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 women can either originate from the cycle in which they were created (fresh cycle) or be frozen (cryopreserved) and thawed before transfer (thaw cycle).

There were 81,062 ART treatment cycles reported from Australian and New Zealand clinics in 2016 (74,357 and 6,705 respectively) representing a 4.0% increase in Australia and 7.4% increase in New Zealand on 2015. This represented 14.8 cycles per 1,000 women of reproductive age (15–44 years) in Australia, compared with 7.0 cycles per 1,000 women of reproductive age in New Zealand. Women used their own oocytes or embryos (autologous cycles) in 94.1% of treatments. Embryos that had been frozen and thawed were used in 38.1% of autologous cycles.

There were 39,980 women who undertook 76,255 autologous fresh and/or thaw cycles in Australia and New Zealand in 2016. On average, 1.9 fresh and/or thaw cycles per woman were undertaken in 2016, with more cycles per woman in Australia (1.9 cycles per woman) than in New Zealand (1.5 cycles per woman). The number of cycles where embryos were selected using preimplantation genetic testing (PGT) increased from 5,773 in 2015 to 7,425 in 2016 (28.6% 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 7.2% of initiated fresh cycles in 2012 to 22.6% of initiated fresh cycles in 2016. 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 clinicians.

Patient’s age

The average age of women undergoing autologous cycles was 35.8 years in 2016, similar to previous years. The average age of women undergoing ART treatment using donor oocytes or embryos was approximately five years older at 40.4 years. Approximately, one in four (24.5%) women who underwent an autologous cycle in 2016 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 (33.0%) aged 40 or older.

Treatment outcomes and number of babies

Of the 81,062 initiated cycles, 66,664 (82.2%) resulted in either an embryo transfer or all oocytes/embryos being cryopreserved. Of the initiated cycles, 22.5% (18,269) resulted in a clinical pregnancy and 17.9% (14,515) in a live delivery. The overall clinical pregnancy rate for cycles reaching embryo transfer was 33.0%. The live delivery rate per initiated autologous fresh cycle was 16.4% after freeze-allcycles 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 27.3% and for thaw cycles reaching embryo transfer cycle was 28.4%.

There was a higher live delivery rate in younger women. For women aged under 30, the live delivery rate per embryo transfer was 36.9% for autologous fresh cycles and 33.3% for autologous thaw cycles. For women aged over 44, the live delivery rate was 1.3% and 11.8% per embryo transfer for autologous fresh and thaw cycles.

There were 15,198 babies born (including 15,057 liveborn babies) following ART treatment in 2016. Of these, 13,596 (89.5%) were from Australian clinics and 1,602 (10.5%) from New Zealand clinics. Eight in ten of the liveborn babies (80.1%) 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 15,475 women were followed from the start of their first autologous non freeze-all fresh cycle during 2014, through subsequent fresh and thaw cycles until December 2016 or until they achieved a live delivery. The cycle-specific live delivery rate per initiated autologous cycle for all women was 22.5% in their first cycle, and 11.9% 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 59.8% in 2012 to 78.4% in 2016); an increase in vitrification as a cryopreservation method (from 76.8% of thaw blastocyst transfer cycles in 2012 to 87.8% in 2016). The use of intracytoplasmic sperm injection (ICSI) as a percentage of embryo transfer cycles in has decreased from 64.7% in 2012 to 62.9% in 2016.

The proportion of embryo transfer cycles transferring a cryopreserved embryo increased from 42.9% of embryo transfer cycles in 2012 to 54.1% in 2016. Of the 14,515 live deliveries resulting for ART treatment, 58.1% resulted from thaw cycles, compared to 41.9% in 2012.

In the last five years the live delivery rate per fresh embryo transfer cycle increased from 22.9% to 23.9%, and the live delivery rate per frozen/thaw embryo transfer cycle increased from 22.0% to 28.2%. This is correlated with the shift to freeze-all cycles. Overall, live delivery rates per embryo transfer have risen from 22.5% in 2012 to 26.2% in 2016, a 16.7% 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 42% decrease from 6.5% in 2012 to 3.8% in 2016. This was achieved by clinicians and patients shifting to single embryo transfer, with the proportion increasing from 73.2% in 2012 to 87.7% in 2016. Importantly, this decrease in the multiple delivery rate was achieved while overall live delivery rates per embryo transfer increased from 22.5% in 2012 to 26.2% in 2016.