Twenty years' experience with the Swiss data registry for assisted reproductive medicine: outcomes, key trends and recommendations for improved practice.

Geyter De,R Moffat,I Gruber,P Fehr,Wolff Von

doi:10.4414/smw.2015.14087

Abstract

The impact of assisted reproductive technology (ART) on Swiss demography was quantified. From 1993 to 2012 the number of deliveries, including multiples, generated by ART was compared with overall delivery numbers. Swiss experts in ART collaborated in a consensus to increase successful outcomes, to reduce the incidence of complications of ART and to validate recommendations through statistical review of available data. Data generated between 1993 and 2012 and published by the Federal Office of Statistics (BfS) were compared with the Swiss database on ART (FIVNAT-CH) as organised by the Swiss Society of Reproductive Medicine (SGRM). From these analyses a panel of Swiss experts in ART extracted recommendations to improve current practice, to prevent complications related to ART and to recommend changes in current Swiss legislation dealing with ART. Since 1993 the age of women giving birth rose together with the number of women asking for ART. This demographic trend was reflected in a rise in the number of deliveries generated by ART (in 2012: 2.2%) and the proportion of multiple births (in 2012: 17.6%). The outcome of ART was most negatively influenced by the age of the treated patient. The number of retrieved oocytes decisively impacted the likelihood of delivery, the risk of multiple births and the incidence of ovarian hyperstimulation syndrome. Optimal ovarian stimulation should be designed for the retrieval of 10 to 15 oocytes per treatment. Swiss legislation should enable and stimulate a policy of elective single embryo transfer to avoid multiple births.

Highlights

At all ages and in all societies infertility has constituted a major health problem
Swiss experts in assisted reproductive technology (ART) collaborated in a consensus to increase successful outcomes, to reduce the incidence of complications of ART and to validate recommendations through statistical review of available data
Data generated between 1993 and 2012 and published by the Federal Office of Statistics (BfS) were compared with the Swiss database on ART (FIVNAT-CH) as organised by the Swiss Society of Reproductive Medicine (SGRM). From these analyses a panel of Swiss experts in ART extracted recommendations to improve current practice, to prevent complications related to ART and to recommend changes in current Swiss legislation dealing with ART

Summary

Introduction

At all ages and in all societies infertility has constituted a major health problem. Its incidence is currently thought to be on the rise due to the increasing age of women at childbirth and sequential family planning. In addition to conventional in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), the technology of cryopreservation of gametes and embryos has been improved to such extent that oocytes can be stored frozen, allowing long term deferral of conception This strategy may become helpful to young women afflicted by malignant diseases requiring chemotherapy or radiation potentially destructive to their ovaries [2]. Transmission of genetic disease to the offspring can be prevented in affected families by the use of preimplantation genetic diagnostics (PGD) or reduced through the sorting of spermatozoa [3] Both multiple deliveries and OHSS are the most common complications of ART and are associated with high morbidity rates and significant financial burden.

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Conclusion