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 woman 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 88,929 ART treatment cycles reported from Australian and New Zealand fertility clinics in 2019 (81,049 and 7,880 respectively), representing an increase of 6.2% in Australia and 2% in New Zealand from 2018. This equates to 15.6 cycles per 1,000 women of reproductive age (15–44 years) in Australia, compared with 7.9 cycles per 1,000 women of reproductive age in New Zealand. Women used their own oocytes or embryos (autologous cycles) in 95% of treatments. Embryos and oocytes that had been frozen and thawed were used in 36.7% of autologous cycles.

There were 46,073 women who undertook 84,081 autologous fresh and/or thaw cycles in Australia and New Zealand in 2019. On average, 1.8 autologous fresh and/or thaw cycles per woman were undertaken in 2019, with more cycles per woman in Australia (1.8 cycles per woman) than in New Zealand (1.7 cycles per woman). The number of cycles where embryos were selected using preimplantation genetic testing (PGT) increased from 9,124 in 2018 to 10,748 in 2019. Over the last five years the proportion of cycles where all oocytes were cryopreserved for potential future use (oocyte freeze-all cycles) has increased from 2.5% of initiated fresh cycles in 2015 to 6.3% in 2019.

Over the same period the proportion of initiated fresh cycles that resulted in all embryos being cryopreserved (embryo freeze-all cycles) increased from 14.7% in 2015 to 21.7% in 2019. 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 or for fertility preservation.

Patient’s age

The average age of women undergoing autologous cycles in 2019 was 35.8 years, which is similar to previous years. The average age of women undergoing ART treatment using donor oocytes or embryos was around five years older at 40.2 years. Approximately one in four (23.5%) women who underwent an autologous cycle in 2019 were aged 40 years or older. The average age of male partners of women undergoing autologous and recipient cycles was 38 years, with approximately one-third (31%) aged 40 years or older.

Treatment outcomes and number of babies

Of the 88,929 initiated ART cycles, 73,401 (82.5%) resulted in either an embryo transfer or all oocytes/embryos being cryopreserved. Of the initiated cycles, 23.2% (20,668) resulted in a clinical pregnancy and 18.3% (16,310) in a live birth. The overall clinical pregnancy rate for cycles reaching embryo transfer was 35.4%. In 2019, there were no GIFT cycles.The live birth rate per initiated autologous fresh cycle was 16.5% 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 28.9% and for thaw cycles reaching embryo transfer cycle was 29.8%.There was a higher live birth rate in younger women. For women aged younger than 30 years, the live birth rate per embryo transfer was 40.4% for autologous fresh cycles and 33.9% for autologous thaw cycles. For women older than 44 years, the live birth rate per embryo transfer was 1.7% for autologous fresh cycles and 9.2% for thaw cycles.

There were 16,927 babies born (including 16,777 liveborn babies) following ART treatment in 2019. Of these, 15,158 (89.6%) were from Australian clinics and 1,769 (10.5%) from New Zealand clinics. Eight in ten liveborn babies (81.5%) 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 15,301 women were followed from the start of their first autologous non-freeze-all fresh cycle during 2017, through subsequent fresh and thaw cyclesuntil December 2019 or until they achieved a live birth. The cycle-specific live birth rate per initiated cycle for all women was 24.7% in their first cycle, and 13.0% in their eighth cycle. Approximately one in five women who did not achieve a live birth in a specific cycle discontinued ART treatment during the period.

Trends in ART procedures

Treatment trends in the last five years have included a continued shift from cleavage stage transfers to blastocyst transfers (from 73.5% in 2015 to 88.3% in 2019); an increase in vitrification as a cryopreservation method (from 86.1% of thaw blastocyst transfer cycles in 2015 to 95.5% in 2019); and a small decrease in the use of intracytoplasmic sperm injection (ICSI) (from 62.9% of embryo transfer cycles in 2015 to 58.2% in 2019).

The proportion of embryo transfer cycles transferring a cryopreserved embryo increased from 50% in 2015 to 58.5% in 2019. Of the 16,310 live births resulting from ART treatment in 2019, 62.1% resulted from thaw cycles, compared to 52.8% in 2015.

In the last five years the live birth rate per fresh embryo transfer cycle increased from 23.9% to 25.5%, and the live birth rate per thaw embryo transfer cycle increased from 26.7% to 29.7%. The greater increase in live birth rates from thaw embryo transfer cycles could be explained by more freeze-all cycles being performed over the years. Overall, live birth rates per embryo transfer have risen from 25.3% in 2015 to 28% in 2019.

Multiple birth trends

A continuing trend in ART treatment in Australia and New Zealand has been the reduction in the rate of multiple births, from 4.4% in 2015 to 2.9% in 2019. This has been achieved by clinicians and patients shifting to single embryo transfer, with the proportion increasing from 85.7% in 2015 to 91.9% in 2019. Importantly, this decrease in the multiple birth rate has been achieved while overall live birth rates per embryo transfer increased from 25.3% in 2015 to 28% in 2019.