Assisted reproductive technology in Australia and New Zealand 2015

image - ANZARD 2015 Report Front Cover
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 women can either originate from the cycle in which they were created (fresh cycle) or be frozen and thawed before transfer (thaw cycle).
There were 77,721 ART treatment cycles reported from Australian and New Zealand clinics in 2015 (71,479 and 6,242 respectively) representing a 5.6% increase in Australia and 6.0% increase in New Zealand on 2014. This represented 14.4 cycles per 1,000 women of reproductive age (15–44 years) in Australia, compared with 6.5 cycles per 1,000 women of reproductive age in New Zealand. Women used their own oocytes or embryos (autologous cycles) in 94.5% of treatments. Embryos that had been frozen and thawed were used in 37.4% of autologous cycles.
There were 39,006 women who undertook 73,481 autologous fresh and/or thaw cycles in Australia and New Zealand in 2015. On average, 1.9 fresh and/or thaw cycles per woman were undertaken in 2015, with more cycles per woman in Australia (1.9 cycles per woman) than in New Zealand (1.6 cycles per woman). The number of cycles where embryos were selected using preimplantation genetic testing (PGT) increased from 3,488 in 2014 to 5,773 in 2015 (65.5% increase)
Over the last five years there has been an increasing trend in the proportion of cycles where all oocytes or embryos are cryopreserved for potential future use (freeze-all cycles) from 5.0% of initiated fresh cycles in 2011 to 17.2% of initiated fresh cycles in 2015. This practice is used for a variety of reasons, including reducing the risk of ovarian hyperstimulation syndrome (OHSS), improving endometrial - embryo synchronicity, as part of a PGT cycle, for fertility preservation, or as a deliberate treatment option used by some clinicians.
Patient’s age
The average age of women undergoing autologous cycles was 35.8 years in 2015, similar to previous years. The average age of women undergoing ART treatment using donor oocytes or embryos was approximately five years older at 40.6 years. Approximately, one in four (24.8%) women who underwent an autologous cycle in 2015 were aged 40 or older. The average age of the male partner of the women undergoing autologous and recipient cycles was 38.1 years, with one-third (33.8%) aged 40 or older.
Treatment outcomes and number of babies
Of the 77,721 initiated cycles, 63,848 (82.2%) resulted in either an embryo transfer or all oocytes/embryos being cryopreserved. Of the initiated cycles, 22.8% (17,726) resulted in a clinical pregnancy and 18.1% (14,040) in a live delivery. The overall clinical pregnancy rate for cycles reaching embryo transfer was 31.9%. The live delivery rate per initiated autologous fresh cycle was 17.0% after freeze-all cycles were excluded. The live delivery rate for fresh cycles reaching embryo transfer was 23.7%. The live delivery rate per initiated autologous thaw cycle was 25.3% and for thaw cycles reaching embryo transfer cycle was 26.8%.
There was a higher live delivery rate in younger women. For women aged under 30, the live delivery rate per embryo transfer was 38.4% for autologous fresh cycles and 32.6% for autologous thaw cycles. For women aged over 44, the live delivery rate was 0.7% and 7.6% per embryo transfer for autologous fresh and thaw cycles.
There were 14,791 babies born (including 14,655 liveborn babies) following ART treatment in 2015. Of these, 13,344 (90.2%) were from Australian clinics and 1,447 (9.8%) from New Zealand clinics. Over three-quarters of the liveborn babies (78.8%) were full-term singletons of normal birthweight.
Cycle-specific success rates
ANZARD includes data items that make it possible to follow a woman’s consecutive ART treatment cycles. A cohort of 16,355 women were followed from the start of their first autologous non freeze-all fresh cycle during 2013, through subsequent fresh and thaw cycles until December 2015 or until they achieved a live delivery. The cycle-specific live delivery rate per initiated autologous cycle for all women was 23.3% in their first cycle, and 14.5% after eight cycles. Of women who did not achieve a live birth in a specific cycle, approximately one in four did not return for further ART treatment.
Trends in ART procedures
Treatment trends in the last five years have shown a greater shift from cleavage stage transfers to blastocyst transfers (from 57.7% in 2011 to 73.5% in 2015); an increase in vitrification as a cryopreservation method (from 73.0% of thaw blastocyst transfer cycles in 2011 to 86.1% in 2015). The use of intracytoplasmic sperm injection (ICSI) has remained stable at around 63% of embryo transfer cycles in 2011-2015.
The proportion of embryo transfer cycles transferring a cryopreserved embryo increased from 40.8% of embryo transfer cycles in 2011 to 50.0% in 2015.  Of the 14,040 live deliveries resulting for ART treatment, 52.8% resulted from thaw cycles, compared to 38.9% in 2011.
In the last five years the live delivery rate per fresh embryo transfer cycle remained stable around 23%, while the live delivery rate per frozen/thaw embryo transfer cycle increased from 20.6% to 26.6%. Overall, live delivery rates per embryo transfer have risen from 21.6% in 2011 to 25.3% in 2015, a 17.1% improvement.
Multiple birth trends
A continuing trend in ART treatment in Australia and New Zealand has been the reduction in the rate of multiple deliveries, with a 36% decrease from 6.9% in 2011 to 4.4% in 2015. This was achieved by clinicians and patients shifting to single embryo transfer, with the proportion increasing from 73.2% in 2011 to 85.7% in 2015. Importantly, this decrease in the multiple delivery rate was achieved while overall live delivery rates per embryo transfer increased from 21.6% in 2011 to 25.2% in 2015.
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