Assisted reproductive technologies in Africa: The African Network and Registry for ART, 2018 and 2019.

RESEARCH QUESTION: What were the utilization, practices and outcomes of assisted reproductive technology (ART) in Africa in 2018 and 2019? DESIGN: Cycle-based data (CBD) and retrospective summary data were collected cross-sectionally from voluntarily participating ART centres. RESULTS: 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. CONCLUSION: 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.

Assisted reproductive technology in Africa: a 5-year trend analysis from the African Network and Registry for ART.

RESEARCH QUESTION: What were the trends in utilization, outcomes and practices in assisted reproductive technology (ART) in Africa between 2013 and 2017? DESIGN: Cycle-based data and retrospective summary data were collected cross-sectionally from voluntarily participating ART centres. RESULTS: During the 5-year period, 153,917 ART procedures were reported from 73 centres in 18 countries. ART utilization remained low in all countries and years. Autologous fresh ART was by far the most common intervention, with little change in the clinical pregnancy rate (CPR) per aspiration (34.9% in 2013; 31.7% in 2017) and a consistent preponderance of young women. Oocyte donation represented less than 10% of reported procedures. Although the transfer of multiple embryos prevailed, elective single-embryo transfer (eSET) resulted in a CPR of 43.2% per transfer in fresh autologous cycles, which was notably higher compared with non-elective SET cycles (16.6%) and all dual embryo transfers (DET; 37.3%). Compared with eSET, elective DET further increased the CPR by less than 5% while raising the multiple delivery rate by 33.4%. The majority of multiples were born preterm. Many pregnancies were, however, lost to follow-up, compromising the delivery and birth outcome data. CONCLUSION: ART monitoring has been successfully established in Africa although progress must continue. Although data are not yet representative, best evidence indicates low access to ART. Perinatal outcome supports eSET, but other social determinants responsible for multiple embryo transfers are important factors to consider. Efforts must be directed at improving pregnancy follow-up. Registry data are integral to the widening of access to high-quality ART in Africa.