The latest report (the eighth since 1989) on worldwide availability and uptake of assisted reproductive technologies (ARTs) shows continued growth in demand and progress towards fewer embryo implantations. The study, produced by the International Committee for Monitoring Assisted Reproductive Technology (ICMART) is based on figures from 1563 clinics in 53 countries and compiles all available data for the year 2002 (the latest available).
From a macro perspective the data showed a 25 per cent increase in reported ART cases (partly attributable to improved data collection but also strongly suggestive of a significant growth in demand across the period). The total number of reported cycles was slightly more than 600,000, resulting in almost a quarter of a million live births. Overall delivery rates were around 22.4 per cent for each conventional IVF aspiration and 21.2 per cent for each sperm injection (ICSI - intracytoplasmic sperm injection). The cumulative delivery rate per aspiration was 26 per cent, with a range from 14 to 39 (the US achieving the highest for a high availability nation at 37.5 per cent).
There was, however, a huge variation in availability with the extremes being Ecuador where only two cycles were performed for every million inhabitants and Israel where the figure reached 3,688 per million. The size of the difference between countries with better healthcare and availability led to Professor Jacques de Mouzon, leader of the study, to suggest that there may be a place for more 'low cost' ART with lower success rates but higher availability (thus reducing pressure on provides to implant multiple embryos during the small number of expensive cycles received).
While the proportion of twin pregnancies decreased from 26.5 per cent to 25.7 per cent, and triplets from 2.9 per cent to 2.5 per cent, Dr Tarlatzis, President of the International Federation of Fertility Societies, expressed concern at the 'continued high incidence of multiple pregnancy'. The report noted that multiple pregnancies saw more premature births (94.2 per cent of triplets compared to 13.5 per cent for singletons) and higher mortality (71.2 per 1,000 among triplets, compared to 10.7 for singletons).
A 47 per cent increase in the use of frozen embryo transfer cycles was seen as positive and indicative of a move away from multiple implantations. A substantial increase in demand for ICSI was less easily explained.
Professor Mouzon said of the new data that even though imperfect, the study ''gives data that can inform debate and decision-making on issues such as availability and the benefits and risks of this important medical practice'.