ICMART World Report on In Vitro Fertilization 2000: How Does the United States Compare?

Abstract

To compare the results of IVF from different countries and regions of the world with those obtained in the United States for the year 2000. Retrospective survey of regional, national and individual clinic registers of IVF results, including the SART/CDC registry. Data forms from the International Committee for Monitoring Assisted Reproductive Technology (ICMART) were sent in English with instructions to regional and national registries and selected individuals around the world. Returned surveys were analyzed using sums, percentages, means and regression analysis. The CDC returned the data for the US.Data were collected from individual country summaries and not by individual patients. Pregnancy rates and delivery rates were calculated per aspiration. 1,429 clinics in 49 countries reported, representing approximately 2/3 of the 2,200 IVF clinics in the world. The United States (US) had 408 clinics. The mean centers’ activity varied greatly, with many small centers with less than 100 cycles in United States (36%) compared to Europe (15%), whereas centers with more than 500 cycles for those regions respectively were 11% and 37%.The clinics worldwide reported 367,731 aspirations, including 191,109 for IVF, 175,147 for ICSI and 1,475 for GIFT. There were 52,875 frozen embryo transfers (FET), and 14,848 oocyte donor transfers. The US had 63,861 aspiration cycles, including 28,940 IVF, 34,430 ICSI and 491 GIFT. The US did not report FET, but had 6,941 oocyte donation transfer cycles. Europe represented by far the largest activity with 207,004 aspirations and 40,154 FET. For conventional IVF average pregnancy rate (PR) and delivery rate (DR) were 26.7% and 18.6% respectively worldwide, compared with 38.5% and 31.0%, respectively, in the US. For ICSI, world average PR and DR were 27.7% and 20.4%, respectively, compared with 35.2% and 28.6% in the US. On a world basis, 49.4% of the women were over age 34 and 14.4% over 39, compared with the US where the percentage was 54.9% and 18.0%. For ICSI the figures were 47.4% and 14.2% respectively, worldwide, and 51.2% and 15.3% in the US. The mean number of embryos transferred for IVF and ICSI were 2.5 and 2.7, respectively, compared to 3.0 and 3.1 in the US. The proportion of twin pregnancies was 26.9% for IVF and 26.2% for ICSI worldwide, compared to 31.7% and 30.5%, respectively, in the US. Triplet pregnancies were 2.8% for IVF and 2.9% for ICSI worldwide compared with 4.7% and 3.9%, respectively, in the US. The triplet rate was closely associated with the number of transferred embryos, but the pregnancy rate was not, except in the United States and Chile. Oocyte donation had a higher PR and DR at 41.9% and 32.5%, respectively, worldwide, compared with 51.7% and 43.5% in the US. Approximately 2/3 of the IVF cycles in the world are reported and compared to results in the US. The US has higher pregnancy rates and also higher multiple pregnancy rates, likely as a result of transferring more embryos than many countries. While extreme caution must be exercised because of limitations of the study design, data collection and analysis in comparing different regions of the world, such data are very useful in increasing our understanding of clinical utilization of IVF and its outcomes.