2019年欧洲辅助生殖技术的数据和趋势:来自ESHRE的结果

2024-05-26 生殖医学论坛 生殖医学论坛 发表于上海

与往年相比,2019年报告的辅助生殖技术(ART)和人工授精(IUI)周期数及其结果以及为生育力保护(FP)所干预措施的数据和趋势是什么?

STUDY QUESTION

研究问题

What are the data and trends on ART and IUI cycle numbers and their outcomes, and on fertility preservation (FP) interventions, reported in 2019 as compared to previous years?

与往年相比,2019年报告的辅助生殖技术(ART)和人工授精(IUI)周期数及其结果以及为生育力保护(FP)所干预措施的数据和趋势是什么?

SUMMARY ANSWER

总结回答

The 23rd ESHRE report highlights the rising ART treatment cycles and children born, alongside a decline in twin deliveries owing to decreasing multiple embryo transfers; fresh IVF or ICSI cycles exhibited higher delivery rates, whereas frozen embryo transfers (FET) showed higher pregnancy rates (PRs), and reported IUI cycles decreased while maintaining stable outcomes.

第23届ESHRE报告强调了ART周期数和出生婴儿的增加,以及由于多胚胎移植周期的减少导致的双胎分娩率下降;新鲜的体外受精(IVF)或卵胞浆内单精子注射(ICSI)周期的分娩率较高,而冻胚移植(FET)周期显示更高的妊娠率(PRs),且报告的IUI在保持稳定结果的同时周期数有所减少。

WHAT IS KNOWN ALREADY

已知信息

ART aggregated data generated by national registries, clinics, or professional societies have been gathered and analyzed by the European IVF-Monitoring (EIM) Consortium since 1997 and reported in a total of 22 manuscripts published in Human Reproduction and Human Reproduction Open.

自1997年以来,由欧洲辅助生殖技术监测(EIM)联盟收集和分析了由国家登记处、诊所或专业协会生成的辅助生殖技术(ART)聚合数据,并在《Human Reproduction》和《Human Reproduction Open》上发表了共22篇论文。

STUDY DESIGN, SIZE, DURATION

研究设计、规模、持续时间

Data on medically assisted reproduction (MAR) from European countries are collected by EIM for ESHRE each year. The data on treatment cycles performed between 1 January and 31 December 2019 were provided by either national registries or registries based on initiatives of medical associations and scientific organizations or committed persons in one of the 44 countries that are members of the EIM Consortium.

EIM每年为ESHRE收集来自欧洲国家的医学辅助生殖(MAR)数据。2019年1月1日至12月31日期间进行的治疗周期数据由国家登记处、基于医学协会和科学组织倡议的登记处或EIM联盟44个成员国之一的相关人员提供。

PARTICIPANTS/MATERIALS, SETTING, METHODS

参与者/材料、背景、方法

Overall, 1487 clinics offering ART services in 40 countries reported, for the second time, a total of more than 1 million (1 077 813) treatment cycles, including 160 782 with IVF, 427 980 with ICSI, 335 744 with FET, 64 089 with preimplantation genetic testing (PGT), 82 373 with egg donation (ED), 546 with IVM of oocytes, and 6299 cycles with frozen oocyte replacement (FOR). A total of 1169 institutions reported data on IUI cycles using either husband/partner’s semen (IUI-H; n = 147 711) or donor semen (IUI-D; n = 51 651) in 33 and 24 countries, respectively. Eighteen countries reported 24 139 interventions in pre- and post-pubertal patients for FP, including oocyte, ovarian tissue, semen, and testicular tissue banking.

总体而言,来自40个国家的1487家提供ART服务的诊所再次报告了超过100万(1,077,813)个治疗周期的数据,其中IVF 160782个周期,ICSI 427980个周期,FET 335744个周期,胚胎植入前遗传学检测(PGT)64089个周期,卵子捐赠(ED)82373个周期,卵母细胞体外成熟(IVM)546个周期,冷冻卵子周期(FOR)6299个周期。共有1169个机构报告了分别在33个国家和24个国家使用丈夫/伴侣精液的人工授精周期(IUI-H;n=147711)或供精周期(IUI-D;n=51651)数据。另有18个国家报告了24,139例青春期前后患者进行生育保护的干预措施,包括卵母细胞冷冻、卵巢组织、精液和睾丸组织储存。

MAIN RESULTS AND THE ROLE OF CHANCE

主要结果和机会的作用

In 21 countries (21 in 2018) in which all ART clinics reported to the registry 476 760 treatment cycles were registered for a total population of approximately 300 million inhabitants, allowing the best estimate of a mean of 1581 cycles performed per million inhabitants (range: 437–3621). Among the reporting countries, for IVF the clinical PRs per aspiration slightly decreased while they remained similar per transfer compared to 2018 (21.8% and 34.6% versus 25.5% and 34.1%, respectively). In ICSI, the corresponding PRs showed similar trends compared to 2018 (20.2% and 33.5%, versus 22.5% and 32.1%) When freeze-all cycles were not considered for the calculations, the clinical PRs per aspiration were 28.5% (28.8% in 2018) and 26.2% (27.3% in 2018) for IVF and ICSI, respectively. After FET with embryos originating from own eggs, the PR per thawing was at 35.1% (versus 33.4% in 2018), and with embryos originating from donated eggs at 43.0% (41.8% in 2018). After ED, the PR per fresh embryo transfer was 50.5% (49.6% in 2018) and per FOR 44.8% (44.9% in 2018). In IVF and ICSI together, the trend toward the transfer of fewer embryos continues with the transfer of 1, 2, 3, and ≥4 embryos in 55.4%, 39.9%, 2.6%, and 0.2% of all treatments, respectively (corresponding to 50.7%, 45.1%, 3.9%, and 0.3% in 2018). This resulted in a reduced proportion of twin delivery rates (DRs) of 11.9% (12.4% in 2018) and a similar triplet DR of 0.3%. Treatments with FET in 2019 resulted in twin and triplet DR of 8.9% and 0.1%, respectively (versus 9.4% and 0.1% in 2018). After IUI, the DRs remained similar at 8.7% after IUI-H (8.8% in 2018) and at 12.1% after IUI-D (12.6% in 2018). Twin and triplet DRs after IUI-H were 8.7% and 0.4% (in 2018: 8.4% and 0.3%) and 6.2% and 0.2% after IUI-D (in 2018: 6.4% and 0.2%), respectively. Eighteen countries (16 in 2018) provided data on FP in a total number of 24 139 interventions (20 994 in 2018). Cryopreservation of ejaculated sperm (n = 11 592 versus n = 10 503 in 2018) and cryopreservation of oocytes (n = 10 784 versus n = 9123 in 2018) were most frequently reported.

21个国家(2018年为21个)中所有ART诊所共登记报告了476760个治疗周期,总人口约为3亿,最佳估计平均值为每百万居民有1581个周期(范围:437-3621)。在报告国家中,与 2018 年相比,IVF每取卵周期的临床PR略有下降,但每移植周期的临床PR保持相似(分别为21.8%和34.6% vs 25.5%和34.1%)。在ICSI中,相应的PR与2018年相比显示出相似的趋势(20.2%和33.5% vs 22.5%和32.1%)。当计算中不考虑全胚冷冻周期时,每取卵周期的临床PR为 28.5%(2018年为28.8%)。IVF和ICSI 分别为26.2%(2018年)和26.2%(2018年为27.3%)。来自自卵的胚胎行FET后,每次解冻的PR为35.1%(2018年为33.4%),而来自赠卵的胚胎为43.0%(2018年为41.8%)。ED后,每鲜胚移植周期的PR为50.5%(2018年为49.6%),每FOR周期的PR为44.8%(2018年为44.9%)。在IVF和ICSI中,移植胚胎数量减少的趋势仍然存在,移植1枚、2枚、3枚、≥4枚胚胎的比例分别为55.4%、39.9%、2.6%和0.2%(2018年分别为50.7%、45.1%、3.9%和0.3%)。这导致双胎分娩率(DR)的比例下降至11.9%(2018年为12.4%),三胎分娩率也下降至0.3%。2019年FET治疗的双胎和三胎DR分别为8.9%和0.1%(2018年为9.4%和0.1%)。IUI-H后的DR保持相似,为8.7%(2018年为8.8%),IUI-D后的DR为12.1%(2018年为12.6%)。IUI-H后双胎和三胎的DR分别为8.7%和0.4%(2018年为8.4%和0.3%),IUI-D后分别为6.2%和0.2%(2018年为6.4%和0.2%)。18个国家(2018年为16个)提供了总计24139项生育力保存干预措施的数据(2018年为20994项)。最常被报道的是精液冷冻(n=11592 vs n=10503 2018年)和卵母细胞冷冻(n=10784 vs n=109123 2018年)。

LIMITATIONS, REASONS FOR CAUTION

局限性和谨慎的理由

Caution with the interpretation of results should remain as data collection systems and completeness of reporting vary among European countries. Some countries were unable to deliver data about the number of initiated cycles and/or deliveries.

由于欧洲国家的数据收集系统和报告的完整性各不相同,因此对结果的解释应保持谨慎。一些国家无法提供有关启动周期和/或分娩数的数据。

WIDER IMPLICATIONS OF THE FINDINGS

研究结果更广泛的影响

The 23rd ESHRE data collection on ART, IUI, and FP interventions shows a continuous increase of reported treatment numbers and MAR-derived livebirths in Europe. Although it is the largest data collection on MAR in Europe, further efforts toward optimization of both the collection and the reporting, from the perspective of improving surveillance and vigilance in the field of reproductive medicine, are awaited.

第23次ESHRE关于ART、IUI和FP干预措施的数据收集显示,欧洲报告的治疗数量和MAR获得的活产持续增加。虽然这是欧洲关于MAR的最大规模的数据收集,但从改善生殖医学领域的监测和警惕的角度来看,还有待进一步努力优化收集和报告。

参考文献:

The European IVF Monitoring Consortium (EIM) for the European Society of Human Reproduction and Embryology (ESHRE) , Jesper Smeenk, Christine Wyns, Christian De Geyter, Markus Kupka, Christina Bergh, Irene Cuevas Saiz, Diane De Neubourg, Karel Rezabek, Andreas Tandler-Schneider, Ionna Rugescu, Veerle Goossens, ART in Europe, 2019: results generated from European registries by ESHRE, Human Reproduction, Volume 38, Issue 12, December 2023, Pages 2321–2338, https://doi.org/10.1093/humrep/dead197

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