World Preliminary Report on ART

Year 2011

GD Adamson, J de Mouzon, M Banker, S Dyer O Ishihara, R Mansour, KG Nygren, G Chambers, F Zegers-Hochschild ICMART: An NGO with WHO (Sheryl Vanderpoel)

Disclosures !  Industry

!  Advanced Reproductive Care (ARC): Founder and CEO !  Professional Organizations

!  ASRM: Past President !  FIGO: Chair, Reproductive Medicine Committee !  ICMART: International Committee Monitoring ART !  IFFS: Executive Committee !  WERF: President !  WHO: Co-chair, Infertility Assessment Task Force

!  Funded Research Studies & Consulting !  Bayer !  Ferring !  LabCorp !  Ziva

Supporters American Society for Reproductive Medicine (ASRM) European Society for Human Embryology and Reproduction (ESHRE) Fertility Society of Australia (FSA) Indian Society for Assisted Reproduction Japan Society for Reproductive Medicine (JSRM) Japan Society of Fertilization and Implantation (JSFI) Latin American Society for Assisted Reproduction (REDLARA) Society for Assisted Reproductive Technology (SART) Government of Canada Ferring Pharmaceuticals World Health Organization (WHO)

Dedicated to Kathryn Tunstall

World report 2011 Countries/region Participating (n)

Africa 8 America, Latin 12 America, North 2 Asia 5 Australia-NZ 2 Europe 33 Middle East 1 Israel 1 Total 2011 64

World Report Coverage History

0 200 400 600 800 1000 1200 1400

30 35 40 45 50 55 60 65 70

Countries Cycles

Thousand Cycles

Countries

2011: 1,281,492 cycles + 111,000 9.5% increase

Main Contributors (>50,000 cycles)

! TOTAL 1,281,492 !  Japan 268,255 !  USA: 142,325 !  France 88,518 !  Spain 71,638 !  Germany 70,154 69 % !  Italy 61,270 !  UK 60,147 !  Australia 59,212 !  Russia 57,454

World Coverage 2011

!  64 countries (25 in 1991 to 58 in 2010) !  Almost all Europe, America, Australia-NZ !  Missing countries : Africa, Middle-East, Asia !  But 8 African countries (Benin, Cameroon, Ivory

coast, Mali, Morocco, South Africa, Togo, Tunisia,): expectations for the future ?

2,547 clinics (+79) : 75 % of all clinics 32 countries >90% coverage (29 full)

!  Estimate of the overall coverage !  63 % - 70 % of World activity

Evolution of ART Cycles by Region

0

100.000

200.000

300.000

400.000

500.000

600.000

700.000

1993 1995 1996 1998 2000 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

North America Latin America Europe

Australia- New Zealand Asia Middle East

Regional Contribution of ART Cycles to the World Report (2011)

* Corresponds to aspiration cycles in IVF, ICSI & GIFT and transfer cycles in FET & OD.

Europe 49%

North America

13%

Asia 26%

Africa 1%

Middle East 3% Latin America 3%

Australia & New Zealand 5%

N = 1,281,492

Global Results 2011

!  1,281,472 initiated cycles for 241,535 deliveries !  Compared to 2010 :

!  + 111,000 cycles; 9.5% increase !  + 16,609 deliveries; 7.4% increase

!  Recent development: Freeze all !  Embryo freezing without transfer !  51,694 cycles (+18%)

!  46,971 Japan (27.8% of Retrievals) !  Removed from calculations:

PR-DR per cycle/aspiration !  Included in cumulative rates

Global Results 2011 1,281,472 Initiated Cycles

!  832,796 aspirations (+8;5%) Delivery rates** !  248,281 IVF* !  501,965 ICSI* 20.0% (-1.1%) !  53 GIFT

!  286,368 Thaws (+3.6%) 20.1% (+0.9%) !  12,744 PGD/PGS (Asp, + 0.8%) 23.8% (+10 %) !  62,811 Egg donations (+ 28.3%) 32.9% (-3.4%) !  71,698 cancellations (+10.0%) reported by 51

*Not counted: India, Australia, New Zealand & Israel combining IVF& ICSI ** DR after removing Freeze all CYCLE

Trends in Procedure Distribution: Aspirations, FET, Egg Donation

0%

20%

40%

60%

80%

100%

ED Thawings Fresh asp

Trends in Procedure Distribution: Aspirations

24,1 44,7 52,0 54,8 56,2 60,0 63,0 65,5 66,6 69,1 67,1 64,8 66,9

71,3

54,3 47,6 45,0 43,7 39,9 36,9 34,5 33,3 30,8 32,8 35,2 33,1

0%

20%

40%

60%

80%

100%

GIFT IVF

ICSI

68,9

100,0

73,2

56,9

85,4 74,5

67,2

0%

20%

40%

60%

80%

100%

GIFT

IVF

ICSI

Procedure Distribution By Region 2011

*excludes Israel, and calculated on transfers for ANZ

Delivery Rates Per Retrieval By Region: IVF & ICSI 2011

0

10

20

30

40

50

NA Lat Am EU ANZ Asia

32,3

23,1 19,9 19,8

9,7

43,9

27,2

25,1 30,6

20,6

%

Fresh cycles Cumulative

Transfers of 1-2 Embryos per Region (%) 1998 - 2011

0,0 10,0 20,0 30,0 40,0 50,0 60,0 70,0 80,0 90,0

100,0

North America

Latin America

Europe Asia Australia Africa

1 & 2, 1998

1 & 2, 2009

1 & 2, 2011

%%

Delivery Rate (fresh) and Twin Pregnancies per Region 1998 - 2011

0

5

10

15

20

25

30

35

North America

Latin America

Europe Australia-NZ

Asia Africa

Deliv/Ret,1998 Deliv/Ret,2011 Twins, 1998 Twins, 2011

%%

Triplet Pregnancies per Region 1998 - 2011

0 1 2 3 4 5 6 7 8 9

North America Latin America Europe A-NZ Asia Africa

Triplets + 1998 Triplets + 2011

%

Conclusion

!  1,281,492 cycles reported (+9.5%) !  Estimated1.8-2.0 million worldwide

!  284,159 babies born (+4.0%) !  Estimated 430,000 worldwide

!  ~6.0+ million babies born since ART began in 1978 !  67.2% ICSI (+2,4%); 23.2% women>40 (+0.4%) !  Mean number of transferred embryos: 1.66 (-0.23) !  20.0 % Delivery rate per aspiration (-1.1%),

26.3% cumulative delivery rate/asp (-0.5%) !  Huge differences in availability, practice and results

Publications !  2000 report published (FS 2006), !  2002 report published (HR 2009) !  2003 report published (FS 2011) !  2004 report published (HR 2013) !  2005 report published (FS2013) !  2006 report published (HR 2014) !  2007 report published (F&S 2014) !  2008 in preparation (HR 2015) !  2009 in preparation (F&S 2015) !  2010 in preparation (HR 2016) !  Glossary ICMART / WHO:

!  F&S and Hum Reprod 2006, !  Revision, F&S and HR 2009 !  Revision 2014-2015 in preparation

THANK YOU

To Our Contributors !  Registers : Regional Organisations

!  EUROPE : ESHRE : Austria, Belarus, Belgium, Bulgaria, Cyprus, Czech Rep, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Kazakhstan, Lithuania, Moldova, Montenegro, Norway, Poland, Portugal, Romania, Russia, Serbia, Slovenia, Spain, Sweden, Switzerland, The Netherlands, UK, Ukraine

!  AUSTRALIA -NEW ZEALAND : Australia, New Zealand !  LATIN AMERICA : Argentina, Brazil, Chile, Colombia, Ecuador,

Guatemala, Mexico, Nicaragua, Panama, Peru, Uruguay, Venezuela !  NORTH AMERICA : Canada, USA !  Middle-East : Lebanon,

!  Registers : National Level : !  Israel, India, Indonesia, Japan, Korea, Taiwan, South Africa

!  Individual clinics: Benin, Cameroon,Ivory Coast, Mali, Morocco, Togo,Tunisia

THANK YOU!