Europe's healthcare systems supports trend for quality and quantity in ART

July 02, 2003

Madrid, Spain: Europe's systems for healthcare are generally more able to support couples seeking fertility treatment than anywhere else in the world, experts will tell the annual meeting of the European Society of Human Reproduction and Embryology today (Wednesday, 2 July).

Prof Karl Nygren and Dr Anders Nyboe Andersen, authors of the fourth ESHRE report on ART in Europe[1], will tell the conference that although there is wide variation between individual European countries, and in particular between the Nordic countries and the southern European countries, Europe performs about 60% of all assisted reproductive technology treatments in the world and ART is available to more couples in Europe than anywhere else.

Out of just under 500,000 ART treatment cycles performed worldwide in 2000, 275,187 cycles were carried out in 21 European countries reporting these data. The availability of fertility treatment for couples has steadily increased in Europe over the past four years. Prof Nygren, Associate Professor of Obstetrics and Gynaecology at Sofiahemmet Hospital in Stockholm, Sweden, will say: "Denmark is way ahead of everyone else with 1,826 cycles per million of the population performed in 2000. Out of all the children born in Denmark that year, 3.7% were ART babies. By comparison, in the USA there were approximately 250 cycles per million of the population performed. Europe appears to have embraced ART socially, ethically and legally and has incorporated it into its healthcare systems in a way that has made fertility treatment more easily available than anywhere else in the world."

Prof Nygren and Dr Nyboe Andersen, Head of the Fertility Clinic at the Rigshospitalet at Copenhagen University Hospital, Denmark, will be presenting the ESHRE report for the year 2000 - the most recent figures available. It contains data from 21 European countries[2] and over 500 clinics. In 1997 there were about 200,000 treatment cycles in Europe and in 2000 this had increased to 275,187 - a 37% increase.

As in previous years, three countries performed more than 50% of all treatment cycles in Europe: Germany performed 63,005, France 56,754, and the UK 34,634. In Spain, the host country for the conference, 14,519 treatment cycles were reported in 2000. The majority of treatments were IVF (55.8%), and ICSI (44.1%). However there was considerable variation, and in Spain, Poland and Belgium, for instance, the majority of treatments were ICSI (63%). Switzerland had the highest proportion of ICSI treatments at 68%.

Out of the ten countries reporting data from all their clinics, fertility treatment was available to the highest proportion of the population in Denmark where there were 1,826 treatment cycles per million of the population. The Nordic countries and Slovenia top the list in terms of availability, with Denmark followed by Finland (1,440 cycles), Slovenia (1,199), Sweden (1,034), Iceland (1,020), Norway (986), Netherlands (966), France (965), Switzerland (654) and the UK (585).

Dr Nyboe Andersen will say: "We think that Denmark has nearly reached saturation point, with hardly anyone who wants fertility treatment having to wait."

Not only are the numbers of treatment cycles increasing, but also the numbers of embryos transferred in one cycle is declining, thus reducing the chances of multiple pregnancies that can be risky for both mothers and their babies. For instance, in 1997 three or more embryos were transferred in 52.6% of treatments. But in 2000 the proportion of transfers involving three or more embryos had dropped to 39.9%.

However, there were wide variations between European countries. Greece had the highest proportion of transfers of three or more embryos at 74.1%, Hungary had 73.3%, Ukraine 72.5%, Spain 68.5%, and Russia 68%, compared with Sweden at 3.8%, Finland 6.1% and Denmark 8.3%. In the UK the proportion of transfers involving three embryos was 33.8% and there were no transfers of four or more embryos.[3]

The proportion of IVF and ICSI treatments that result in the birth of a single child rose from 70.4% in 1997 to 74% in 2000, while the proportion of twin deliveries dropped from 25.8% to 24%, triplets from 3.6% to 2% and quadruplets from 0.15% to 0.04%.

Dr Nyboe Andersen will say: "It is good news that the proportion of multiple deliveries continues to decline. However some European countries still transfer three or more embryos with a resulting higher number of multiple births. For instance, the average proportion of twin and triplet deliveries in 2000 in Europe was 26% after IVF or ICSI, yet in Spain nearly 32% of deliveries were twins or triplets and in the Ukraine this figure was 36.3%."

Prof Nygren will conclude: "Overall, this report shows a continuing trend in Europe of quantity and quality in Europe. ART is increasingly available to couples and the efficacy of the technique is improving."
There is no abstract (presentation at 12.00hrs CET Wednesday 2 July, Madrid room).

[1]"ART in Europe, 2000 - fourth ESHRE report" by Prof Karl Nygren and Dr Anders Nyboe Andersen.
[2]The 21 countries are Belgium, Denmark, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Netherlands, Norway, Poland, Portugal, Russia, Slovenia, Spain, Sweden, Switzerland, UK and the Ukraine.
[3] In August 2001 the UK's Human Fertilisation and Embryology Authority issued guidance that only two embryos should be transferred in one treatment cycle; three could be transferred only in exceptional circumstances.

European Society of Human Reproduction and Embryology

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