Epidémiology, Research and Development, Paris, France.
National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health, School of Women's and Children's Health, University of New South Wales, Sydney, Australia.
Hum Reprod. 2020 Aug 1;35(8):1900-1913. doi: 10.1093/humrep/deaa090.
What was the utilization, effectiveness and safety of practices in ART globally in 2012 and what global trends could be observed?
The total number of ART cycles increased by almost 20% since 2011 and the main trends were an increase in frozen embryo transfers (FET), oocyte donation, preimplantation genetic testing and single embryo transfers (SET), whereas pregnancy and delivery rates (PR, DR) remained stable, and multiple deliveries decreased.
ART is widely practiced throughout the world, but continues to be characterized by significant disparities in utilization, availability, practice, effectiveness and safety. The International Committee for Monitoring Assisted Reproductive Technologies (ICMART) annual world report provides a major tool for tracking trends in ART treatment for over 25 years and gives important data to ART professionals, public health authorities, patients and the general public.
STUDY DESIGN, SIZE, DURATION: A retrospective, cross-sectional survey on the utilization, effectiveness and safety of ART procedures performed globally during 2012 was carried out.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Sixty-nine countries and 2600 ART clinics submitted data on ART cycles performed during the year 2012, and their pregnancy outcome, through national and regional ART registries. ART cycles and outcomes are described at country, regional and global levels. Aggregate country data were processed and analyzed based on methods developed by ICMART.
A total of 1 149 817 ART cycles were reported for the treatment year 2012. After imputing data for missing values and non-reporting clinics in reporting countries, 1 948 898 cycles (an increase of 18.6% from 2011) resulted in >465 286 babies (+17.9%) in reporting countries. China did not report and is not included in this estimate. The best estimate of global utilization including China is ∼2.8 million cycles and 0.9 million babies. From 2011 to 2012, the number of reported aspirations and FET cycles increased by 6.9% and 16.0%, respectively. The proportion of women aged 40 years or older undergoing non-donor ART increased from 24.0% in 2011 to 25.2% in 2012. ICSI, as a percentage of non-donor aspiration cycles, increased from 66.5% in 2011 to 68.9% in 2012. The IVF/ICSI combined delivery rates per fresh aspiration and FET cycles were 19.8% and 22.1%, respectively. In fresh non-donor cycles, SET increased from 31.4% in 2011 to 33.7% in 2012, while the average number of transferred embryos decreased from 1.91 to 1.88, respectively-but with wide country variation. The rates of twin deliveries following fresh non-donor transfers decreased from 19.6% in 2011 to 18.0% in 2012, and the triplet rate decreased from 0.9% to 0.8%. In FET non-donor cycles, SET was 54.8%, with an average of 1.54 embryos transferred and twin and triplet rates of 11.1% and 0.4%, respectively. The cumulative DR per aspiration increased from 28.0% in 2011 to 28.9% in 2012. The overall perinatal mortality rate per 1000 births was 21.4 following fresh IVF/ICSI and 15.9 per 1000 following FET.
LIMITATIONS, REASONS FOR CAUTION: The data presented depend on the quality and completeness of data submitted by individual countries to ICMART directly or through regional registries. This report covers approximately two-thirds of` world ART activity, with a major missing country, China. Continued efforts to improve the quality and consistency of reporting ART data by registries are still needed, including the use of internationally agreed standard definitions (International Glossary of Infertility and Fertility Care).
The ICMART world reports provide the most comprehensive global statistical census and review of ART utilization, effectiveness, safety and quality. While ART treatment continues to increase globally, the wide disparities in access to treatment, procedures performed and embryo transfer practices warrant attention by clinicians and policy makers. With the increasing practice of SET and of freeze all and resulting increased proportion of FET cycles, it is clear that PR and DR per aspiration in fresh cycles do not give an overall accurate estimation of ART efficiency. It is time to use cumulative live birth rate per aspiration, combining the outcomes of FET cycles with the associated fresh cycle from which the embryos were obtained, and to obtain global consensus on this approach.
STUDY FUNDING/COMPETING INTEREST(S): The authors declare no conflict of interest and no specific support from any organizations in relation to this manuscript. ICMART gratefully acknowledges financial support from the following organizations: American Society for Reproductive Medicine; European Society for Human Reproduction and Embryology; Fertility Society of Australia; Japan Society for Reproductive Medicine; Japan Society of Fertilization and Implantation; Red Latinoamericana de Reproduccion Asistida; Society for Assisted Reproductive Technology; Ferring Pharmaceuticals and Abbott (both providing ICMART unrestricted grants unrelated to world reports).
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2012 年全球辅助生殖技术（ART）实践的利用、效果和安全性如何，有哪些全球趋势？
自 2011 年以来，ART 周期总数增加了近 20%，主要趋势是冷冻胚胎移植（FET）、卵母细胞捐赠、植入前遗传学检测和单胚胎移植（SET）的增加，而妊娠和分娩率（PR、DR）保持稳定，多胎分娩减少。
ART 在全球范围内广泛应用，但在利用、可用性、实践、效果和安全性方面仍存在显著差异。国际监测辅助生殖技术委员会（ICMART）年度世界报告提供了 25 多年来监测 ART 治疗趋势的主要工具，并为 ART 专业人员、公共卫生当局、患者和公众提供了重要数据。
研究设计、规模、持续时间：对 2012 年全球进行的 ART 程序的利用、效果和安全性进行了回顾性、横断面调查。
参与者/材料、设置、方法：69 个国家和 2600 家 ART 诊所通过国家和地区的 ART 登记处提交了 2012 年进行的 ART 周期及其妊娠结果的数据。在国家、地区和全球各级描述了 ART 周期和结果。根据 ICMART 制定的方法处理和分析了汇总的国家数据。
报告了 2012 年治疗年度的 1149817 个 ART 周期。在对报告国家的缺失值和未报告诊所的数据进行插补后，1948898 个周期（比 2011 年增加 18.6%）导致报告国家的 465286 多个婴儿（增加 17.9%）。中国没有报告，也不包括在这一估计中。包括中国在内的全球最佳估计利用率约为 280 万周期和 90 万婴儿。从 2011 年到 2012 年，报告的抽吸和 FET 周期数量分别增加了 6.9%和 16.0%。40 岁或以上妇女进行非供体 ART 的比例从 2011 年的 24.0%增加到 2012 年的 25.2%。在非供体抽吸周期中，ICSI 作为非供体抽吸周期的百分比从 2011 年的 66.5%增加到 2012 年的 68.9%。新鲜非供体周期中 SET 的 IVF/ICSI 联合分娩率分别为 19.8%和 22.1%。在新鲜非供体周期中，SET 从 2011 年的 31.4%增加到 2012 年的 33.7%，而转移胚胎的平均数量从 1.91 减少到 1.88，但存在广泛的国家差异。新鲜非供体移植后双胞胎分娩率从 2011 年的 19.6%下降到 2012 年的 18.0%，三胞胎率从 0.9%下降到 0.8%。在 FET 非供体周期中，SET 为 54.8%，平均转移 1.54 个胚胎，双胞胎和三胞胎率分别为 11.1%和 0.4%。每个抽吸周期的累积 DR 从 2011 年的 28.0%增加到 2012 年的 28.9%。新鲜 IVF/ICSI 后每 1000 次活产的围产期死亡率为 21.4%，FET 后每 1000 次活产的围产期死亡率为 15.9%。
局限性、谨慎的原因：所呈现的数据取决于各国直接或通过区域登记处向 ICMART 提交的数据的质量和完整性。本报告涵盖了全球大约三分之二的 ART 活动，主要缺少一个国家，中国。仍然需要继续努力提高登记处报告 ART 数据的质量和一致性，包括使用国际公认的标准化定义（国际不孕不育和生育保健词汇表）。
ICMART 世界报告提供了最全面的全球统计普查和 ART 利用、效果、安全性和质量评估。尽管全球 ART 治疗仍在继续增加，但在获得治疗、所进行的程序和胚胎转移实践方面存在着明显的差异，这需要临床医生和政策制定者的关注。随着 SET 和冷冻所有的实施以及由此导致的 FET 周期比例的增加，很明显，新鲜周期中的 PR 和 DR 并不能准确估计 ART 的效率。现在是时候使用累积活产率/妊娠率，将 FET 周期的结果与获得胚胎的相关新鲜周期结合起来，并在全球范围内就这一方法达成共识。
研究基金/利益冲突：作者声明没有冲突的利益，也没有得到任何组织的具体支持。ICMART 非常感谢以下组织的财政支持：美国生殖医学学会；欧洲人类生殖与胚胎学会；澳大利亚生殖医学学会；日本生殖医学学会；日本受精与植入学会；拉丁美洲辅助生殖技术协会；生殖技术学会；费雷林制药公司和雅培公司（两者都为 ICMART 提供了与世界报告无关的不受限制的赠款）。
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