Assisted Reproductive Technology Registry Research Articles

The landscape of assisted reproductive technology access in India.

Historically, infertility has been stigmatized in the Indian society, primarily due to societal norms that equate marriage with procreation. In twentieth century, India focused primarily on over-fertility in its family planning programs, with little attention given to the complexities of infertility. The introduction of Assisted Reproductive Technology (ART) in the late 1970s made a global revolution, including in India, offering hope to infertile couples. Despite a significant rise in ART clinics offering a wide range of treatment options in the recent years, challenges remain, particularly regarding the affordability. In India, ART is typically dominated by the private sector as government support remains limited. Efforts to standardize ART practices, including the establishment of the National ART & Surrogacy Registry and ART act aim to regulate, improve outcomes and curb unethical practice. Despite these advancements, the high cost of treatment cycles and lack of insurance coverage limit many couples' ability to undergo fertility treatment. Addressing these issues requires a multifaceted approach, including policy reform, increased public awareness, and the development of affordable treatment options to ensure broader access to reproductive care across India.

Assisted reproductive technology-associated risk factors for placenta accreta spectrum after vaginal delivery

This study aimed to investigate assisted reproductive technology (ART) factors associated with placenta accreta spectrum (PAS) after vaginal delivery. This was a registry-based retrospective cohort study using the Japanese national ART registry. Cases of live singleton infants born via vaginal delivery after single embryo transfer (ET) between 2007 and 2020 were included (n = 224,043). PAS was diagnosed in 1412 cases (0.63% of deliveries), including 1360 cases (96.3%) derived from frozen-thawed ET cycles and 52 (3.7%) following fresh ET. Among fresh ET cycles, assisted hatching (AH) (adjusted odds ratio [aOR], 2.5; 95% confidence interval [CI] 1.4–4.7) and blastocyst embryo transfer (aOR, 2.2; 95% CI 1.3–3.9) were associated with a significantly increased risk of PAS. For frozen-thawed ET cycles, hormone replacement cycles (HRCs) constituted the greatest risk factor (aOR, 11.4; 95% CI 8.7–15.0), with PAS occurring in 1.4% of all vaginal deliveries following HRC (1258/91,418 deliveries) compared with only 0.11% following natural cycles (55/47,936). AH was also associated with a significantly increased risk of PAS in frozen-thawed cycles (aOR, 1.2; 95% CI 1.02–1.3). Our findings indicate the need for additional care in the management of patients undergoing vaginal delivery following ART with HRC and AH.

Assisted reproductive technology in Japan: A summary report for 2021 by the Ethics Committee of the Japan Society of Obstetrics and Gynecology.

The Japan Society of Obstetrics and Gynecology (JSOG) registry gathers comprehensive data from registered assisted reproductive technology (ART) facilities in Japan. Herein, we report 2021 ART cycle characteristics and outcomes. Descriptive statistics were used to summarize and analyze 2021 data. In 2021, 625 ART facilities participated in the registry; 27 facilities did not conduct ART cycles and 598 registered treatment cycles. In total, 498 140 cycles were registered, and there were 69 797 neonates (increases of 10.7% and 15.5%, respectively, from the previous year). The number of freeze-all invitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles decreased in 2021; the number of neonates born was 2268 for IVF-embryo transfer (ET) cycles and 2850 for ICSI cycles. Frozen-thawed ET (FET) cycles increased markedly from 2020 (11.2% increase). In 2021, 239 428 FET cycles were conducted, resulting in 87 174 pregnancies and 64 679 neonates. For fresh transfers, the total single ET, singleton pregnancy rate, and singleton live birth rates were 82.7%, 97.0%, and 97.3%; for FET, these rates were 84.9%, 96.9%, and 97.1%. The 2021 Japanese ART registry analysis showed marked increases in both total treatment cycles and live births from the previous year.

Assisted reproductive technology-associated risk factors for retained products of conception

ObjectiveTo evaluate assisted reproductive technology-associated risk factors for retained products of conception among live births. DesignRegistry-based retrospective cohort study. SettingNot applicable. Patient(s)Cycle-specific data for a total of 369,608 singleton live births following fresh and frozen–thawed embryo transfers between 2007 and 2017 were obtained from the Japanese assisted reproductive technology registry. Intervention(s)None Main outcome measure(s)Retained products of conception after delivery. Odds ratios and 95% confidence intervals for risk factors associated with retained products of conception during fresh and frozen cycles. Result(s)In total, 132 deliveries (0.04% of eligible assisted reproductive technology registry deliveries) had retained products of conception; 122 (92.4%) of these deliveries occurred after frozen–thawed embryo transfer cycles. Cases with retained products of conception were significantly more likely to have undergone vaginal delivery than cases without retained products of conception (78.0% vs. 61.1%, p < 0.001); they were also more likely to have been complicated with placenta accreta spectrum (24.2% vs. 0.45%, p < 0.001). Among patients undergoing frozen–thawed embryo transfers, factors associated with significantly increased risk of retained products of conception were embryo stage at transfer, use of hormone replacement cycles, and assisted hatching. Use of hormone replacement cycles represented the largest risk factor (adjusted odds ratio, 4.9; 95% confidence interval, 2.0 to 12.4), such that retained products of conception occurred in 0.05% of deliveries following hormone replacement cycles (51 of 97,958 deliveries) but only 0.01% of deliveries following natural cycles (5 of 47,079 deliveries). Subgroup analysis showed that hormone replacement cycles and assisted hatching remained significant risk factors for retained products of conception in cases without polycystic ovary syndrome/anovulation and cases with vaginal delivery, but not cases with cesarean section. Among fresh embryo transfers, an increased number of retrieved oocytes was the only significant risk factor for retained products of conception. Conclusion(s)Our analyses demonstrated that the majority of cases involving retained products of conception were derived from frozen–thawed embryo transfers and identified the use of hormone replacement cycles as the largest risk factor for retained products of conception within this group.

O-113 Recent research on fertility staff emotions

Abstract Infertility-related psychological research is traditionally oriented more at analysing the wellbeing of couples undergoing Assisted Reproductive Technologies (ART), than to studying the job-related effects on the healthcare fertility staff. The unfulfilled desire for a child can cause an emotional crisis for couples: they may experience high levels of stress with physical, emotional, social and financial concerns related to infertility and ART treatment. Little is known instead about the emotional reaction of healthcare members to infertility and treatment delivery. In fact, it is well documented that patients with infertility problems may challenge usual approaches to care, leading to potential difficulties in the therapeutic relationship: patients undergoing ART are often dissatisfied with the level of empathy and attention received by the healthcare staff. Besides, patients may be experienced as manipulative, emotionally dependent, self-destructive, non-compliant and with a hostile attitude, thus raising negative feelings of frustration, anxiety, and dislike among healthcare professionals. This is the aim of the research titled “What about fertility staff emotions? An explorative analysis of healthcare professionals’ subjective perspective”, aimed at understanding the subjective perspective of the fertility professionals and their emotional dynamics in relationship with patients. An in-depth explorative research study was conducted on 12 healthcare professionals working in the fertility clinic of a public healthcare hospital of Rome. Structured interviews with open-ended questions were conducted and Emotional Text Analysis was carried out to analyse the transcripts of their interviews. Five thematic domains were detected that describe the staff’s emotions about their professional experience, as follows: performance anxiety (Cluster 1), ambivalence between omnipotence and powerlessness (Cluster 2), care burden (Cluster 3), feeling of duty (Cluster 4), and sense of interdependence (Cluster 5). This study suggests that the professionals’ awareness about the implicitly emotional meanings, beliefs, values, referred to the professional function and therapeutic relationship may facilitate team work and care relationship. For this reason, the Italian National ART Register of the National Institute of Health and the Department of Dynamic Clinical and Health Psychology of La Sapienza University carried out a research to examine the characteristics of psychological services in Italian ART centres. A questionnaire consisting in 26 questions was sent to the physicians in charge of 341 ART centres active in Italy. The overall picture was rather disappointing in that only half of the responding centres (47%) have a psychologist permanently on staff and psychological intervention seems to be considered as targeting the inner world of the individual or the couple and not their relationship with the ART context. Moreover, relatively few couples (10-20%) resort to counselling in 70% of the responding centres. Referrals did not seem to be regulated by specific policies and procedures in 60% of the cases and in 70% of centres the fee for psychological counselling was not included in the ART treatment fee. Furthermore, 30% of the responding centres worked with an independent psychologist who is called in upon request. It is possible to hypothesise instead that health professionals in the field of reproductive medicine could offer their care on an ongoing basis during the course of treatment with an integrated and collaborative approach that also involves: 1. education, training, and support of the fertility clinic staff to help reduce staff stress, prevent burnout, and improve overall patient care. 2. offer support to adopt an emotional accompanying function into the healthcare relationship, through attempts at restitution, clinical supervision, joint listening setting (physician, psychologist, patients), analysis and sharing of the emotional dimensions involved in the Centre's activity, in order to improve the care experience of the patient and of the carers in relation to each other. This approach may represent a real multidisciplinary model of caretaking.

Model-based estimation of the health care expenditure and out-of-pocket payment for assisted reproductive technology: A retrospective linkage study using the Japanese national ART registry.

From April 2022, the Japanese government funding system for assisted reproductive technology (ART) has shifted from government subsidies to universal health insurance. To date, studies estimating the health care expenditure for ART are scarce. We estimated health care expenditures for ART cycles and compared the proportion of patients' out-of-pocket payment by ovarian stimulation protocols under the Japanese government subsidy system. We linked payment information for government subsidies in Saitama Prefecture during 2016 and 2017 with the Japanese ART registry. Health care expenditures for all treatment cycles in Japan during 2017 among women aged <43 years (n = 369 757) were estimated using a generalized linear model. We linked 6269 subsidy applications to the Japanese ART registry. The average treatment fee for a fresh cycle was 376 434 JPY (standard deviation = 159 581). However, significant variation was observed across ovarian stimulation protocols. The estimated health care expenditure for ART during 2017 was 101 278 629 888 JPY (920 714 817 USD), leading to a 0.24% increase in the national health care expenditure for fiscal year 2017. Fresh cycles accounted for 70% of the expenditure. The proportion of the average patient out-of-pocket payment for one treatment cycle was smaller for natural (0%) and mild ovarian stimulation using clomiphene citrate (4.5%-20.7%) than those of conventional stimulation (30.3%-32.4%). Health insurance coverage for ART would increase national health care expenditure by 0.24%. Under the subsidy system, the proportion of the average patient out-of-pocket payment was smaller for natural and mild ovarian stimulation than conventional stimulations.

The time has come for harmonized international ART registration

For more than two decades, the European IVF-Monitoring Consortium has collected data on IVF in Europe with the aim of monitoring the quality and safety of assisted reproductive technology (ART) treatments, to ensure the highest performance with the lowest risk for patients and their offspring. Likewise, the Society for Assisted Reproductive Technology in the USA and the Australia/New Zealand Assisted Reproduction Database collect, process and publish data in their regions. The better the legal framework for ART surveillance, the more complete and reliable are the datasets. Worldwide, the landscape of ART regulation is fragmented, and until there is a legal obligation to report ART data in all countries, with an appropriate quality control of the data collected, the reported outcomes should be interpreted with caution. Once uniform and harmonized data are achieved, consensus reports based on collective findings can begin to address key topics such as cycle segmentation and complications. Improved registration systems and datasets allowing optimized surveillance should be developed in collaboration with patient representatives to consider patients’ needs, especially aiming to provide higher transparency around ART services. Support from national and international reproductive medicine societies will also be essential to the future evolution of ART registries.

O-273 Risk of hypertensive disorders in pregnancy after fresh and frozen embryo transfer in assisted reproduction: A population-based cohort study with within sibship analysis

Abstract Study question Is the risk of hypertensive disorders in pregnancy (HDP) increased following assisted reproductive technology (ART) with fresh or frozen cycles compared to conception without ART? Summary answer Pregnancies after frozen embryo transfer (FET) had a substantially higher risk of HDP, also after accounting for constant parental factors in within sibship comparisons. What is known already FET in assisted reproductive technology (ART) is increasingly common because of improved cryopreservation methods, blastocyst culture, and freeze-all practice. Conventional observational studies have raised concerns about treatment safety due to higher risk of HDP after FET compared to both non-ART and fresh embryo transfer (fresh-ET). Whether this is attributable to parental factors or treatment is unknown. Within sibship comparisons can provide unique insight by controlling for confounding from unmeasured, constant parental factors, like genetics, preconception lifestyle and health, as well as socioeconomic status. Study design, size, duration Population-based cohort study with within sibship comparison using health registry data from three Nordic countries. In total, 4,523,028 singleton pregnancies resulting in delivery between 1988 and 2015 were included, of which 78,300 were after fresh-ET, and 18,037 were after FET. We identified 33,209 sibships that were conceived using two or three different conception methods (fresh-ET, FET, and non-ART). Participants/materials, setting, methods Data were collected from several national health registries in Denmark, Norway, and Sweden, including ART, medical birth, and patient registries, and linked using the residents’ unique identification numbers. Adjusted odds ratios (aOR) of HDP with 95% confidence intervals (CI) were estimated using multilevel logistic regression, where random effects provided conventional population estimates, and fixed effects gave within sibship estimates. Main models included adjustment for maternal age, parity, birth year and country. Main results and the role of chance Risk of HDP was higher after FET compared to non-ART conception, both at the population level (7.4% vs 4.3%, aOR 1.74, 95% CI 1.61 to 1.89) and within sibships (aOR 2.02, 95% CI 1.72 to 2.39). For fresh-ET, the risk was similar to non-ART, both at the population level (5.9% vs 4.3%, aOR 1.02, 95% CI 0.98 to 1.07) and within sibships (aOR 0.99, 95% CI 0.89 to 1.09). Sensitivity analyses with adjustment for body mass index (BMI) and smoking, restriction to full siblings (same mother and father) and siblings born within a three-year interval, were all consistent with our main findings. Furthermore, the results were not driven by order of conception method or other ART procedures (intracytoplasmic sperm injection, culture duration or number of embryos transferred). Limitations, reasons for caution Despite the extra control for shared confounders provided by the within sibship analyses, we cannot exclude residual confounding from non-shared confounders, such as smoking and BMI, where confounder control was limited by a large proportion of missingness, and causes of infertility, which were largely unknown. Wider implications of the findings Our findings are important for the ongoing discussion about the freeze-all policy, and further investigation of which treatment factors might be involved is warranted. Trial registration number Not applicable

O-080 Impact of age-limit policy change for assisted reproductive technology (ART) subsidy in Japan

Abstract Study question What was the impact on treatment age in Japan after a subsidy policy change that set age limits for assisted reproductive technology (ART) treatment? Summary answer The national policy introducing age limits in the subsidy may have promoted ART treatment among younger women. What is known already Japan has provided partial subsidies for ART treatment since 2004. To promote treatment at a younger age, the government introduced a subsidy policy in 2016 that set age limits: up to six treatment cycles for women younger than 40 years of age; and up to three cycles for women between 40 and 42 years old. However, two out of 47 prefectures continued to provide subsidies to women aged 43 and older. Study design, size, duration We conducted a time series analysis of the utilisation of ART before and after the introduction of age limits, using data from the Japanese national ART registry from 2012 to 2016. Participants/materials, setting, methods We described the number of fresh and frozen treatment cycles, comparing the number between 45 prefectures that followed the national policy change (hereafter, prefectures with age limits) and two prefectures that did not (hereafter, prefectures without age limits). Ordinary least squares regression models were used to assess the impact of the policy change by prefecture on the number of ART cycles by women of different ages. Main results and the role of chance The overall number of fresh and frozen ART cycles continuously increased in all age groups from 2012 to 2016. Meanwhile, the number of fresh ART cycles among women aged ≤ 36 and 37-39 years in 2016 increased from the previous year by + 4.0% and +1.8% in prefectures with age limits, whereas it decreased in prefectures without age limits: -3.1% and -2.3%, respectively. The number of fresh ART cycles among women aged 40-42 and 43-45 years in prefectures with age limits in 2016 changed by + 1.5% and -0.1%, respectively, whereas it increased considerably in prefectures without age limits by + 9.6% and +65.4%, respectively. Similar changes were shown for the frozen cycles. After controlling for underlying time trends and prefectural characteristics, the policy change significantly increased the number of fresh and frozen ART treatment cycles among women aged ≤ 36 years and decreased the treatment cycles of women aged 40-42 years. Limitations, reasons for caution We evaluated the change observed in the year of the policy change and could not assess longer-term trends. Additionally, unobserved factors might have contributed to the change in treatment numbers. Wider implications of the findings The introduction of a policy to set an age limit for the partial ART subsidy resulted in a significant increase in treatment even among age groups younger than the boundary groups. The policy change might have conveyed educational messages regarding the benefits of early treatment. Trial registration number not applicable

Down syndrome live births following assisted reproductive technology in Japan: a nationwide survey between 2007 and 2016.

The use of assisted reproductive technology (ART) and prenatal genetic testing have become more widespread in line with an increase in maternal age. However, the effect of the introduction of non-invasive prenatal testing (NIPT) in April 2013 on pregnancy outcomes in Japan, including the prevalence of Down syndrome live births following ART, has not been investigated. This study aimed to evaluate the trends in the prevalence of Down syndrome live births following ART in Japan. This population-based retrospective study used the Japanese nationwide ART registry. All clinical pregnancies resulting in live births, stillbirths, and termination of pregnancy (TOP) following ART from 2007 to 2016 were included. Pregnancy outcomes involving infants with Down syndrome were evaluated. Among 351,808 pregnancies, the proportion of mothers with advanced age increased significantly from 2007 to 2016 (from 49.5 to 62.4% and 8.9 to 17.8% for mothers aged ≥ 35 and ≥ 40years, respectively). The proportion of live births with Down syndrome was 77.3% in 2007, which remained consistent until 2012, but then decreased significantly to 45.1% after 2013 (P < 0.001). The prevalence of Down syndrome live births increased up to 2012 (19.5/10,000 live births), decreased significantly in 2013 (12.1/10,000 live births), and then remained almost stable (11.1-14.7/10,000 live births). The introduction of NIPT balanced the prevalence of Down syndrome live births following ART with recent increasing maternal age in Japan.

Optimal individualization of patient-oriented ovarian stimulation in Japanese assisted reproductive technology clinics, a review for unique setting with advanced-age patients.

Ovarian stimulation is a key issue in assisted reproductive technology (ART) treatment. ART practice in Japan is unique with various types of ovarian stimulation protocols, which may contribute to lower pregnancy rates compared to other countries. This review aims to clarify optimal individualized ovarian stimulation for improving the pregnancy rate per one oocyte retrieval cycle in Japan. We performed a literature review to describe ovarian stimulation, classification of infertile women depending on ovarian reserve and response, and Japanese ART data and discussed optimal conventional and mild ovarian stimulation protocols in Japan. According to Japanese ART registry data, the live birth rate of 30-35-year-old women was 32%-37% per ET cycle; therefore, four to five embryos are calculatedly needed when aiming a cumulative live birth rate of ≥80%. Mild stimulation aimed at collecting 5-10 oocytes can be alternative choice as an optimal ovarian stimulation protocol in young women. In 40-year-old women, the live birth rate is 18.8%, resulting in eight or more embryos as necessary. Conventional stimulation must be required in women with advanced age. In poor responders, however, mild stimulation may be sufficient for maximumly extracting their ovarian function. In Japan, mild ovarian stimulation can be selected in patients with a good prognosis and poor responders; however, conventional ovarian stimulation is necessary for women in advanced age.

Assisted reproductive technology in Japan: A summary report for 2019 by the Ethics Committee of the Japan Society of Obstetrics and Gynecology.

PurposeThe Japan Society of Obstetrics and Gynecology records online annual cycle‐based information for assisted reproductive technology (ART). This report presents the characteristics and treatment outcomes of ART cycles registered during 2019.MethodsThe Japanese ART registry includes cycle‐specific information from 619 participating facilities, including treatment and pregnancy outcomes. Descriptive analyses were conducted for cycles registered during 2019.ResultsIn 2019, 458 101 treatment cycles and 60 598 neonates were reported, both of which increased from 2018. The number of fresh cycles, including in vitro fertilization and intracytoplasmic sperm injection, decreased, while frozen‐thawed embryo transfer (ET) cycles increased. The mean maternal age was 37.9 years (standard deviation ± 4.7). Of 239 348 oocyte retrievals, 123 690 (51.7%) involved freeze‐all‐embryos cycles; fresh ET was performed in 41 831 cycles (a decreasing trend since 2015). In 2019, there were 211 597 frozen‐thawed ET cycles, resulting in 74 882 pregnancies and 54 168 neonates born. Single ET was performed in 82.6% of fresh transfers and 85.1% of frozen‐thawed cycles, with singleton live birth rates of 97.3% for both.ConclusionsThe number of fresh cycles decreased but frozen cycles increased in 2019. Single ET was performed in >80% of cases, and the proportion of babies born from frozen‐thawed ET increased.

Cumulative live birth rate according to the number of receiving governmental subsidies for assisted reproductive technology in Saitama Prefecture, Japan: A retrospective study using individual data for governmental subsidies.

PurposeWe investigated the cumulative live birth rate (CLBR) in women receiving governmental subsidies for assisted reproductive technology (ART) in Saitama Prefecture, Japan.MethodsWomen who applied for subsidies from Saitama Prefectural Government for the first time in 2016 were enrolled and followed up until the end of 2017. Treatment information, including live birth, was obtained from the Japanese ART registry by linking it with unique identification numbers for treatment. Patients’ factors associated with having a live birth were investigated.ResultsOf 1,072 women (2,513 applications), 495 (46.2%) had a live birth with 8 (1.6%) twin pregnancies. The CLBR over six subsidized cycles was 53.7% for women aged <40 years, and 17.2% over three subsidized cycles for women 40‐42 years; highest among women <35 years (58.4%), followed by those aged 35‐39 years (49.3%). Multivariate analysis revealed patient age as the only independent factor for having a live birth.ConclusionsThe CLBR of women receiving subsidies for ART was greatest in women aged <35 years. Effective policies for promoting ART among younger couples who seek infertility treatment are essential.

The Danish National Register of assisted reproductive technology: content and research potentials.

The Danish National Register of assisted reproductive technology (ART) was initially established in 1994. The register comprises complete information on all ART procedures in public and private clinics in Denmark from 2013 and onwards, including baseline information on the cause of infertility and a number of health-related patient characteristics. The register enables monitoring and research on infertility treatment and reproductive topics in single women or couples seeking assisted reproduction, and the register is thus a key component of the Danish health information system within human reproduction. We aimed to provide an updated description of the register including advantages and pitfalls when using the register for reproductive epidemiological research, and a description of the accessibility for researchers. The Danish ART register is a valuable tool for epidemiological research. However, the inherent strengths and limitations ought to be in perspective when designing studies and interpreting the study results. Reports with annually aggregated data on ART treatments, can be accessed on the Danish Health Data Authority web page and researchers may obtain access to individual pseudonomized data via secure servers at the Danish Health Data Authority and Statistics Denmark.

Assisted reproductive technology in Japan: A summary report for 2018 by the Ethics Committee of the Japan Society of Obstetrics and Gynecology.

PurposeSince 2007, the Japan Society of Obstetrics and Gynecology (JSOG) has collected cycle‐based data for assisted reproductive technology (ART) in an online registry. Here, we present the characteristics and treatment outcomes of ART cycles registered during 2018.MethodsThe Japanese ART registry consists of cycle‐specific information for all ART treatment cycles implemented at 621 participating facilities. We conducted descriptive analyses for such cycles registered for 2018.ResultsIn total, 454 893 treatment cycles and 56 979 neonates were reported in 2018: both increased from 2017. The mean maternal age was 38.0 years (standard deviation ± 4.7). Of 247 402 oocyte retrievals, 118 378 (47.8%) involved freeze‐all‐embryos cycles; fresh embryo transfer (ET) was performed in 50 463 cycles: a decreasing trend since 2015. A total of 199 914 frozen‐thawed ET cycles were reported, resulting in 69 357 pregnancies and 49 360 neonates born. Single ET (SET) was performed in 82.2% of fresh transfers and 83.4% of frozen‐thawed cycles, with singleton pregnancy/live birth rates of 97.2%/97.2% and 97.0%/97.2%, respectively.ConclusionsTotal ART cycles and subsequent live births increased in 2018. SET was performed in over 80% of cases, and the mode of ET has shifted continuously from using fresh embryos to frozen‐thawed ones compared with previous years.

Incidences and risk factors of moderate-to-severe ovarian hyperstimulation syndrome and severe hemoperitoneum in 1,435,108 oocyte retrievals

Research questionWhat are the risk factors affecting the incidences of moderate-to-severe ovarian hyperstimulation syndrome (OHSS) and severe hemoperitoneum in assisted reproductive technology (ART) treatment cycles? DesignA retrospective cohort study was conducted on 1,435,108 oocyte retrieval cycles among Japanese ART registry data between 2007 and 2015. The study included 11,378 cycles with moderate-to-severe OHSS, 1182 cycles with severe hemoperitoneum, including 27 cycles with both conditions, and 1,422,575 cycles without moderate-to-severe OHSS and severe hemoperitoneum. ResultsThe incidences of moderate-to-severe OHSS and severe hemoperitoneum were 0.79% and 0.08%, respectively, and decreased by 0.57-fold and 0.29-fold from 2007 to 2015, respectively. In cycles with OHSS and cycles with hemoperitoneum women were younger (odds ratios [OR] 0.91 and 0.95, respectively) and had more retrieved oocytes (OR 1.09 and 1.01, respectively) compared with cycles without both complications. The use of a gonadotrophin-releasing hormone (GnRH) agonist protocol for ovarian stimulation was the highest risk factor in cycles with OHSS and hemoperitoneum (OR 1.83 and 1.24, respectively), followed by GnRH antagonist protocol (reference), gonadotrophin with or without oral medicine (OR 0.45 and 0.56, respectively) and natural or oral medicine (OR 0.02 and 0.19, respectively). In fresh embryo transfer, clinical pregnancy was associated with an increased risk of OHSS and hemoperitoneum (OR 1.19 and 2.34, respectively). ConclusionsThe highest risk factors affecting OHSS and hemoperitoneum were the use of a GnRH agonist protocol and clinical pregnancy following fresh embryo transfer. The incidences of OHSS and hemoperitoneum have decreased yearly with a reduction of GnRH agonist use and fresh embryo transfer.

The efficacy of assisted reproductive treatment in women with epilepsy

Research questionThe question of interest for this study was to examine the chance of a live birth following assisted reproductive technology (ART) treatment in women with epilepsy compared with women without epilepsy. In sub-analyses, the chance of biochemical and clinical pregnancies, and the impact of antiepileptic drugs (AED) treatment prior to embryo transfer, was analysed. DesignThis register-based cohort study was based on the Danish ART register comprising all women who underwent embryo transfer during 2006 to 2017, which included 730 ART treatments in 264 women with a history of epilepsy, and 128,387 ART treatments in 42,938 women without epilepsy. Adjustments were made for comorbidity, women's age, calendar year, type of infertility treatment and cause of infertility. A possible impact of AED use at the time of embryo transfer was studied in a sub-analysis. The primary outcome was live birth within a period of 140–308 days after the date of embryo transfer. ResultsThe adjusted odds ratio for a live birth per embryo transfer in women with epilepsy, relative to women without epilepsy, was 1.06 (95% confidence interval [CI] 0.88–1.28). The adjusted odds ratio for a live birth among users of an AED was 1.22 (95% CI 0.77–1.92) relative to women who had stopped the use of AED prior to embryo transfer. ConclusionsThe chances of a live birth per embryo transfer were similar in women with and without epilepsy. These are novel and reassuring findings on the efficacy of infertility treatment in women with epilepsy.

Data Reporting as Care Infrastructure: Assembling ART Registries in Japan, Taiwan, and South Korea

Collecting and reporting national data has become a routine practice for assisted reproductive technology (ART) governance. This article compares the building of national registries, the making of health statistics, and the utilization of these data in Japan, Taiwan, and South Korea. Instead of viewing data registries as tools for health surveillance or monitoring, we approach them in terms of their effectiveness in generating care. Conceptualizing ART data reporting as care infrastructure, built on Maria Puig de la Bellacasa’s “matters of care,” allows us to compare the extent to which data are collected for strengthening a community’s ethical obligation, presented as indicators that could reflect quality of care and inform evidence-based policy making that promotes clinical practices for healthy outcomes. We find that sociotechnical imaginaries for ART were shaped by the fact that, in its early stages, in vitro fertilization was considered controversial in Japan, a source of nationalist glory in Taiwan, and a marginal procedure in South Korea. This in turn led to different trajectories of designing national registries in these countries, resulting in different care outcomes. We also point to the importance of mediators, including reflexive medical practitioners, care-centered state bureaucrats, and activists, in translating registry data into better ART health care.

Development of assisted reproductive technology services in Thailand between 2008 and 2014 before the new law: Results generated from the National ART Registry, Royal Thai College of Obstetricians and Gynecologists

Abstract Background While the assisted reproductive technology (ART) relieves the burden of infertility in many couples, it presents significant public health challenges due to the substantial risk for multiple birth delivery and preterm birth, which are associated with poor maternal and fetal health outcomes. For this reason, it is important to monitor the development and effectiveness of ART services in Thailand. Objective To analyze the trends of ART services in Thailand between 2008 and 2014. Methods ART clinics in Thailand are required to submit data to the Royal Thai College of Obstetricians and Gynecologists via the National Reporting System. The data from 2008 to 2014 were collected and analyzed. Results The number of ART centers was increased from 35 to 47. The total fresh ART cycles were also increased from 3,723 to 6,516. The percentage values of intracytoplasmic sperm injection (ICSI), in vitro fertilization, gamete intrafallopian transfer, and zygote intrafallopian transfer cycles were changed from 77.87 to 95.59, 21.43 to 4.31, 0.21 to 0.09, and 0.45 to 0.05, respectively. The clinical pregnancy rates were 28.79–33.19, 22.84–51.34, 14.29–42.86, and 0.00–26.67, respectively. The clinical pregnancy rates in fresh vs. frozen-thawed cycles were 31.01–36.33 vs. 31.54–37.34 (P &lt; 0.05). The clinical pregnancy rates in female age &lt;35 vs. 35–39 vs. ≥40 years were 36.97–40.70 vs. 32.74–33.42 vs. 21.08–31.34, respectively (P &lt; 0.001), and the percentage values of multifetal pregnancy rate were 18.75 vs. 13.30 and 13.69, respectively (P &lt; 0.001). There were increasing preimplantation genetic screening (PGS) cycles, with the percentage of the clinical pregnancy rate (25.90–42.63, P &lt; 0.05). The clinical pregnancy rates in medium-sized ART centers (100–300 cycles per year) vs. in small and large centers were 30.79–41.14 vs. 28.01–34.04 and 8.70–40.35, respectively (P &lt; 0.001). Trends of increasing percentage of ART birth rate to total birth rate ratio were 0.24–0.34 (P &lt; 0.05). Conclusions There were higher clinical pregnancy rates in frozen-thawed cycles. Higher multifetal pregnancy rate and clinical pregnancy rate were also found in younger females. There were increasing uses of ICSI and PGS. A trend toward increasing ART birth to total birth ratio was observed.

Predictive factors for oocyte retrieval failure in treatment cycles with assisted reproductive technology: a retrospective cohort study using the nation-wide art registry of Japan

The purpose of this study was to evaluate the prognostic factors for oocyte retrieval failure in patients undergoing assisted reproductive technology (ART) treatment cycles. A retrospective cohort study. The present study was approved by the Ethical Committee on human subjects. The data analyzed in this study were part of the Japanese ART registry database, which was collected by the Japan Society of Obstetrics and Gynecology from 2010 to 2012. We analyzed the data of 464,480 fresh cycles with transvaginal oocyte aspiration. The cycles with oocyte retrieval failure and those with one or more oocytes retrieved were compared to determine predictive factors for oocyte retrieval failure using multivariate logistic regression analyses. The number of cycles with oocyte retrieval failure was 36,600 (7.9%). According to the multivariate analysis, age, cause of infertility, and controlled ovarian hyperstimulation (COH) were the independent prognostic factors for oocyte retrieval failure. The percentages of oocyte retrieval failure in the age groups of 29 years old and under, 30-34 years old, 35-39 years old, 40-44 years old, and over 45 years old were 3.2%, 4.2%, 5.9%, 10.2%, and 18.6%, respectively. The odds ratios of patients in their 30’s and 40’s were 1.7 and 4.0 times those of the patients in their 20’s, respectively. The percentages of oocyte retrieval failure that corresponded to infertility caused by a male factor, tubal factor, endometriosis, and unknown factors were 5.6%, 7.3%, 8.0%, and 9.2%, respectively. The odds ratios for oocyte retrieval failure in the tubal factor, endometriosis, and unknown groups were 1.3, 1.4, and 1.7 times those in the male factor group, respectively. The percentages of oocyte retrieval failure in the COH cases using aromatase inhibitor or clomiphene (AI+CC), GnRH agonist, and GnRH antagonist were 10%, 1.5%, and 3.5%, respectively. The odds ratios for oocyte retrieval failure in the GnRH antagonist and AI+CC protocols were 2.4 and 5.3 times those for the GnRH agonist protocol, respectively. The percentage of oocyte retrieval failure in the natural cycles was 21%. The predictive factors for oocyte retrieval failure might be related to a patient’s age, particular causes of infertility, and COH protocols. These results provide information that may be useful for counseling patients before ART treatments.