Summary

Assisted reproductive technology (ART) is a group of procedures that involve the in vitro (outside of body) handling of human oocytes (eggs) and sperm or embryos for the purposes of establishing a pregnancy. Each ART treatment involves a number of stages and is generally referred to as an ART treatment cycle. The embryos transferred to a female patient can either originate from the cycle in which they were created (fresh cycle) or be frozen (cryopreserved) and thawed before transfer (thaw cycle).

Over 110,000 ART treatment cycles were performed in Australia and New Zealand in 2021

There were 111,253 ART treatment cycles performed in Australian and New Zealand ART Units in 2021 (102,157 and 9,096 respectively). This represents an increase of 17.1% in Australia and 7.1% in New Zealand from 2020. This equates to 19.6 cycles per 1,000 women of reproductive age (15–44 years) in Australia, compared with 8.7 cycles per 1,000 women of reproductive age in New Zealand. Communities and health services were affected by the COVID pandemic in 2020 and 2021.

Women used their own oocytes or embryos (autologous cycles) in approximately 95% (104,917) of fresh and/or thaw cycles. These cycles were undertaken by 53,509 women, with more cycles per woman in Australia (2.0 cycles per woman) than in New Zealand (1.7 cycles per woman). Thawed embryos or oocytes were transferred in 36.9% of autologous cycles. There were 5,881 cycles where all oocytes or embryos were frozen for medical or non-medical fertility preservation, and 280 surrogacy gestational carrier cycles. Approximately 8% of cycles performed in 2021 underwent preimplantation genetic testing (PGT).

One in three recipient cycles were in single females or female-female couples

Of the 108,273 autologous and recipient cycles, 11.9% were undertaken by single female and 4.1% by female-female intending parents. More than one in three (36.1%) oocyte/embryo recipient cycles were in single female or female-female intending parents, noting that this includes cycles where oocytes or embryos were provided by one female intending parent to her female partner.

The average age of female patients undertaking ART in 2021 was 36 years

The average age of female patients undergoing autologous and recipient cycles in 2021 was 36 years, with one in four (25.3%) aged 40 years or older. The average age of male partners was 38 years.

One in three cycles attributed to male infertility

Male factor infertility was reported in approximately one in three cycles. The principal cause of male infertility was unexplained in the majority (74%) of these cycles.

Thaw cycles had higher live birth rates than fresh cycles

Of the 108,273 autologous and recipient cycles, 67,894 resulted in an embryo transfer and 22,685 resulted in all oocytes/embryos being frozen. The remaining cycles were either cancelled before egg retrieval, did not progress to embryo freezing or to embryo transfer. The overall clinical pregnancy rate for autologous and recipient cycles reaching embryo transfer was 36.6%.

The live birth rate per initiated autologous fresh cycle was 15.5% after freeze-all cycles were excluded, and 25.3% for fresh cycles reaching embryo transfer. The live birth rate per initiated autologous thaw cycle was 30.9% and for thaw cycles reaching embryo transfer cycle it was 31.5%.

There was a higher live birth rate in younger women. For women aged under 30 years, the live birth rate per embryo transfer was 40.2% for autologous fresh cycles and 35.9% for autologous thaw cycles. For women older than 44 years, the live birth rate per embryo transfer was 3.7% for autologous fresh cycles and 12.9% for thaw cycles.

More than 20,000 babies were born following ART treatment in Australia and New Zealand

There were 20,690 babies born (including 20,440 liveborn babies) following ART treatment in 2021. Of these, 18,594 (89.9%) were from treatments performed in Australian ART Units and 2,096 (10.1%) were from New Zealand ART Units. Eight in ten liveborn babies (81.8%) were full-term singletons of normal birthweight.

More than one third of women achieved a live birth in their first ever complete ART cycle

More than one third (37.1%) of the 36,123 women who started their first ART ovarian stimulation cycle between January 2018 and December 2019 and were followed until December 2021, achieved a live birth in their first complete ART cycle (defined as an ovarian stimulation cycle including fresh and frozen/thaw embryo transfers), and 57% by their sixth complete ART cycle. Assuming that women who discontinued treatment had an equal chance of achieving a live birth as those who continued, the estimated cumulative live birth rate after the sixth complete cycle would be 76%. Cumulative live birth rates vary by female age.

Trends in ART laboratory practices

The proportion of embryo transfer cycles that used embryos fertilised using intracytoplasmic sperm injection (ICSI) decreased from 62.2% in 2017 to 55.6% in 2021.

The proportion of embryo transfer cycles transferring a cryopreserved (frozen) embryo increased from 55.8% in 2017 to 60.6% in 2021. Of the 19,742 live births resulting from ART treatment in 2021, 65.4% resulted from thaw cycles, compared to 60.2% in 2017. The proportion of initiated fresh cycles that resulted in all oocytes/embryos being frozen (freeze-all cycles) increased from 24.2% in 2017 to 33.4% in 2021.

Other trends in the last five years include the continued shift from cleavage-stage transfers to blastocyst transfers (from 82% in 2017 to 91.5% in 2021) and an increase in vitrification as a cryopreservation method (from 91.5% of thaw blastocyst transfer cycles in 2017 to 97.2% in 2021).

Live birth rates per thaw cycle continue to increase

In the last five years, the live birth rate per fresh embryo transfer cycle increased from 24.1% in 2017 to 25.5% in 2021. The live birth rate per thaw embryo transfer cycle increased from 28.9% in 2017 to 31.4% in 2021. Overall, live birth rate per embryo transfer cycle have risen from 26.8% in 2017 to 29.1% in 2021.

Single embryo transfers continue to increase resulting in a low multiple birth rate

The proportion of single embryo transfers continued to increase from 89.4% in 2017 to 93.6% in 2021. The multiple birth rate (twins and triplets) following ART treatment decreased from 3.6% in 2017 to 2.8% in 2020 and marginally increased to 3% in 2021.