Hum. Reprod. Advance Access published online on April 30, 2007
Human Reproduction, doi:10.1093/humrep/dem053
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Assisted reproductive technology in Europe, 2003. Results generated from European registers by ESHRE
The European IVF-monitoring (EIM)1,2 Consortium, for the European Society of Human Reproduction and Embryology (ESHRE),2
2 Correspondence address. ESHRE Central Office, Meerstraat 60, B-1852 Grimbergen, Belgium; E-mail: bruno.vandeneede{at}eshre.com
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Abstract |
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BACKGROUND: European results of assisted reproductive techniques (ARTs) from treatments initiated during 2003 are presented in this seventh report.
METHODS: Data were mainly collected from already existing national registers. From 28 countries, 725 clinics reported 365 103 treatment cycles with: IVF 132 932, ICSI 162 149, frozen embryo replacement (FER) 60 412, oocyte donation (OD) 7548, PGD/PGS 1956 and IVM 109. Overall, this represents a 13% increase since 2002. For the third time, results on European data on intrauterine inseminations (IUIs) were reported from 19 countries. A total of 99 577 cycles (IUI-H, 82 834; IUI-D, 16 743) were included.
RESULTS: In those 15 countries where all clinics reported to the register, a total of 284 765 cycles were performed in a population of 278.7 million, corresponding to 1022 cycles per million inhabitants. For IVF, the clinical pregnancy rates per aspiration and per transfer were 26.1 and 29.6%, respectively. For ICSI, the corresponding rates were 26.5 and 28.7%. After IUI-H, the clinical pregnancy rate was 12.2% in women below 40 years and 8.8% in women 
40 years. After IVF and ICSI, the distribution of transfer of one, two, three and four or more embryos was 15.7, 55.9, 24.9 and 3.5%, respectively. Compared to the year 2002, fewer embryos were transferred, but huge differences still exist between countries. The distribution of singleton, twin and triplet deliveries for IVF and ICSI combined was 76.7, 22.0 and 1.1%, respectively. This gives a total multiple delivery rate of 23.1% compared with 24.5% in 2002. The range of triplet deliveries after IVF and ICSI varied from 0.0 to 4.4% between countries. After IUI-H in women below 40 years of age, 11.4% were twin and 2.2% triplet gestations.
Key words: ESHRE/Europe/ICSI/IUI/IVF/register data
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Introduction |
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This report is the seventh annual ESHRE publication on European data on assisted reproduction technology (ART). The six previous, also published in Human Reproduction (ESHRE, 2001a
,b, 2002, 2004, 2005, 2006), covered treatment cycles during 1997–2002.
Data have been collected from 28 European countries and covers ART with IVF, ICSI, frozen embryo replacements (FERs), oocyte donations (ODs), in vitro maturation (IVM) and pooled data on preimplantation genetic diagnosis (PGD) and screening (PGS) during 2003. Additionally, for 2003 data on intrauterine inseminations with husband semen (IUI-H; 18 countries) and inseminations with donor semen (IUI-D; 16 countries) were included. According to the International Committee for Monitoring ART (ICMART)-WHO definitions (WHO, 2002) IUI-H and IUI-D should not be classified as ART. However, the European IVF Monitoring (EIM) Consortium has decided to continue to include the IUI activity in the annual reports. The reasons are that these treatments are frequently used, they give a contribution to the annual birth rates and include risks like multiple gestations and ethical concerns as when donor sperm is used.
A sixth meeting with the EIM Consortium was held at the ESHRE meeting in Prague in June 2006 with representatives from participating countries, where the present and future reporting systems were discussed. The Czech Republic and Cyprus were unable to provide data for 2003, but Austria and Serbia and Montenegro joined the consortium and provided data. Latvia and Lithuania provided data again. The consortium stressed that efforts should be made to have better coverage in the Balkan and Eastern European countries. To that end, an ESHRE-EIM workshop was held in Belgrade during September 2006.
The Consortium noted that the quality of data still differs between countries. It was noted that in some large southern European countries the proportion of clinics that provided data should be increased compared with the present status: Spain (35%), Greece (50%) and Italy (60%). However, both Greece and Italy are going to establish compulsory national data collection programmes in the coming years. In 2003, data collection systems, coverage, definitions and validation still differed between countries. However, since the ESHRE Consortium meeting in Madrid 2003, it was decided that in the coming years the EIM Consortium members should continue to adapt to the definitions listed by ICMART as originally published in the WHO report (WHO, 2002), and now in Human Reproduction (Zegers-Hochschild, 2006a) and Fertility and Sterility (Zegers-Hochschild, 2006b).
The Consortium decided to continue to present annual reports and to try to improve the quality of the reports.
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Material and Methods |
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TopAbstractIntroductionMaterial and MethodsResultsCommentsSupplementary dataReferences |
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Data collection
The present report summarizes data from IVF treatments started during 2003. The data include treatments with IVF, ICSI, OD, FER, PGD/PGS, IVM and IUI-H and IUI-D performed from 1 January 2003 to 31 December 2003. Follow-up data on pregnancies and deliveries are cohort data. For IUI only pregnancies, and not deliveries, were recorded. The number of clinics reporting IUI data may differ from the number of clinics presenting data on the in vitro techniques.
As it is evident from the tables, registers from a number of countries have been unable to provide some of the data.
The reporting principle used for 2003 data is basically similar to the preceding year (ESHRE, 2001a,b, 2002, 2004, 2005, 2006).
As the data presented here are incomplete and generated through different methods using different definitions in different countries, interpretation of the data must be done with some caution.
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Results |
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Number of treatment cycles
Table 1 shows the number of all treatment cycles recorded in each country, the number of clinics in the country and the number of clinics reporting to the register. The cycles are subdivided into the IVF, ICSI, FER, OD, IVM and PDG/PGS. In Belgium, France and Iceland, the number of aspirations was used, as the number of initiated cycles was not available. In relation to FER, the number of transfers rather than the number of thawings were used in Austria, Finland and the Netherlands. Totally, 725 clinics from 28 countries reported 365 103 cycles.
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Table 2 shows data from those 15 countries where all clinics reported to the register. The number of cycles is related to the total population in the country and the number of infants born after ART is expressed in percentage of the total number of live-born in the country. Overall 284 765 cycles were undertaken in a population of 278.7 million, giving a mean of 1022 cycles per million. The proportion of infants born after ART in those 15 countries ranged from 0.2 to 3.9%.
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Size of the clinics
Table 3 shows the size distribution of the 725 reporting clinics. The size of a clinic (or unit) is based on all cycles performed per year.
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The distribution of clinics according to the number of cycles varies considerably among the countries. Among the larger countries, it could be noted that in Italy 41% of the clinics did less than 100 cycles annually, whereas in Belgium, Germany and the Netherlands 33–69% of the clinics did more than 1000 cycles a year.
To what extent these variations may influence results cannot be estimated from the present report.
Age distribution
Table 4 shows the age distribution of those women treated with IVF or ICSI in various countries.
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Number of embryos transferred
Table 5 shows the number of embryos transferred after IVF and ICSI combined. The total number of single embryo transfers (SET) was 36 655 (15.7%), dual embryo transfers 130 966 (55.9%), triple embryo transfers, 58 304 (24.9%) and four or more embryo transfers 8207 (3.5%). As indicated in the table, major differences were seen between countries. In 2003, several countries had a rise in SET. The highest levels were found in Belgium (43%), Finland (43%) and Sweden (55%). The proportion of triple embryo transfers ranged from 0.1% in Sweden to 60.7% in Lithuania. Transfer of four or more embryos ranged from 0.0% in several countries to 29.8% in Greece.
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Elective SET (eSET) was reported in 7155 cycles from seven countries. The major contributors were Sweden (3272), France (2196) and Finland (1288). No separate data are available regarding the pregnancy rates after eSET.
Pregnancies and deliveries after treatment
Tables 6–9 show the number of pregnancies and deliveries in relation to the number of initiated cycles, aspirations and transfers, for IVF (Table 6), ICSI (Table 7), FER (Table 8) and OD (Table 9).
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Table 6 shows that after IVF the 31 074 pregnancies resulted from 118 919 aspirations and 105 048 embryo transfers. Thus, the mean clinical pregnancy rate was 26.1% per aspiration and 29.6% per embryo transfer. The latter figure ranged from 20.8–44.4% by country. The delivery rates per embryo transfer after IVF have not been summarized due to incomplete or absence of follow-up of pregnancies in many countries (Table 10).
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Table 7 shows that after ICSI the 40 605 pregnancies resulted from 153 134 aspirations and 141 690 transfers. Thus the mean clinical pregnancy rate was 26.5% per aspiration and 28.7% per embryo transfer. The latter figure ranged from 10.2 to 37.1% by country. The delivery rates per embryo transfer after ICSI have not been summarized due to incomplete or absence of follow-up of pregnancies in many countries (Table 10).
Table 8 shows that after FER 9931 pregnancies resulted from 53 354 transfers. Thus the mean clinical pregnancy rate per embryo transfer after FER was 18.6%. The latter figure ranged from 0 to 33.0% by country. The delivery rates per embryo transfer after FER have not been summarized due to incomplete or absence of follow-up of pregnancies in many countries (Table 11).
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Table 9 shows that after OD 2700 clinical pregnancies resulted from 7117 embryo transfers, giving a pregnancy rate per transfer of 37.9%, with a range from 14.3 to 55.2%. The delivery rates per embryo transfer after OD have not been summarized due to incomplete or absence of follow-up of pregnancies in many countries.
Preimplantation genetic diagnosis/screening
PGD/PGS activity was recorded from 12 countries, as indicated in Table 1: totally it involved 1956 cycles, 1833 aspirations, 1382 embryo transfers, 447 pregnancies (32.3% per transfer) and 298 deliveries.
In vitro maturation
IVM was recorded in two countries. Finland (92 cycles) and Russia (17 cycles). The 109 cycles resulted in 10 (9.2%) pregnancies.
Singleton, twin, triplet and quadruplet deliveries
Table 10 shows the deliveries after IVF and ICSI in relation to singleton, twin and triplet deliveries. The distribution of the deliveries was: singleton 36 189 (76.7%), twin 10 396 (22.0%) and triplet 534 (1.1%). Quadruplets occurred in 41 cases in 2003.
Table 11 shows deliveries after FER in relation to singleton, twin and triplet deliveries. It is seen that the distribution of the deliveries was: singleton 5569 (84.4%), twin 956 (14.5%) and triplet 37 (0.6%).
Risks and fetal reductions
Table 12 presents the incidence of ovarian hyperstimulation syndrome (OHSS) recorded from registers in 24 of the 28 countries. It is seen that 2646 cases of OHSS were recorded. The number of IVF and ICSI cycles in those 24 countries were 255 875, corresponding to a risk of OHSS of 1.0% of all stimulated cycles. Other complications are seen in the table.
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Table 12 also gives data on the number of recorded fetal reductions. In total, 480 fetal reductions were recorded.
Intrauterine inseminations
Table 13 gives data on IUI-H divided in female age groups <40 years (upper panel) and 40 years (lower panel). For France, no stratification for age was available, and the overall results are included in the group below 40 years of age.
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In women below 40 years of age, 79 515 treatments resulted in 9702 pregnancies giving a pregnancy rate per procedure of 12.2%. In women at 40 years or above, the corresponding figures were 3319, 293 and 8.8%.
In women below 40, singleton, twin and triplet pregnancies accounted for 86.4, 11.4 and 2.2%, respectively, of the pregnancies. In women above 40, the corresponding figures were 93.8, 6.2 and 0%.
Table 14 gives data on IUI-D divided in female age groups <40 years (upper panel) and 40 years (lower panel). For France, no stratification for age was available, and the overall results are included in the group below 40 years of age.
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In women below 40 years of age, 15 039 treatments resulted in 2514 pregnancies given a pregnancy rate per insemination of 16.7%. In women at 40 years or above, the corresponding figures were 1704, 106 and 6.3%.
In women below 40, singleton, twin and triplet pregnancies accounted for 88.2, 10.6 and 1.2% of the pregnancies. In women above 40, the corresponding figures were 97.1%, 2.9% and 0%.
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Comments |
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TopAbstractIntroductionMaterial and MethodsResultsCommentsSupplementary dataReferences |
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The present report is the seventh consecutive European report on ART data. Together these reports cover treatment cycles from 1997 to 2003. It can be argued that as long as data are incomplete, generated through different methods of data collection and still using partly different definitions, the data should not be summarized, as it occurs in this report. We would stress, however, that the purpose of this report is more to provide a review of data from the participating National Registers. The focus should thus be on each specific country rather than on summary data.
In 2003, the number of countries reporting to ESHRE's EIM Consortium increased to 28 countries, now covering the whole of Western Europe because Austria joined the Consortium this year. In Central, Eastern and South Eastern Europe, no data were available from a number of countries, like Bosnia, the Czech Republic, Romania and Slovakia. Excluding the Baltic coutries, only Russia and Ukraine provide data.
There has also been an increase in the number of countries (now 15) with complete coverage in their reporting system, defined in the way that all clinics in the country report. As Germany now fulfils this criteria, and as Germany reported more than 100 000 cycles, the majority of data from Europe in the present report originates from countries where the reporting is complete, at least representing all clinics. We still do not have a complete European set of data, as the present report only includes around 70% of all centres in the reporting countries. However, we believe that those clinics that do not report are likely to be smaller in size than those that do report.
The number of reported cycles also continues to grow. In 2003, the total number of cycles reported from 725 clinics reached 365 103, compared with 324 238 cycles from 631 clinics in 2002, an increase by 13%. Additionally the present report includes close to 100 000 IUI-H and IUI-D cycles. It should be noted that the increased number of cycles from Germany during 2003 may in part be explained by more restricted access to free-of-charge public health insurance covered ART from January 2004. It is believed that many couples therefore wanted to be treated during 2003.
During the 7-year period of EIM reporting, the number of cycles has increased from 203 893 in 1997 to the 365 103 in 2003, equivalent to an overall increase by 79%. This marked increase during the period is partly due to a better coverage in the reporting systems but is also due to a true expansion of activities.
The analysis of initiated cycles is confronted with several difficulties. In some countries, the number of initiated cycles was not reported at all and, in most of the other countries, the calculated cancellation rate was far beneath 10%. In other countries, like Germany, the number of initiated cycles that did not reach oocyte recovery was as high as 18.6% after IVF. The criteria for cancellation may certainly vary from country to country, but another explanation may be that the cancellation rates are generally underestimated. In the German system, the quality assurance program only allows cycles to be recorded prospectively. A started cycle thus has to be reported a few days after the start of stimulation, and certainly before planned oocyte retrieval. This will give the true cancellation rates. There is thus a real need to improve the collection of cancelled cycles in order to be able to deliver proper information on the results of ART to the patients and to really compare the countries regarding this variable.
Within Europe, the largest contribution comes from Germany with some 102 000 treatment cycles followed by France with 
60 000 cycles and the UK with 37 000 reported cycles. For comparison, the ASRM/SART registry reported close to 123 000 cycles from the USA in 2003 (Wright et al., 2006).
In southern Europe, a number of countries still in 2003 had a low coverage with 44 out of 187 (Spain), 124 out of 207 (Italy) and 22 out of 44 (Greece) clinics reporting to the EIM. Both Italy and Greece are now in the process of establishing statutory National IVF Registers, which will allow a complete coverage. The situation in Spain remains uncertain.
The availability of services remained highest in Denmark with 2008 cycles per million inhabitants. It should be noted that in the largest Western European countries, the availability was also high in Germany (1243) and France (978) but somewhat lower in the UK (623). The proportion of ART children to all children born in 2003 was also high in the five Nordic countries (2.5–3.9%), Slovenia (2.9%) and Germany (2.6%). In Belgium, the figure is only 1.0%, but this seems to be due to gross under-reporting of deliveries in Belgium (Tables 6 and 7). In the UK and France, it was 1.5%.
The proportion of ICSI versus standard IVF procedures increased from 49% in 2001 to 52% in 2002 and to 55% in 2003, so ICSI is clearly being used increasingly.
The number of embryos transferred in IVF and ICSI cycles differed substantially between countries, also in this report, but there is a clear trend during the years of observation towards transfers with fewer embryos. The mean number of SET increased from 12.0% in 2001 to 13.7% in 2002 and to 15.7% in 2003. The proportion of two embryo transfers increased from 51.7% in 2001 to 54.8% in 2002 and to 55.9% in 2003. The proportion of three embryo transfers decreased from 39.6% in 1999 to 33.3% in 2000, 30.8% in 2001 and 26.9% in 2002 and down to 24.9% in 2003. Four embryo transfers also decreased from 9.3% in 1999 to 6.9% in 2000, 5.5% in 2001 and 4.7% in 2002 and down to 3.5% in 2003. In conclusion, the reduction in the number of embryos transferred continued in 2003.
This report is unable to define the number of eSET versus SET, but the rise in the number of one embryo transfers is undoubtedly due to a rise in eSET. As seen in Table 5 there were seven countries that reported transfer of a single embryo in more than 20% of all cycles. The highest rates were in Belgium and Finland (43%) and Sweden (55%). Of these, eSET is preferred in the IVF legislation in Belgium and Sweden, whereas in Finland the progress has been made collegially by IVF units.
The consistent trend towards transfer of fewer embryos is also reflected in the overall occurrence of multiple deliveries after IVF and ICSI. In 2000, the average multiple delivery rate was 26.9%, declining to 25.5% in 2001, 24.5% in 2002 and 23.1% in 2003. During the 7-year period of EIM reporting, the most remarkable finding regarding multiples has been the reduction in triplet deliveries from 3.6% in 1997, to 2.3% in 1998, 2.3% in 1999, 1.9% in 2000, 1.5% in 2001, 1.3% in 2002 and 1.1% in 2003. Still, however, huge differences exist between countries in relation to triplet rates.
When analysing the range of multiple delivery rates in different countries, the number of fetal reductions should also be considered. A total of 480 procedures were reported, the largest numbers being from France (126), the UK (98), Greece (83) and Spain (59). Without this intervention, the proportion of triplet deliveries would certainly have been higher, considering that the number of reported reductions is almost as high as the number of recorded triplet deliveries (n = 534, Table 10).
Pregnancy rates for IVF, ICSI and FER were basically unchanged in 2003, compared to 2002. For IVF, the mean pregnancy rate per transfer was 29.6% compared to 29.5% in 2002. For ICSI, the mean pregnancy rate was 28.7% compared to 29.4% in 2002. For FER, it was 18.6% compared to 18.4% in 2002. The figures from Europe remain lower than in the USA where 42% of ART transfers resulted in a pregnancy (Wright et al., 2006). However, the multiple birth rates in the USA were also considerably higher at 34% after fresh transfers.
Another relevant end-point of ART is the cumulative delivery rate per started ‘fresh cycle’ (Tiitinen et al., 2004). The importance of this is evident looking at the data from Finland where 4438 started stimulation cycles resulted in 956 deliveries (21.5%). However, as Finland has a policy with extensive use of cryopreservation, 2552 FER cycles (57.5% of the fresh cycles) were also done and these resulted in a further 419 deliveries. Assuming that there is a steady state from year to year between fresh and FER cycles, the 4 438 fresh cycles resulted in 956 + 419 = 1375 deliveries that gives a cumulative delivery rate of 31.0% per started stimulation cycle. The extensive use of eSET and cryopreservation thus gave a very favourably delivery rate per cycle, and an overall multiple delivery rate as low as 12.6%.
The comparison between pregnancy rate and delivery rate shows that the pregnancy loss rate (including induced abortions, spontaneous abortions and extrauterine pregnancies) still varies too much between the countries (Tables 6–8). This raises the question of major differences either in applying the WHO/ESHRE definitions for a clinical pregnancy or in reporting the pregnancy outcomes. Additionally 10% of all pregnancies are lost for follow-up. This shows the work has to be continued at the international level to be able to make appropriate comparisons between countries.
Altogether, 1956 cycles with PGD/PGS were reported, compared to 1563 in 2002. ESHRE has a specially focused and more comprehensive reporting on PGD by the sixth ESHRE PGD Consortium report, which included a total of 2984 cycles in 2003. The two reporting systems are different, as the PGD Consortium bases their reports on detailed data from individual clinics. A comparison indicates that the number of PGD cycles reported to the National Registers, only include around two-thirds of the total activity (Sermon et al., 2006).
For the second year, the present seventh report include European data on treatments with IUI-H (82 828 cycles) and IUI-D (14 779 cycles). The coverage of IUI activities is probably much less comprehensive than for the in vitro techniques. In women below 40 years of age, the pregnancy rate was 12.2% for IUI-H and 16.7% for IUI-D. In women at 40 years or above, the corresponding figures were 8.8% and 6.2%.
After IUI-H in women below 40 years of age, twin pregnancies occurred in 11.4% and triplet pregnancies in 2.2%. The data suggest that the twinning rates are only half of what is found with the in vitro techniques, but that the triplet rates are now higher.
To summarize, the present seventh ESHRE report on ART for Europe in 2003 shows a continuing expansion of the register regarding participating clinics, countries and the number of treatment cycles reported. The pregnancy rates after IVF, ICSI and FER were basically unchanged, but less embryos were transferred and the multiple delivery rates continue to decline and accounted for 23% of all deliveries in 2003. Elective SET had a considerable impact in Belgium, Finland and Sweden and several other countries transferred a single embryo in more that 20% of cycles. This transfer policy is now documented, on a national basis, to have the expected effect on multiple delivery rates after transfer of fresh embryos. The figures were as low as 11.8% in Sweden, 13.5% in Finland and 17.0% in Belgium. Twin gestations seem to be much less frequent after IUI-H and IUI-D Compared with IVF and ICSI, but triplets are now more frequent.
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Supplementary data |
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Supplementary data are available at http://humrep.oxfordjournals.org
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Footnotes |
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1 EIM Committee: Chairman, K.G. Nygren; co-ordinator, A. Nyboe Andersen; members, L. Gianaroli, R. Felberbaum and J. de Mouzon. V. Goossens is scientific officer at ESHRE Central Office, Brussels. See Supplementary data for contributing centres and contact persons representing the data collection programmes in the participating European countries.
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References |
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TopAbstractIntroductionMaterial and MethodsResultsCommentsSupplementary dataReferences |
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ESHRE. (2001a) The European IVF-monitoring programme (EIM), for the European Society of Human Reproduction and Embryology (ESHRE). Assisted reproductive technology in Europe, 1997. Results generated from European registers by ESHRE. Hum Reprod 16:384–391.
ESHRE. (2001b) The European IVF monitoring programme (EIM), for the European Society of Human Reproduction and Embryology (ESHRE). Assisted reproductive technology in Europe, 1998. Results generated from European registers by ESHRE. Hum Reprod 16:2459–2471.
ESHRE. (2002) The European IVF monitoring programme (EIM), for the European Society of Human Reproduction and Embryology (ESHRE). Assisted reproductive technology in Europe, 1999. Results generated from European registers by ESHRE. Hum Reprod 17:3260–3274.
ESHRE. (2004) The European IVF monitoring programme (EIM), for the European Society of Human Reproduction and Embryology (ESHRE). Assisted reproductive technology in Europe, 2000. Results generated from European registers by ESHRE. Hum Reprod 19:490–503.
ESHRE. (2005) The European IVF monitoring programme (EIM), for the European Society of Human Reproduction and Embryology (ESHRE). Assisted reproductive technology in Europe, 2001. Results generated from European registers by ESHRE. Hum Reprod 20:1158–1176.
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Sermon KD, Michiels A, Harton G, et al. (2006) ESHRE PGD Consortium data collection VI: Cycles from January to December 2003 with pregnancy follow-up to October 2004. Hum Reprod doi:10.1093/humrep/del402.
Tiitinen A, Hyden-Granskog C, Gissler M. (2004) What is the most relevant standard of success in assisted reproduction? The value of cryopreservation on cumulative pregnancy rates per single oocyte retrieval should not be forgotten. Hum Reprod 19:2439–2441.
World Health Organization. (2002) In Vayena E, Rowe PJ, Griffin PD (Eds.). Current Practise and Controversies in Assisted Reproduction(World Health Organization, Geneva) 99: pp. 19–22.
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Submitted on January 31, 2007; accepted on February 13, 2007.
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 D. Hvidtjorn, L. Schieve, D. Schendel, B. Jacobsson, C. Svaerke, and P. Thorsen Cerebral Palsy, Autism Spectrum Disorders, and Developmental Delay in Children Born After Assisted Conception: A Systematic Review and Meta-analysis Arch Pediatr Adolesc Med, January 1, 2009; 163(1): 72 - 83. [Abstract] [Full Text] [PDF]
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 A. Svensson, M. Connolly, F. Gallo, and L. Hagglund Long-term fiscal implications of subsidizing in-vitro fertilization in Sweden: A lifetime tax perspective Scand J Public Health, November 1, 2008; 36(8): 841 - 849. [Abstract] [PDF]
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S. M. Nelson and I. A. Greer The potential role of heparin in assisted conception Hum. Reprod. Update, November 1, 2008; 14(6): 623 - 645. [Abstract] [Full Text] [PDF]
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A. Nyboe Andersen, E. Carlsen, and A. Loft Trends in the use of intracytoplasmatic sperm injection marked variability between countries Hum. Reprod. Update, November 1, 2008; 14(6): 593 - 604. [Abstract] [Full Text] [PDF]
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S. Ziebe, P. Devroey, and on behalf of the State of the ART 2007 Workshop Gr Assisted reproductive technologies are an integrated part of national strategies addressing demographic and reproductive challenges Hum. Reprod. Update, November 1, 2008; 14(6): 583 - 592. [Abstract] [Full Text] [PDF]
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J. C. Boxmeer, R. P.M. Steegers-Theunissen, J. Lindemans, M. F. Wildhagen, E. Martini, E. A.P. Steegers, and N. S. Macklon Homocysteine metabolism in the pre-ovulatory follicle during ovarian stimulation Hum. Reprod., November 1, 2008; 23(11): 2570 - 2576. [Abstract] [Full Text] [PDF]
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 K I Aston, C M Peterson, and D T Carrell Monozygotic twinning associated with assisted reproductive technologies: a review Reproduction, October 1, 2008; 136(4): 377 - 386. [Abstract] [Full Text] [PDF]
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 M Connolly, S Hoorens, and W Ledger Money in--babies out: assessing the long-term economic impact of IVF-conceived children J. Med. Ethics, September 1, 2008; 34(9): 653 - 654. [Full Text] [PDF]
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A.M. van Peperstraten, W.L.D.M. Nelen, R.P.M.G Hermens, L. Jansen, E. Scheenjes, D.D.M. Braat, R.P.T.M. Grol, and J.A.M. Kremer Why don't we perform elective single embryo transfer? A qualitative study among IVF patients and professionals Hum. Reprod., September 1, 2008; 23(9): 2036 - 2042. [Abstract] [Full Text] [PDF]
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C. L.R. Barratt The human sperm proteome: the potential for new biomarkers of male fertility and a transformation in our understanding of the spermatozoon as a machine: Commentary on the article 'Identification of proteomic differences in asthenozoospermic sperm samples' by Martinez et al. Hum. Reprod., June 1, 2008; 23(6): 1240 - 1241. [Full Text] [PDF]
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E. Hemminki, R. Klemetti, T. Sevon, and M. Gissler Induced abortions previous to IVF: an epidemiologic register-based study from Finland Hum. Reprod., June 1, 2008; 23(6): 1320 - 1323. [Abstract] [Full Text] [PDF]
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M. C. Magli, E. Van den Abbeel, K. Lundin, D. Royere, J. Van der Elst, L. Gianaroli, and for Committee of the Special Interest Group on Emb Revised guidelines for good practice in IVF laboratories Hum. Reprod., June 1, 2008; 23(6): 1253 - 1262. [Abstract] [Full Text] [PDF]
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K.J. Middelburg, M.J. Heineman, A.F. Bos, and M. Hadders-Algra Neuromotor, cognitive, language and behavioural outcome in children born following IVF or ICSI-a systematic review Hum. Reprod. Update, May 1, 2008; 14(3): 219 - 231. [Abstract] [Full Text] [PDF]
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B.C. Jacod, K.D. Lichtenbelt, G.H. Schuring-Blom, J.S.E. Laven, D. van Opstal, M.J.C. Eijkemans, N.S. Macklon, and on behalf of the IVF-CPM Study Group Does confined placental mosaicism account for adverse perinatal outcomes in IVF pregnancies? Hum. Reprod., May 1, 2008; 23(5): 1107 - 1112. [Abstract] [Full Text] [PDF]
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A. Nyboe Andersen, V. Goossens, A.P. Ferraretti, S. Bhattacharya, R. Felberbaum, J. de Mouzon, K.G. Nygren, and The European IVF-monitoring (EIM) Consortium, for Assisted reproductive technology in Europe, 2004: results generated from European registers by ESHRE Hum. Reprod., April 1, 2008; 23(4): 756 - 771. [Abstract] [Full Text] [PDF]
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 A. Pinborg, A. Loft, and A. N. Andersen Acupuncture with in vitro fertilisation BMJ, March 8, 2008; 336(7643): 517 - 518. [Full Text] [PDF]
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L. Oakley, P. Doyle, and N. Maconochie Lifetime prevalence of infertility and infertility treatment in the UK: results from a population-based survey of reproduction Hum. Reprod., February 1, 2008; 23(2): 447 - 450. [Abstract] [Full Text] [PDF]
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 R. M. Rivera, P. Stein, J. R. Weaver, J. Mager, R. M. Schultz, and M. S. Bartolomei Manipulations of mouse embryos prior to implantation result in aberrant expression of imprinted genes on day 9.5 of development Hum. Mol. Genet., January 1, 2008; 17(1): 1 - 14. [Abstract] [Full Text] [PDF]
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G. M. Chambers, M. G. Chapman, N. Grayson, M. Shanahan, and E. A. Sullivan Babies born after ART treatment cost more than non-ART babies: a cost analysis of inpatient birth-admission costs of singleton and multiple gestation pregnancies Hum. Reprod., December 1, 2007; 22(12): 3108 - 3115. [Abstract] [Full Text] [PDF]
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G. Griesinger, K. Diedrich, and C. Altgassen Stronger reduction of assisted reproduction technique treatment cycle numbers in economically weak geographical regions following the German healthcare modernization law in 2004 Hum. Reprod., November 1, 2007; 22(11): 3027 - 3030. [Abstract] [Full Text] [PDF]
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 M. A. Aboulghar Preventing Ovarian Hyperstimulation Syndrome J. Clin. Endocrinol. Metab., August 1, 2007; 92(8): 2882 - 2884. [Full Text] [PDF]
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