FIVNAT-CH Schweizerische Gesellschaft für Reproduktionsmedizin Société Suisse de Médecine de la Reproduction

Transcription

1 SGRM / SSMR Schweizerische Gesellschaft für Reproduktionsmedizin FIVNAT-CH Schweizerische Gesellschaft für Reproduktionsmedizin Annual report 2013 Cycles 2012 Version Date of analysis Author: Costanzo Limoni, FIVNAT Statistician, 6826 Riva S Vitale (TI)

2 SUMMARY TABLE SUMMARY RESULTS...3 PARTICIPATING CENTERS AND TREATMENT CYCLES... 3 PATIENTS DEMOGRAPHY... 3 DISTRIBUTION OF NUMBER OF TREATMENT CYCLES BY PATIENT... 3 DISTRIBUTION OF NUMBER OF EMBRYOS TRANSFERRED BY CYCLE... 3 CYCLES WITH SPERM DONOR... 4 TREATMENT CYCLES MAIN RESULTS... 4 OUTCOME BY PATIENT... 5 CLINICAL PREGNANCIES FOLLOW-UP... 5 CHILDREN DELIVERIES... 6 CHILD STATUS AT BIRTH (1)... 6 CHILD STATUS AT BIRTH (2)... 6 EVOLUTION OF INITIATED CYCLES BY TECHNIQUE...7 SIZE OF CLINICS (TREATMENT CYCLES)...8 PATIENTS' RESIDENCE...9 TREATMENTS BY REGION...9 TYPE OF INFERTILITY...10 INDICATIONS TO TREATMENT...10 TYPE OF STIMULATION...11 TRANSFER COMPLICATIONS...11 AGE OF WOMEN NEW PATIENTS...12 AGE OF WOMEN - MEAN AGE EVOLUTION...12 OOCYTES OBTAINED, FERTILIZED AND EMBRYOS TRANSFERRED...13 USE OF EMBRYOS AND ZYGOTES...14 DETAILED RESULTS BY TECHNIQUE - FRESH CYCLES...15 DETAILED RESULTS BY TECHNIQUE - CRYO CYCLES...16 PREGNANCY RATES BY WOMAN S AGE...17 FRESH CYCLES CRYO CYCLES PREGNANCY RATES BY WOMAN'S AGE MEDIAN WOMAN'S AGE BY CENTER PREGNANCY RATES BY NUMBER OF TRANSFERRED EMBRYOS FRESH CYCLES CRYO CYCLES NUMBER OF TRANSFERRED EMBRYOS BY CYCLE MEAN NUMBER OF TRANSFERRED EMBRYOS BY CENTER PREGNANCY RATES BY DAY OF TRANSFER...21 FRESH CYCLES PREGNANCY RATES BY CENTER AND FRESH CYCLES...22 PREGNANCY RATES BY CENTER FRESH+CRYO CYCLES...22 PREGNANCY RATES BY CENTER, FRESH CYCLE AND PATIENT...23 IN IN 2012 AND OVER A 5 YEARS PERIOD: Page Page 2

3 SUMMARY RESULTS 1 PARTICIPATING CENTERS AND TREATMENT CYCLES FIVNAT STATISTICS EVOLUTION 2011/2012 Participating centers Available centers Number of treated patients 5'495 5' % Number of new patients 3'342 3' % Treatment cycles FRESH 5'197 5' % CRYO 3'902 4' % TOTAL 9'099 9' % PATIENTS DEMOGRAPHY FIVNAT STATISTICS 2012 N % Living in Switzerland % Living abroad % TOTAL No OF PATIENTS DISTRIBUTION OF NUMBER OF TREATMENT CYCLES BY PATIENT FIVNAT STATISTICS 2012 N % 1 cycle 3' % 2 cycles 1' % 3 cycles % 4 cycles or more % TOTAL No OF PATIENTS 5'558 DISTRIBUTION OF NUMBER OF EMBRYOS TRANSFERRED BY CYCLE FIVNAT STATISTICS 2012 N % 1 embryo % 2 embryos % 3 embryos % 3+ embryos % Unknown % 1 In some cases and for all Tables and Figures of this report, the sum of percentages may not add up to 100%, due to rounding. Page 3

4 CYCLES WITH SPERM DONOR FIVNAT STATISTICS 2012 FRESH CRYO TOTAL All Initiated cycles All Patients Patients with donor % of all Patients 3.6% 1.3% 3.0% Cycles with donor'sperm % of all Initiated cycles 3.2% 1.5% 2.5% No of transfers with donor sperm % of all transfer cycles 3.4% 1.6% 2.6% TREATMENT CYCLES MAIN RESULTS FIVNAT STATISTICS 2012 FRESH CRYO TOTAL Initiated cycles Patients Cycles by patients living in CH 91.3% 93.1% 92.1% New patients New patients % of all patients 61.2% - - OPU % of initiated cycles 90.3% - - Transfers % of initiated cycles 79.3% 88.0% 83.1% Transfers % of OPU cycles 87.8% - - Clinical pregnancies % of Initiated cycles 20.8% 20.2% 20.5%...% of OPU cycles 23.1% % of Transfer cycles 26.3% 22.9% 24.7% Implantation rate (%) 16.4% 14.6% 15.6% Page 4

5 OUTCOME BY PATIENT FIVNAT STATISTICS 2012 FRESH CRYO TOTAL Patients Initiated cycles Age woman... Mean Median Q Q Clinical pregnancies % by Patients 33.6% 35.6% 35.3% Deliveries % by Patients 25.9% 26.2% 26.2% *Patients undergoing both fresh and thawing treatment cycles are considered only once for the calculation of the cumulated clinical pregnancy rate and delivery rate by patient, i.e. 5'558 CLINICAL PREGNANCIES FOLLOW-UP FIVNAT STATISTICS 2012 FRESH CRYO TOTAL Clinical pregnancies Deliveries % of Clinical pregnancies 74.2% 74.2% 74.2% Spontaneous abortions % of Clinical pregnancies 21.0% 22.4% 21.6% Extra uterine pregnancies % of Clinical pregnancies 2.4% 1.7% 2.1% Extra and intra uterine pregnancies % of Clinical pregnancies. 0.1% 0.1% Selective abortion % of Clinical pregnancies 0.9% 0.5% 0.7% Unknown results % of Clinical pregnancies 1.5% 1.2% 1.4% Page 5

6 CHILDREN DELIVERIES FIVNAT STATISTICS 2012 FRESH CRYO TOTAL Deliveries Singletons % of deliveries 80.9% 83.9% 82.2% Twins % of deliveries 18.1% 15.8% 17.1% Triplets % of deliveries 1.0% 0.3% 0.7% Unknown % of deliveries 0.0% 0.0% 0.0% TOTAL NO OF DELIVERED KNOWN CHILDREN '724 CHILD STATUS AT BIRTH (1) FIVNAT STATISTICS 2012 FRESH CRYO TOTAL Total no of delivered children '724 Alive % 99.7% 99.1% Dead in utero % 0.27% 0.52% Unknown % 0.00% 0.35% CHILD STATUS AT BIRTH (2) FIVNAT STATISTICS 2012 FRESH CRYO TOTAL Living with complications Neonatal death < Day 7 Neonatal death < Day 28 Malformations Unknown % 1.2% 1.5% % 0.3% 0.2% % 0.1% 0.2% % 1.6% 1.6% % 0.0% 0.3% Page 6

7 EVOLUTION OF INITIATED CYCLES BY TECHNIQUE TREATMENT CYCLES - EVOLUTION '109 7'815 8'467 9'088 9'540 9'456 9'546 4'060 3'049 4'503 3'312 4'884 3'583 5'188 5'482 5'376 5'358 3'900 4'058 4'080 4' FRESH CRYO TOTAL TECHNIQUE IVF Fresh ICSI Fresh '195 4' TOTAL FRESH '197* 5'482* IVF Cryo ICSI Cryo '160 3' TOTAL CRYO * 3'902* 4' TOTAL '099 9' *The TOTAL Fresh also includes 6 cycles without known technique and mixed ICSI+IVF cycles, as well as the TOTAL cryo includes 173 cycles without known technique and mixed ICSI+IVF cycles. Page 7

8 Centers Schweizerische Gesellschaft für Reproduktionsmedizin SIZE OF CLINICS (TREATMENT CYCLES) Statistics based on 24centers SIZE OF CLINICS Number of treatment cycles (Fresh+Cryo) SIZE OF CLINICS <100 cycles cycles cycles cycles >1000 cycles Frequency Percent 8% 25% 46% 17% 4% Page 8

9 PATIENTS' RESIDENCE 100% PATIENTS RESIDENCE 2% 7% 9% 75% 72% 50% 98% 93% 91% 25% 28% 0% CH-D CH-F CH-I TOTAL Living in CH Living abroad TREATMENTS BY REGION TREATMENT CYCLES BY REGION 70.4% 64.0% 68.5% 20.4% 27.6% 24.4% 9.2% 8.4% 7.1% TI CH-F CH-D Page 9

10 TYPE OF INFERTILITY TYPE OF INFERTILITY ALL PATIENTS FEMALE Primary % Secondary % Unknown 14.2% MALE Primary % Secondary % Unknown % INDICATIONS TO TREATMENT INDICATION TO TREATMENT ALL PATIENTS NEW PATIENTS TOTAL % % Tubal % % Anovulation/Dysovulation/PCO % % Endometriosis % % Male infertility % % Immunological male % 8 0.2% Donor sperm IVF/ICSI % % Unexplained Infertility % % Genetic causes of Infertility 2 0.0% 1 0.0% PGD 8 0.1% 4 0.1% Hepatitis 0.0% 0 0.0% HIV 4 0.1% 0 0.0% Other % % Multiple causes % % Missing 3 0.1% % Page 10

11 TYPE OF STIMULATION TYPE OF STIMULATION 2012 FRESH CYCLES CRYO CYCLES None % % Clomiphene (alone) % % HMG % % u-fsh % 8 0.2% r-fsh % % r-lh 0 0.0% 0 0.% Aromatase inhibitor 1 0.0% % Other % % Mixed stimulation % 9 0.2% Missing 8 0.1% 5 0.1% TOTAL % % TRANSFER COMPLICATIONS TRANSFER COMPLICATIONS 2012 N Complications with hospitalization 25 Fresh cycles complications Cryo cycles complications OHSS 20 Bleeding, infections 1 OHSS 3 Other 1 Complications without hospitalization Outpatient OHSS 32 Peritonitis 0 Hemoperitoneum 2 Psychiatric disorder 2 Thromboembolism 0 Adnexal torsion / ovarian torsion 3 **OHSS= Ovarian Hyperstimulation Syndrome. Other 2 Page 11

12 AGE OF WOMEN NEW PATIENTS AGE OF WOM EN - N ew Patients 1,1% 1,0% 0,9% 1,2% 2,1% 2,3% 16,1% 16,7% 16,6% 17,9% 17,5% 19,7% 41,6% 39,9% 41,3% 39,9% 39,4% 29,5% 30,9% 29,9% 29,6% 30,0% 40,4% 29,1% ,8% 11,3% 11,2% 11,3% 11,1% 8,5% AGE OF WOMEN - MEAN AGE EVOLUTION CYCLE TYPE FRESH CRYO TOTAL New patients are by definition treated in a fresh cycle Page 12

13 OOCYTES OBTAINED, FERTILIZED AND EMBRYOS TRANSFERRED FIVNAT-CH STATISTICS 2012 FRESH CRYO TOTAL Oocytes collected Oocytes fertilized Zygotes 2PN obtained % of inseminated oocytes 65.2% 52.5% 65.2% Cleaved embryos Frozen zygotes Frozen (or refrozen) embryos Thawed zygotes Thawed embryos Embryos/Zygotes transferred Median Transfer of 1 embryo Transfer of 2 embryos Transfer of 3 embryos Transfer of more than 3 embryos Max *15 embryos transferred with unknown number per cycle Page 13

14 USE OF EMBRYOS AND ZYGOTES Embryos destroyed in fresh cycles n % Total number of destroyed embryos In the laboratory: % 1) Development stop % 2) Bad development potential % 3) Decision o0f patient % 4) Other reasons % 5) Reason unknown 0 0.0% Number of embryos vaginally transferred % Embryos destroyed in cryo cycles n % Total number of destroyed embryos In the laboratory: % 1) Development stop % 2) Bad development potential % 3) Decision of patient % 4) Other reasons 1 0.1% 5) Reason unknown 4 0.5% Number of embryos vaginally transferred % Zygotes destroyed in destruction cycles Number of destruction cycles 564 n % Number of destroyed zygotes Embryos destroyed in destruction cycles 1) Decision of patient % 2) Lost contact % 3) End of cryo contract % 4) Other reasons % 5) Reason unknown 0 0.0% Number of destruction cycles 4 n % Number of destroyed zygotes Embryos donated for research 1) Decision of patient 0 0.0% 2) Lost contact 0 0.0% 3) End of cryo contract % 4) Other reasons 0 0.0% 5) Reason unknown 0 0.0% n % Number of embryos donated for research ) Development stop % 2) Bad development potential 0 0.0% 3) Decision of patient % 4) Other reasons 0 0.0% 5) Reason unknown 0 0.0% Page 14

15 DETAILED RESULTS BY TECHNIQUE - FRESH CYCLES FIVNAT STATISTICS FRESH CYCLES TECHNIQUE IVF ICSI MIXED UNKNOWN TOTAL Initiated cycles Patients Cycles by patients living in CH 74.0% 94.6% 90.2% 100.0% 91.3% Cycles in % by technique 15.5% 80.9% 3.4% 0.1% 100.0% Age woman... Mean Median Q Q Oocyte pick-up % of initiated cycles 85.3% 91.6% 83.2% 0.0% 90.3% Transfers % of initiated cycles 73.7% 80.5% 76.6% 16.7% 79.3%...% of OPU cycles 86.3% 87.9% 92.2%. 87.8% Transfers with donor'sperm % of Initiated cycles 12.6% 0.9% 1.6%. 2.7% Oocytes collected Oocytes fertilized Zygotes 2PN obtained % of inseminated oocytes 60.1% 66.3% 63.4%. 65.2% Cleaved embryos Frozen zygotes Frozen embryos Embryos/Oocytes transferred Median MAX Biochemical pregnancies Clinical pregnancies % of Initiated cycles 22.0% 20.1% 33.7% 16.7% 20.8%...% of OPU cycles 25.8% 21.9% 40.5%. 23.1%...% of Transfer cycles 29.9% 24.9% 44.0% 100.0% 26.3% Implantation rate (%) 19.3% 15.5% 28.5% 50.0% 16.4% Deliveries % of Initiated cycles 17.1% 14.8% 23.9% 0.0% 15.5%...% of OPU cycles 20.0% 16.2% 28.8%. 17.1%...% of Transfer cycles 23.2% 18.4% 31.2% 0.0% 19.5% Page 15

16 DETAILED RESULTS BY TECHNIQUE - CRYO CYCLES FIVNAT STATISTICS CRYO CYCLES TECHNIQUE IVF ICSI MIXED UNKNOWN TOTAL Initiated cycles Patients Cycles by patients living in CH 81.1% 94.7% 96.9% 98.3% 93.1% Cycles in % by technique 13.5% 80.0% 2.3% 4.1% 100.0% Age woman... Mean Median Q Q Transfers % of initiated cycles 90.7% 92.0% 92.9% 0.6% 88.0% Transfers with donor's sperm % of Transfer cycles 3.9% 1.2%.. 1.6% Thawed zygotes Thawed embryos Embryos transferred Median MAX Biochemical pregnancies Clinical pregnancies % of Initiated cycles 20.8% 21.0% 23.5% 0.0% 20.2%...% of Transfer cycles 23.0% 22.8% 25.3% 0.0% 22.9% Implantation rate (%) 15.1% 14.5% 17.2%. 14.6% Deliveries % of Initiated cycles 15.9% 15.6% 16.3% 0.0% 15.0%...% of Transfer cycles 17.5% 16.9% 17.6% 0.0% 17.0% Page 16

17 FIVNAT STATISTICS 2012 PREGNANCY RATES BY WOMAN S AGE FRESH CYCLES TOTAL IVF ICSI IVF ICSI IVF ICSI IVF ICSI IVF ICSI Initiated cycles Transfers % of Initiated cycles 71.7% 84.8% 79.1% 81.8% 77.2% 82.1% 70.7% 74.4% 26.5% 66.7% 79.3% Clinical pregnancies % of Initiated cycles 30.2% 25.6% 36.3% 27.0% 22.3% 21.4% 8.6% 10.4% 0.0% 0.0% 20.8% % of OPU cycles 32.7% 27.0% 40.6% 28.6% 25.5% 23.5% 10.4% 12.0% 0.0% 0.0% 23.1% % of Transfer cycles 42.1% 30.2% 45.9% 33.0% 28.8% 26.1% 12.1% 13.9% 0.0% 0.0% 26.3% Deliveries % of Transfer cycles 28.9% 23.6% 40.9% 27.1% 21.3% 18.2% 6.4% 7.9% 0.0% 0.0% 19.5% Singletons % of deliveries 72.7% 78.9% 76.9% 74.8% 78.9% 86.8% 88.9% 90.2% % Twins % of deliveries 27.3% 21.1% 23.1% 24.5% 19.3% 11.8% 11.1% 8.2% % Triplets % of deliveries % 1.8% 1.4%. 1.6%.. 1.0% FIVNAT STATISTICS 2012 CRYO CYCLES TOTAL IVF ICSI IVF ICSI IVF ICSI IVF ICSI IVF ICSI Initiated cycles Transfers % of Initiated cycles 94.4% 86.5% 92.4% 89.2% 90.0% 87.1% 89.3% 87.1% 85.7% 91.3% 88.1% Clinical pregnancies % of Initiated cycles 33.3% 23.7% 25.7% 24.3% 22.9% 19.6% 10.0% 12.2% 0.0% 8.7% 20.2% % of Transfer cycles 35.3% 27.4% 27.8% 27.3% 25.5% 22.5% 11.2% 14.1% 0.0% 9.5% 22.9% Deliveries % of Initiated cycles 25.0% 17.5% 18.8% 18.7% 18.8% 14.4% 6.4% 8.1% 0.0% 0.0% 15.0% % of Transfer cycles 26.5% 20.2% 20.3% 21.0% 20.8% 16.5% 7.2% 9.3% 0.0% 0.0% 17.0% Singletons % of deliveries 88.9% 87.1% 81.5% 80.8% 82.2% 84.2% 88.9% 92.3% % Twins % of deliveries 11.1% 12.9% 14.8% 18.7% 17.8% 15.8% 11.1% 7.7% % Triplets % of deliveries.. 3.7% 0.5% % Cycles with MIXED technique have been recoded as ICSI. Only cycles with known woman s age are shown. Page 17

18 Woman s age PREGNANCY RATES Schweizerische Gesellschaft für Reproduktionsmedizin PREGNANCY RATES BY WOMAN'S AGE 30% 25% 20% PREGNANCY RATES BY WOMAN S AGE 28.3% 26.2% 24.6% 24.5% 21.6% 20.0% 15% 10% 9.6% 11.7% 5% 0% < Fresh Cryo MEDIAN WOMAN'S AGE BY CENTER MEDIAN WOMAN S AGE BY CENTER FIVNAT Median Centers Page 18

19 PREGNANCY RATES BY NUMBER OF TRANSFERRED EMBRYOS FRESH CYCLES 1 embryo 2 embryos 3 embryos TOTAL FIVNAT STATISTICS 2012 IVF ICSI IVF ICSI IVF ICSI Transfer cycles Clinical pregnancies % of Transfer cycles 14.0% 16.5% 35.5% 29.1% 26.4% 26.7% 26.3% Deliveries % of Transfer cycles 10.3% 11.0% 28.1% 22.0% 18.9% 19.0% 19.5% Singletons % of deliveries 100.0% 96.9% 76.3% 78.5% 70.0% 80.4% 80.8% Twins % of deliveries. 2.1% 22.9% 20.9% 30.0% 16.8% 18.2% Triplets % of deliveries. 1.0% 0.8% 0.6%. 2.8% 1.0% CRYO CYCLES 1 embryo 2 embryos 3 embryos TOTAL FIVNAT STATISTICS 2012 IVF ICSI IVF ICSI IVF ICSI Transfer cycles Clinical pregnancies % of Transfer cycles 14.6% 16.2% 25.5% 25.5% 34.8% 27.1% 22.9% Deliveries % of Transfer cycles 11.5% 13.0% 18.4% 18.4% 32.6% 19.6% 17.0% Singletons % of deliveries 100.0% 98.4% 80.7% 81.2% 73.3% 71.0% 83.9% Twins % of deliveries. 1.6% 19.3% 18.5% 20.0% 29.0% 15.8% Triplets % of deliveries % 6.7%. 0.3% Only cycles with known number of transferred embryos are shown. Page 19

20 NUMBER OF TRANSFERRED EMBRYOS BY CYCLE 100% TRANSFERRED EMBRYOS BY CYCLE 7% 14% 12% 80% 60% 61% 60% 61% 40% 20% 24% 30% 27% 0% FRESH CRYO TOTAL 1 Embryo 2 Embryos 3 Embryos MEAN NUMBER OF TRANSFERRED EMBRYOS BY CENTER 2.25 TRANSFERRED EMBRYOS BY CENTER MEAN VALUES FIVNAT CENTERS Page 20

21 PREGNANCY RATES BY DAY OF TRANSFER FRESH CYCLES FIVNAT STATISTICS days 3 days 4 days 5+ days TOTAL Transfer cycles % of Transfer cycles 55.0% 35.1% 1.8% 8.1% 100.0% Clinical pregnancies % of Transfer cycles 26.6% 25.8% 23.7% 27.2% 26.3% Deliveries % of Transfer cycles 19.8% 19.4% 18.4% 18.6% 19.5% Singletons % of deliveries 81.6% 81.3% 64.3% 78.1% 80.9% Twins % of deliveries 17.5% 18.1% 35.7% 18.8% 18.1% Triplets % of deliveries 0.9% 0.7%. 3.1% 1.0% Only cycles with known day of transfer are shown (10 cycles with missing date of transfer). Page 21

22 PREGNANCY RATES BY CENTER AND FRESH CYCLES 35% 30% PREGNANCY RATE BY CENTER Initiated FRESH CYCLES 31,4% 25% 20% 15% 10% 8,8% 5% 0% PREGNANCY RATES BY CENTER FRESH+CRYO CYCLES 40% PREGN AN CY RATE BY CEN TER FRESH CYCLES + CRYO CYCLES 35% 30% 25% 31,4% 23,2% 20% 15% 13,3% 10% 8,8% 5% 0% Page 22

23 PREGNANCY RATES BY CENTER, FRESH CYCLE AND PATIENT IN 2012 PREGN AN CY RATE BY CEN TER FRESH CYCLES + BY PATIEN T 50% 46,2% 40% 30% 31,4% 20% 17,5% 10% 8,8% 0% IN 2012 AND OVER A 5 YEARS PERIOD: PREGN AN CY RATE BY CEN TER BY PATIEN T Cycles 2012 a nd Cumula ted % 60% FIVNAT 54.6% 67,2% 50% 40% 46,2% 30% 24,7% 20% 17,5% 10% 0% Results refer to a 5 years period ( ) for each treated patient (cumulated fresh and cryo cycles). Page 23