Department of Obstetrics and Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; African Network and Registry for Assisted Reproductive Technology.
Department of Obstetrics and Gynaecology, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; African Network and Registry for Assisted Reproductive Technology.
Reprod Biomed Online. 2023 May;46(5):835-845. doi: 10.1016/j.rbmo.2023.01.014. Epub 2023 Jan 26.
What were the utilization, practices and outcomes of assisted reproductive technology (ART) in Africa in 2018 and 2019?
Cycle-based data (CBD) and retrospective summary data were collected cross-sectionally from voluntarily participating ART centres.
During 2018, 43,958 ART procedures were reported by 67 centres in 16 countries, increasing to 45,185 procedures reported by 70 centres in 18 countries in 2019. Autologous fresh procedures predominated at 70%, whereas autologous frozen embryo transfers (FET) increased from 21.2% to 23.1% and oocyte donation cycles remained below 10%. In 2019, the mean age of women undergoing autologous fresh embryo transfer was 33.9 years and received a mean number of 2.4 embryos per transfer. The clinical pregnancy rate (CPR) per fresh embryo transfer was 42.8% in 2018 and 38.4% in 2019, with corresponding rates of 38.3% and 31.8% after FET. In both years, most ART procedures, excluding single embryo transfer (SET), were associated with a multiple delivery rate above 20%, reaching over 30% after elective dual embryo transfer in autologous cycles and after fresh oocyte donation. Multiples were predominantly born preterm with a substantially increased perinatal mortality rate. The CBD for both years showed that elective SET (eSET) achieved a high CPR without compromising safety.
This third report of The African Network and Registry for Assisted Reproductive Technology documents the prevailing practice of multiple embryo transfers in a cohort of relatively young women while highlighting the importance of disaggregating eSET, non-eSET and double embryo transfer. The high CPR after eSET and the increase in cryopreservation cycles are encouraging trends towards decreasing the number of embryos transferred without compromising effectiveness. Improved follow-up of ART pregnancies is required.
2018 年和 2019 年非洲辅助生殖技术（ART）的利用、实践和结果如何？
从自愿参与的 ART 中心收集基于周期的数据（CBD）和回顾性总结数据。
2018 年，16 个国家的 67 个中心报告了 43958 例 ART 手术，而 2019 年，18 个国家的 70 个中心报告了 45185 例。自体新鲜手术占主导地位，占 70%，而自体冷冻胚胎移植（FET）从 21.2%增加到 23.1%，卵母细胞捐赠周期仍低于 10%。2019 年，接受自体新鲜胚胎移植的妇女的平均年龄为 33.9 岁，每个移植周期平均接受 2.4 个胚胎。2018 年新鲜胚胎移植的临床妊娠率（CPR）为 42.8%，2019 年为 38.4%，FET 后的相应比率为 38.3%和 31.8%。在这两年中，除了单胚胎移植（SET）外，大多数 ART 手术与超过 20%的多胎分娩率相关，在自体周期中选择性双胚胎移植和新鲜卵母细胞捐赠后，这一比率超过 30%。多胎主要是早产儿，围产期死亡率显著增加。这两年的 CBD 显示，选择性 SET（eSET）在相对年轻的妇女中实现了高 CPR，同时又不影响安全性。
第三次非洲辅助生殖技术网络和注册报告记录了在一组相对年轻的妇女中，多个胚胎移植的普遍做法，同时强调了对 eSET、非 eSET 和双胚胎移植进行细分的重要性。eSET 后高 CPR 和冷冻保存周期的增加是朝着减少胚胎移植数量而不影响效果的令人鼓舞的趋势。需要对 ART 妊娠进行更好的随访。
