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).

Almost 96,000 ART treatment cycles were performed in Australia and New Zealand in 2020

There were 95,699 ART treatment cycles performed in Australian and New Zealand ART. Units in 2020 (87,206 and 8,493 respectively), representing an increase of 7.6% in Australia and 7.8% in New Zealand from 2019. This equates to 16.5 cycles per 1,000 women of reproductive age (15–44 years) in Australia, compared with 8.3 cycles per 1,000 women of reproductive age in New Zealand.

Women used their own oocytes or embryos (autologous cycles) in approximately 95% (90,529) of fresh and/or thaw cycles. These cycles were undertaken by 46,846 women, with more cycles per woman in Australia (2.0 cycles per woman) than in New Zealand (1.7 cycles per woman). Thawed embryos and oocytes were transferred in 37.1% of autologous cycles. There were 3,642 cycles where all oocytes or embryos were frozen for medical or nonmedical fertility preservation, and 238 surrogacy gestational carrier cycles. More than 8% of cycles performed in 2020 underwent preimplantation genetic testing (PGT).

One in seven ART treatment cycles were in single females or female-female couples

Of the 93,275 autologous and recipient cycles, 10.2% were undertaken by single females and 3.9% by female-female intending parents. Almost one in four (24.9%) oocyte/embryo recipient cycles were in female-female intending parents. Cycles involving single males and male-male intending parent(s) are reported in Chapter 5.

The average age of female patients undertaking ART in 2020 was 35 years

The average age of female patients undergoing autologous and recipient cycles in 2020 was 35 years, with one in four (23.9%) aged 40 years or older. The average age of male partners was 38 years.

The cause of male infertility reported for the first time

Male factor infertility was reported in one in 3 cycles. The principal cause in the majority of these cycles (77%) was idiopathic (unexplained).

Thaw cycles had higher live birth rates than fresh cycles

Of the 93,275 autologous and recipient cycles, 58,585 resulted in an embryo transfer and 17,939 resulted in all oocytes/embryos being frozen. The overall clinical pregnancy rate for autologous and recipient cycles reaching embryo transfer was 36.3%. The live birth rate per initiated autologous fresh cycle was 16.2% 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 30.7% and for thaw cycles reaching embryo transfer cycle it was 31.3%.

There was a higher live birth rate in younger women. For women aged under 30 years, the live birth rate per embryo transfer was 40.8% 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 1.2% for autologous fresh cycles and 7.7% for thaw cycles.

More than 18,000 babies were born following ART treatment in Australia and New Zealand

There were 18,462 babies born (including 18,257 liveborn babies) following ART treatment in 2020. Of these, 16,439 (89%) were from treatments performed in Australian ART Units and 2,023 (11%) were from New Zealand ART Units. Eight in ten liveborn babies (81.5%) were full-term singletons of normal birthweight.

One in four women achieved a live birth in their first ever IVF cycle

For the 17,757 women who commenced ART treatment in 2018 and were followed until December 2020, one in four (25.4%) achieved a live birth in their first cycle, and one in six (15.9%) 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 treatment continue: Decreased use of ICSI

The proportion of embryo transfer cycles that used embryos fertilised using intracytoplasmic sperm injection (ICSI) decreased from 62.9% in 2016 to 56.1% in 2020.

The proportion of embryo transfer cycles transferring a cryopreserved (frozen) embryo increased from 54% in 2016 to 60.5% in 2020. Of the 17,761 live birth events resulting from ART treatment in 2020, 64.9% resulted from thaw cycles, compared to 56.6% in 2016.

The proportion of initiated fresh cycles that resulted in all oocytes/embryos being frozen (freezeall cycles) increased from 20.1% in 2016 to 25.0% in 2020. Laboratory trends in the last five years have included a continued shift from cleavage-stage transfers to blastocyst transfers (from 78.4% in 2016 to 89.4% in 2020); an increase in vitrification as a cryopreservation method (from 87.8% of thaw blastocyst transfer cycles in 2016 to 96.4% in 2020); and a decrease in the use of ICSI (from 62.9% of embryo transfer cycles in 2016 to 56.1% in 2020).

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 23.9% in 2016 to 25.5% in 2019 and to 25.4% in 2020. The live birth rate per thaw embryo transfer cycle increased from 28.2% in 2016 to 31.2% in 2020. Overall, live birth rates per embryo transfer have risen from 26.2% in 2016 to 27.6% in 2020.

The multiple birth rate continued to decline, to 2.8% of ART-conceived births

The decline in the multiple birth rate (twins and triplets) following ART treatment continues, from 3.7% in 2016 to 2.8% in 2020. This has been achieved by clinicians and patients shifting to the safer practice of single embryo transfer, with the proportion increasing from 87.7% in 2016 to 93% in 2020.