Summary Data
10
IVF & ICSI: Procedures & Outcome
11
IVF: Age
12
IVF: Embryo Transfers
13
ICSI: Age
14
ICSI: Embryo Transfers
15
Cause of Infertility
16
Ovarian Stimulation
17
IVF & ICSI: Clinical Pregnancies by Age and Embryo Transfer
18, 19
IVF & ICSI: Pregnancy Outcome by Age
20, 21
Cryopreservation
22
Oocyte Donation
23, 24
Overview: 2009 - 2012
25
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INTRODUCTION Dear Colleagues,
Dear Colleagues,
I congratulate Professor Silke Dyer and the SARA team on the publication of another outstanding report. The analysis of the 2012 data was more detailed than in previous years, and the results provide us with new insights into the South African practice of ART.
This is the 4th report of the South African Registry of Assisted Reproductive Techniques (SARA). Once again it has been a privilege to analyse the pooled data and generate this report. ART data monitoring is a team effort and my sincere gratitude goes to all the ART units and their clinical and laboratory staff who have made this report possible. It is particularly encouraging to see that the majority of units are now using our online program, and as a result the quality and quantity of our data continues to improve. You will for example find new information in this report on the indication for ART, use of stimulation protocols, mean number of embryos transferred and multiple pregnancy rates.
SASREG (Southern African Society for Reproductive Medicine and Gynecological Endoscopy) is proud to have SARA as its official agency for national anonymous IVF data collection. Many of the goals of SASREG are dependent on having this accurate data, in order to negotiate with government and funders to ultimately improve our patient care. We are also proud to contribute to the ICMART (International Committee Monitoring Assisted Reproductive Techniques) database and world reports.
While SARA is now well established, we are engaging with an exciting regional project namely to establish an ART registry in sub-Saharan Africa. I am grateful to the SASREG Committee for supporting my involvement in this initiative. The increasing use and globalisation of ART make monitoring of safety and effectiveness mandatory. This is arguably nowhere more important than in low resource settings where the use of precious health resources should be paralleled by information on resultant impact and outcome. In addition, forming a regional ART registry is a powerful way of putting infertility and ART on the map of reproductive health in Africa, and of putting Africa on the global map of ART and infertility-related reproductive health. The project is still in its infancy, but I have received positive responses from ART units in Mauritius, Kenya, Uganda, Ghana and Nigeria and upcoming units in Namibia and Botswana have also expressed interest. While this will be first and foremost an intra-African collaboration, we have the full support from ICMART (International Committee Monitoring Assisted Reproductive Techniques) in addition to which WHO has also expressed interest. It is fortuitous that the Latin American Registry for ART, which has been operational since 1991, has recently implemented a new, case-by-case data collection program. This was presented at the 2014 ESHRE conference in Munich, Germany, by Dr Fernando Zegers-Hochschild . We have received much support from him and his team, and once again they are offering their assistance by making the new data collection program available to us and our region. Not only does this program provide us with a firm platform from which to launch multinational data collection, but it also offers our national ART units an easier and better way of collecting and reporting their data in future. Details will be circulated to all medical and laboratory directors of SARA participating ART centres in the near future.
The high pregnancy rates in this report compare favorably with international data, and we can be proud of the high quality of care provided to our patients. However, despite this success, we are only providing a service to approximately 6% of couples in need and hence must seek to improve access to ART. Although the average number of embryos transferred was 2, there were still a significant number of procedures where more than 2 embryos were transferred. If funding models for IVF treatment are introduced in the future, it is likely that the number of embryos transferred will have to be reduced as part of a managed health care system. Many clinics provided separate oocyte donation data for the 2012 report, and national benchmark pregnancy rates are now available. Valid and accurate data are vital for SARA to produce meaningful national reports. IVF units need to have adequately trained staff and proper record keeping systems in order to provide accurate data. The ongoing accreditation of IVF units and clinic personnel remains interlinked with the collection of ART data. I encourage all clinics to remain dedicated to submitting their data and participating in national accreditation programs in the future. Thank you to everyone who has contributed to make this report a success. Dr Paul le Roux SASREG President 2014-2017 SARA Committee
As in previous years I wish to thank and acknowledge the SASREG secretariat, in particular Ms Virosha Basdeo, who assisted in the handling of the data, and Mr Dudley Randall for his overall supervision. I am most grateful to the RLA team: Dr Fernando ZegersHochschild and Ms Carolina Musri, who pooled and reported on the data submitted on line. Merck (Pty) Ltd, South Africa provided some financial support to SARA. Prof Silke Dyer Chair: SARA Committee
SASREG Committee Member
3
INTRODUCTION Dear Colleagues, It is always with great excitement that I anticipate the release of the next SARA report -maybe because as an embryologist our data is our pride and joy. I am therefore also very excited to join the SARA task team and be part of such an excellent project. I would like to thank Professor Silke Dyer and her task team for preparing another insightful SARA report. I also wish to acknowledge every embryologist and their time and effort required to report their clinic’s data. The online electronic submission has made it easier for some and is one of SARA’s points of interest to improve in the coming years. The 2012 report contains new and valuable information regarding our clinical and laboratory practice and in turn informing our work. It will, for example, be interesting to observe whether our joint practice will follow the overall international trend of transferring fewer embryos to the point of elective single embryo or blastocyst transfer. As embryologists we play a key role in the success and safety of ART through our handling of gametes and embryos, our culture conditions and laboratory quality control systems, as well as the careful selection of the best embryo(s) for transfer. Our field of fertility treatment continuously develops, changes, improves and widens. We need to ensure that the scope of collected data is adapted accordingly even though a time delay is to be expected. Currently for example, aspirations in embryo ‘freeze-all’ cycles, which are especially used in cancer patients or to avoid ovarian hyperstimulation syndrome, and more recently in frozen oocyte cycles, are either lost to our data collection or, if included, reduce our pregnancy rate per aspiration. Frozen embryo transfers are becoming increasingly successful and may represent the largest cohort of data requiring attention for better inclusion in the SARA report. PGD/PDS cycles are similarly candidates for consideration as their use in South Africa is established but the clinical outcomes insufficiently documented. The active participation and responsible data collection by clinics and especially by the embryologists is central to the growth of SARA and in turn for SARA to continuously contribute to the advancement of our fertility treatment services on all levels. SARA helps us to establish a trusted benchmark of results for our clinics, laboratories and our patients. It also benchmarks South Africa on the international stage, presenting our high quality ART treatment provided year after year. Well done to all who have contributed to another excellent SARA report. Keep up the good work. Ms Lydia Els-Smit (Embryologist) SARA and SASREG Committee Member
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GENERAL Comments • If both IVF and ICSI were done in one cycle, the cycle was captured according to which embryo(s) were transferred; if ‘mixed’ embryos were transferred (ie embryos from IVF and ICSI), the cycle was captured under ICSI. • Embryo Transfers
Presented data refer to fresh embryo transfers unless otherwise stated.
• Oocyte Donations [OD] Four centres reported OD donations as part of the general IVF and ICSI data. These centres included OD aspirations and OD transfers under the age of the DONOR and not the recipient. The remaining centres reported OD separately as part of the extended data reporting (page 23-24).
Abbreviations • OD
Oocyte Donation
• CPR
Clinical Pregnancy Rate
• ET
Embryo Transfer
• IVF
In Vitro Fertilisation
• ICSI
Intracytoplasmic Sperm Injection
Definitions
• Aspirations
The number of cycles resulting in attempted oocyte retrieval irrespective of whether oocytes were successfully retrieved or not.
• Clinical Pregnancy
Any pregnancy with clinical products of conception (ectopic, miscarriage, termination, birth) or ultrasound evidence of pregnancy (irrespective of presence of fetal heart); includes clinical miscarriage, ectopic pregnancy, missed abortion, viable ongoing pregnancy, birth (live or still birth); excludes biochemical pregnancy.
Note: all recorded pregnancies are clinical pregnancies only.
5
PARTICIPATING ART CENTRES 13 Centres Reporting
TABLE 1: DISTRIBUTION OF CENTRES ACCORDING TO NUMBER OF ASPIRATIONS No. of Apsirations per Year
No. of Centres
< 50
1
50 - 100
2
101 - 200
2
201 - 350
3
351 - 500
2
> 500
3
6
SARA: PARTICIPATING ART CENTRES CAPE FERTILITY CLINIC
209 Library Square, 1 Wilderness Road, Claremont - Cape Town Phone 021 674 2088 Fax 021 671 2709 Email info@capefertilityclinic.co.za Website www.capefertilityclinic.co.za Clinicians Dr Paul le Roux, Dr Sulaiman Heylen, Dr Klaus Wiswedel, Dr Nomathamsanqa Matebese, Dr Razak Dhansay Embryologists Ms Kimenthra Raja, Ms Gloria Raidani, Mrs Zulaigha Williams, Mrs Hughlene Baker, Ms Kerith Ferreira, Ms Liezel Potgieter Nurses Sr Karin Schwenke, Sr Heidi Clark, Sr Liz Carter, Sr Di Davids, Sr Florence Rodrigues, Mrs Elaine Brenkman, Sr Cyndi Nel, Sr Jenny Loverock, Sr Danelle Groeneveld Receptionists Mrs Sonia Van Rooyen, Mrs Janine Pasquall, Mrs Nazeema Abrahams, Mrs Roshaan Sheldon, Mrs Desire Heyburgh, Ms Jennifer Parrish Counsellors Ms L van der Westhuizen
CARE CLINIC
21 Jan Hofmeyer Road, Westville - KwaZulu Natal Phone 031 267 7920 Fax 031 267 7928 Email careoffice@ion.za.net Website www.careoffice.co.za Clinicians Dr A Ramdeo Embryologists Mr K K Naidoo, Ms S Umarsingh Nurses Sr K Harilall, Sr V Dicks, Staff Nurse L Dladla
DRS AEVITAS INCORPORATED
Vincent Pallotti Hospital, Park Road, Pinelands - Cape Town Phone 021 531 6999 Fax 021 531 7919 Email medici@aevitas.co.za Website www.aevitas.co.za Clinicians Dr JP Van der Merwe, Prof TF Kruger, Prof TI Siebert, Dr V Hulme Embryologists Dr ML Windt, Mr GM Tinney, Ms N Lans, Ms C Thwaits Nurses Sr S Botha, Sr T Fourie, Sr A Mans, Sr L Zonneveld
Durban Fertility Clinic
607 Kingsway Rd, Kingsway Hospital, Amanzimtoti - KwaZulu Natal Phone 031 904 3980 Fax 031 904 3980 Email sags@intekom.co.za, mahesh@mbhana.co.za, neville@durbanfertilityclinic.co.za Clinicians Dr Sagie Naidu, Dr Mahesh Bhana Embryologists Mr Neville S Moodley
FEMBRYO FERTILITY CLINIC
40A Park Drive, Central Port Elizabeth - Eastern Cape Phone 041 373 0771 Fax 041 374 2006 Email info@fembryo.co.za Website www.fembryo.co.za Clinicians Dr Danie Botha Embryologists Ms Michelle Rijsdijk, Mr Wilhelm Schoeman
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SARA: PARTICIPATING ART CENTRES Genesis Reproductive Centre
Suite G15 Kloof Medi-Clinic, 511 Jochemus Street, Erasmus Kloof Ext 3, Pretoria - Gauteng Phone 012 367 4378 Fax 012 367 4379 Email lourensjt@mweb.co.za, drabri@webmail.co.za Clinicians Dr Abri de Bruin, Dr Johan Pentz Embryologists Mr J Lourens, Mrs S Lourens, Mrs R van Staden
GYNOMED
Suite 11, Block B, Wilgeheuwel Hospital, Amplifier Road, Honeydew - Gauteng Phone 011 796 1100 Fax 011 794 2987 Email info@gynomed.co.za Website www.gynomed.co.za Clinicians Dr HW Lindeque, Dr MVK Giesteira, Dr DS Schulz, Dr B Potgieter Embryologists Ms Cecile Booyse Nurses Sr Sharon Uren, Sr Nicky Labuschagne Counsellors Dr Kobus van Biljon
Medfem Clinic
Corner Peter Place and Nursery Road, 1st Floor, Bryanston - Gauteng Phone 011 540 3440 Fax 011 463 1875 / 0866 521 977 Email ivflab@medfem.co.za Website www.medfem.co.za Clinicians Dr Van Rensburg, Dr Van Schouwenburg, Dr Rodrigues, Dr Clark, Dr Divanovic Embryologists Ms Edolene Bosman, Ms Vicky Wolf, Ms Lizelle Griessel, Ms Esmari Du Plessis, Ms Bianca Faber Nurses Sr Heather Sparrow, Sr Krina Von Molendorff, Sr Hanlie Monerry, Sr Sandra Botes Counsellors Dr Mandy Wolf (Clinical Psychologist)
Pretoria Fertility CENTER
Suite M19 Pretoria East Hospital, Pretoria - Gauteng Phone 012 998 8854/5 Fax 012 998 8856 Email info@ptafertilitycen.co.za Website www.ptafertility.co.za Clinicians Dr MA Trouw Embryologists Ms Elsie McDonald, Ms Linmarié Venter Nurses Sr Lizette White, Sr Rhynette Van Rensburg
Reproductive Medicine Unit
Department of Obstetrics & Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, UCT Maternity Building F Floor, Observatory, 7925 - Western Cape Phone 021 404 6027/8 Fax 021 404 6016 Email obs-infertility@uct.ac.za Clinicians Prof S Dyer, Dr M Patel, Dr M Matjila, Dr L Walmsley, Dr F Olarogun, Prof Z van der Spuy Embryologists Mrs M Vienings, Ms L Cindi, Ms B Wager
8
SARA: PARTICIPATING ART CENTRES Sandton Fertility Centre
Suite 310, East Wing, Morningside Mediclinic, cnr Rivonia and Hill Road, Sandton - Gauteng Phone 011 883 1776, 0861 442 211 Fax 011 784 6886 Email info@sandtonfertility.com Website www.sandtonfertility.com Clinicians Dr GH Mohamed, Dr M Faesen, Dr R Patel Embryologists Mr Prashan Maharaj Nurses Sr Iris Davids
Vitalab Fertility Unit
Inner Circle, 159 Rivonia Road, Morningside, Sandton - Gauteng Phone 011 911 4700 Fax 011 911 4744 Email stephanv@vitalab.com Website www.vitalab.com Clinicians Dr Stephan Volschenk & Partners, Dr MJ Jacobson, Dr L Gobetz Embryologists Ms Jane Meintjies & Colleagues Nurses Sr Anne Hacking & Colleagues Counsellors Ms Bernice Lits, Ms Tanya Rubin
WIJNLAND FERTILITY
9 Oewerpark, Die Boord, Stellenbosch - Cape Phone 021 882 9666 Fax 086 566 1701 Email info@wijnlandfertility.co.za Website www.wijnlandfertility.co.za Clinicians Dr Johannes van Waart, Dr Paul Dalmeyer, Dr Lizette White Embryologists Mrs Lydia Els-Smit, Ms Riana Burger Nurses Sr Ronel Jubber, Sr Anel Prins
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SUMMARY DATA 13 Centres Reporting
SUMMARY DATA: IVF & ICSI Note: These data include OD cycles. •
Total no. aspirations: 4991
•
Total no. fresh embryo transfers: 4193
•
Total no. clinical pregnancies: 1567
•
Clinical PR / aspiration: 31.4%
•
Clinical PR / ET: 37.4%
NATIONAL COVERAGE: IVF & ICSI 4991 aspirations/ 51.8 million people*/year = 96.3 aspirations/ million people/year = 6.4% of estimated optimal ART coverage Estimated need for ART: 1500 cycles/million population/year 1 *
According to Census 2011, Statistics South Africa (www.statssa.gov.za) 1 Collins, Hum Reprod Update 2002: 8, 265
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BASIC DATA REPORTING The following information was provided by 12 centres and is an amalgamation of data provided by three centres that reported basic data only, and nine centres that also reported more extensive data using the SARA On Line Program. One participating centre had to be excluded from the basic data as it did not separate IVF and ICSI cycles, but their data are included in the summary data.
TABLE 2: IVF & ICSI SUMMARY Data include OD cycles from 3 centres that did not report OD separately. IVF
ICSI
Aspirations
994
2423
Embryo Transfers
791
1965
Clinical Pregnancies
281
675
CPR/aspiration
28.2%
27.8%
CPR/ET
35.5%
34.3%
FIGURE 1: DISTRIBUTION OF IVF AND ICSI PROCEDURES
71.3%
70.9%
ICSI IVF
30.3%
28.7%
Aspirations
Embryo Transfers
0%
11
BASIC DATA REPORTING TABLE 3: IVF - PROCEDURES AND PREGNANCIES BY AGE
Data include OD cycles from 3 centres that did not report OD separately. The OD cycles included are captured by age of donor. < 35 YRS
35 - 39 YRS
> 39 YRS
TOTAL
Aspirations (n)
449
354
191
994
Fresh Embryo Transfers (n)
375
293
123
791
Clinical Pregnancies (n)
152
101
28
281
CPR/aspiration (%)
33.8%
28.5%
14.6%
28.3%
CPR/embryo transfers (%)
40.5%
34.5%
22.8%
35.5%
FIGURE 2: IVF - DISTRIBUTION OF PROCEDURES AND PREGNANCIES BY AGE <35y
35-39y
100% 19.2
35.6
45.2
>39y 10
15.5
37
35.9
47.4
54.1
Transfers
Pregnancies
0% Aspirations
12
BASIC DATA REPORTING TABLE 4: IVF - NO. OF TRANSFERS WITH DIFFERENT NUMBER OF EMBRYOS OR BLASTOCYSTS No. centres reporting: 10 (2 centres did not capture this information) Note: Data include OD cycles from 3 centres that did not report OD separately. The OD cycles included are captured by age of donor. < 35 YRS
35 - 39 YRS
> 39 YRS
TOTAL
Single embryo or blastocyst
50
43
23
116
2 embryos or blastocysts
198
147
44
389
3 embryos or blastocysts
32
26
16
74
≥4 embryos or blastocysts
1
5
3
9
Total transfer cycles
281
221
86
588
Mean no. embryos/blastocysts transferred1
1.94
1.96
1.98
1.95
1. Calculation based on the assumption that only 4 embryos/blastocysts were transferred in the category “≥4”.
FIGURE 3: IVF - PRECENTAGE OF TRANSFERS WITH DIFFERENT NUMBER EMBRYOS/BLASTOCYSTS BY AGE 1 100%
0.3 11.4
2
3
4 or more
2.3
3.5
11.8 18.6
70.5
66.5
51.2
17.8
19.4
26.7
< 35y
35-39y
> 39y
0% Mean no. transferred
1.94
1.96
13
1.98
BASIC DATA REPORTING TABLE 5: ICSI - PROCEDURES AND PREGNANCIES BY AGE Data include OD cycles from 4 centres that did not report OD separately. The OD cycles included are captured by age of donor. < 35 YRS
35 - 39 YRS
> 39 YRS
TOTAL
Aspirations (n)
1165
799
459
2423
Fresh Embryo Transfers (n)
995
653
317
1965
Clinical Pregnancies (n)
381
222
72
675
CPR/aspiration (%)
32.7%
27.8%
15.7%
27.8%
CPR/embryo transfers (%)
38.3%
34.0%
22.7%
34.3%
FIGURE 4: ICSi - DISTRIBUTION OF PROCEDURES AND PREGNANCIES BY AGE <35y
35-39y
>39y
100% 18.9
33
48.1
10.7
16.1
32.9
33.2
50.6
56.4
Transfers
Pregnancies
0% Aspirations
14
BASIC DATA REPORTING TABLE 6: ICSI - NO. OF TRANSFERS WITH DIFFERENT NUMBER OF EMBRYOS OR BLASTOCYSTS No. centres reporting: 10 (2 centres did not capture this information) Note: Data include OD cycles from 4 centres that did not report OD separately. The OD cycles included are captured by age of donor. < 35 YRS
35 - 39 YRS
> 39 YRS
TOTAL
Single embryo or blastocyst
122
125
72
319
2 embryos or blastocysts
607
332
132
1071
3 embryos or blastocysts
140
122
77
339
≥4 embryos or blastocysts
22
14
16
52
Total transfer cycles
891
593
297
1781
Mean no. embryos/blastocysts transferred1
2.06
2.04
2.12
2.07
1. Calculation based on the assumption that only 4 embryos/blastocysts were transferred in the category “≥4”.
FIGURE 5: ICSI - PRECENTAGE OF TRANSFERS WITH DIFFERENT NUMBER EMBRYOS/BLASTOCYSTS BY AGE 1 100%
2.5 15.7
68.1
0%
13.7 < 35y
Mean no. transferred
2.06
2
3
4 or more
2.4
5.4
20.6
25.9
56
44.4
24.2
21.1 35-39y 2.04
15
> 39y
2.12
EXTENDED DATA REPORTING The following information was provided by nine centres that submitted their data using the SARA on-line program which captures more extensive information pertaining to ART. However, not all nine centres completed all tables, therefore the number of centres submitting information is specified for each table and figure. FIGURE 6: CAUSE OF INFERTILITY No. centres rerporting: 6 100%
18
14.3
30.9
HIV UNEXPLAINED
32.5
MULTIPLE CAUSES
11.4
MALE ONLY 32.5
FEMALE ONLY
31.7
TUBAL ONLY
15.8 0%
7.9
3
IVF 656 Cycles
ICSI 1604 Cycles
TABLE 7: OVARIAN STIMULATION FOR IVF & ICSI No. centres rerporting: 7 Note: This table does not include OD or frozen embryo transfers. OVARIAN STIMULATION
IVF
ICSI
TOTAL
%
Agonist & FSH/LH/HMG
163
601
764
46.7
Antagonist & FSH/LH/HMG/Clomiphene
103
707
810
49.5
FSH/LH/HMG
3
3
6
0.4
Clomiphene + FSH/LH/HMG
18
28
46
2.8
Others
2
8
10
0.6
289
1347
1636
100
Total
16
EXTENDED DATA REPORTING FIGURE 7: OVARIAN STIMULATION FOR IVF & ICSI No. centres rerporting: 7 Note: Only the three most common stimulation protocols are depicted. These data do not include OD or frozen embryo transfers.
IVF
ICSI
AGONIST
AGONIST
ANTAGONIST
ANTAGONIST
CLOMIPHENE + GONADOTROPHINS
CLOMIPHENE + GONADOTROPHINS
17
EXTENDED DATA REPORTING TABLE 8: IvF & ICSI - OUTCOME BY AGE AND NUMBER OF EMBRYOS/BLASTOCYSTS TRANSFERRED No. centres rerporting: 8 Note: This table does not include OD or frozen embryo transfers. EMBRYOS CP / TFC (%) 1-3
BLASTOCYSTS CP / TFC (%)
TOTAL CP / TFC (%)
One Two Three
3/27 (11.1) 24/84 (28.6) 6/13
4/11 81/170 (47.6) 2/19
7/38 (18.4) 105/254 (41.4) 8/32 (25)
One Two Three ≥ Four
2/34 (5.9) 14/53 (26.4) 15/32 (46.8) 1/3
2/13 26/71 (36.6) 12/27 (44.4) 0/0
4/47 (8.5) 40/124 (32.2) 27/59 (45.8) 1/3
One Two Three ≥ Four
2/19 7/30 (23.3) 7/26 (26.9) 2/3
2/7 2/9 1/16 0/2
4/28 (14.3) 9/39 (23) 8/42 (19) 2/5
NO. TRANSFERRED <35y
35-39y
≥ 40y
1. CP= Clinical Pregnancy
2. TFC = Transfer cycle
3. Percentage in brackets if no. TFC >25
Comment: The higher pregnancy rates associated with the transfer of two instead of one embryo or blastocyst in women < 35y, and with transfer of three instead of two embryo or blastocyst in women 35-39y must be interpreted with caution. Firstly, in several sub-categories the numbers are small and secondly the associated risk of multiple pregnancy is not documented.
18
EXTENDED DATA REPORTING FIGURE 8: IVF & ICSI - PRECENTAGE OF TRANSFERS WITH DIFFERENT NUMBER OF EMBRYOS AND BLASTOCYSTS 1 100%
1.8 21.9
51.5
2
3
4 or more
0.6 18
72.5
24.7 9
0% Embryos
Blastocysts
Comment: Blastocysts were transferred in 48.5% of all transfer cycles. The average number of embryos and blastocysts transferred was 2.0 and 2.1 respectively. For calculation of the average, it was assumed that only 4 embryos/blastocysts were transferred in the category “≥4”.
19
EXTENDED DATA REPORTING TABLE 9: IVF & ICSI - PREGANCY OUTCOME BY AGE No. centres reporting: 7 Note: Data from IVF and ICSI cycles were pooled due to the relatively small numbers of reported pregnancy outcomes following IVF (n=144 for all ages). This table does not include OD or frozen embryo transfers.
< 35 YRS
35-39 YRS
> 39 YRS
TOTAL
321
223
67
611
Loss < 20 weeks
51
55
17
123
Singleton gestation or birth
219
139
40
398
Twin gestation or birth
38
23
4
65
Triplet gestation or birth
2
0
0
2
Outcome unknown
11
6
6
23
Multiple gestations/births (%)1
15.4
14.2
9.1
14.4
Early pregnancy loss rate (%)2
15.9
24.7
25.4
20.1
Clinical Pregnancies
1. Calculated at all multiple gestations/births over all singleton plus multiple gestations/ births 2. Calculated at all early loss over all clinical pregnancies.
FIGURE 9: IVF & ICSI - PREGNANCY OUTCOME Singleton gestation/birth
23
Multiple gestation/birth Loss < 20 weeks
123
Unknown outcome
67
398
20
EXTENDED DATA REPORTING FIGURE 10: IVF & ICSI - PREGNANCY OUTCOME (%) BY AGE No. centres reporting: 7 Note: Data from IVF and ICSI cycles were pooled due to the relatively small numbers of reported pregnancy outcomes following IVF (n=144 for all ages). This figure does not include OD or frozen embryo transfers.
Outcome unknown 100%
Multiple gestation/birth
3.4 12.5
2.7 10.3
Singleton gestation/birth
Loss < 2 weeks
8.9 6
59.7 68.2
15.9
62.3
24.7
25.4
35-39y (N=223)
> 39y (N=67)
0% < 35y (N*=321) * Number of clinical pregnancies Comment: In figure 10 the multiple PR was calculated as multiple pregnancies over all pregnancies. The rate is thus lower than the rate reported in table 9 which reported it as multiple gestations/births over all singleton plus multiple gestations/ births.
21
EXTENDED DATA REPORTING TABLE 10: EMBRYO AND BLASTOCYST CRYOPRESERVATION No. centres reporting: 9 Note: This table does not include cryopreservation in OD cycles.
< 35 YRS
35-39 YRS
> 39 YRS
TOTAL
Cycles with embryo/blastocyst thawed
292
161
109
562
Cycles with embryo/blastocyst transfers
281
156
104
541
-
-
-
2.08
87
52
21
160
29.8
32.3
19.3
28.5
31
33.3
20.2
29.6
Average no. embryos/blastocysts transferred Clinical pregnancies CPR/thaw (%) CPR/transfer (%)
TABLE 11: EMBRYO AND BLASTOCYST CRYOPRESERVATION - PREGANCY OUTCOME BY AGE No. centres reporting: 7 Note: Data do not include OD.
< 35 YRS
35-39 YRS
> 39 YRS
TOTAL
74
46
20
140
Loss < 20 weeks
10
6
5
21
Singleton gestation or birth
29
21
11
61
Twin gestation or birth
8
6
1
15
Outcome unknown
27
13
3
43
Multiple gestations/births (%)1
21.6
22.2
8.3
19.7
Early pregnancy loss rate (%)2
13.5
13
25
15
Clinical Pregnancies
1. Calculated at all multiple gestations/births over all singleton plus multiple gestations/ births 2. Calculated at all early loss over all clinical pregnancies.
22
EXTENDED DATA REPORTING TABLE 12: FRESH OOCYTE DONATION CYCLES BY AGE OF RECIPIENT No. centres reporting: 8
< 35 YRS
35-39 YRS
> 39 YRS
TOTAL
Aspirations
-
-
-
801
Fertilisation by ICSI (%)
-
-
-
72.8
60
141
525
726
2.05
1.95
1.97
1.97
26
72
235
333
-
-
-
41.6%
43.3%
51.1%
44.8%
45.9%
Loss < 20 weeks
5
11
45
61
Singleton gestation or birth
14
40
136
190
Twin gestation or birth
2
10
26
38
Triplet or higher gestation or birth
1
0
2
3
Unknown
4
11
26
41
Multiple gestations/births (%)1
17.6
20
17.1
17.7
Early pregnancy loss rate
19.2
15.3
19.1
18.3
Embryo/blastocyst transfers Average no. embryos/blastocysts transferred Clinical pregnancies CPR/aspiration CPR/transfer Pregnancy outcome
1. Calculated at all multiple gestations/births over all singleton plus multiple gestations/births
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EXTENDED DATA REPORTING TABLE 13: FROZEN OOCYTE DONATION CYCLES BY AGE OF RECIPIENT WITH DONORS < 35y No. centres reporting: 6
< 35 YRS
35-39 YRS
> 39 YRS
TOTAL
Cycles with embryos/blastocysts thawed
17
19
118
154
Cycles with embryos/blastocyst transfers
16
18
116
150
Clinical pregnancies
5
10
30
45
CPR/thaw cycle
29.4
52.6
25.4
29.2
CPR/transfer
31.2
55.6
25.9
30
Comment: Outcome of frozen cycles with donors > 35y and pregnancy outcome following all frozen OD could not be reported because of invalid data.
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SUMMARY TABLE 14: overview 2009 - 2012 2009
2010
2011
2012
12
14
15
13
Aspirations
4512
4923
5643
4991
Fresh embryo transfers
3872
4319
4802
4193
Clinical pregnancies
1303
1595
1794
1567
Clinical PR/ aspiration
28.9%
32.4%
31.8%
31.4%
Clinical PR/ aspiration IVF
31.9%
30.8%
30.2%
28.2%
Clinical PR/ aspiration ICSI
27.9%
32.3%
30.7%
27.8%
Clinical PR/ aspiration OD
-
-
42%
41.6%
63.2%
68.3%
70.1%
71.3%
Total no. centres
ICSI: % of ETs
25
NOTES
26
NOTES
27
The Southern African Society of Reproductive Medicine & Gynaecological Endoscopy Secretariat: PO Box 1935, Durban 4000, South Africa. Tel: +27 31 368 8000 Fax: +27 31 368 6623 Email: info@fertilitysa.org.za Website: www.fertilitysa.org.za
28