Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 145 No. 0506 (2015)

Twenty years’ experience with the Swiss data registry for assisted reproductive medicine: outcomes, key trends and recommendations for improved practice

  • Christian De Geyter
  • Peter Fehr
  • Rebecca Moffat
  • Isabel Marieluise Gruber
  • Michael von Wolff
DOI
https://doi.org/10.4414/smw.2015.14087
Cite this as:
Swiss Med Wkly. 2015;145:w14087
Published
25.01.2015

Abstract

QUESTIONS UNDER STUDY: The impact of assisted reproductive technology (ART) on Swiss demography was quantified. From 1993 to 2012 the number of deliveries, including multiples, generated by ART was compared with overall delivery numbers. Swiss experts in ART collaborated in a consensus to increase successful outcomes, to reduce the incidence of complications of ART and to validate recommendations through statistical review of available data.

METHODS: Data generated between 1993 and 2012 and published by the Federal Office of Statistics (BfS) were compared with the Swiss database on ART (FIVNAT-CH) as organised by the Swiss Society of Reproductive Medicine (SGRM). From these analyses a panel of Swiss experts in ART extracted recommendations to improve current practice, to prevent complications related to ART and to recommend changes in current Swiss legislation dealing with ART.

RESULTS: Since 1993 the age of women giving birth rose together with the number of women asking for ART. This demographic trend was reflected in a rise in the number of deliveries generated by ART (in 2012: 2.2%) and the proportion of multiple births (in 2012: 17.6%). The outcome of ART was most negatively influenced by the age of the treated patient. The number of retrieved oocytes decisively impacted the likelihood of delivery, the risk of multiple births and the incidence of ovarian hyperstimulation syndrome.

CONCLUSIONS: Optimal ovarian stimulation should be designed for the retrieval of 10 to 15 oocytes per treatment. Swiss legislation should enable and stimulate a policy of elective single embryo transfer to avoid multiple births.

References

  1. De Geyter C, De Geyter M, Behre HM. 2009 Assisted Fertilization. Chapter 23 in: “Andrology” (Eds.: E. Nieschlag, H.M. Behre), Third Edition, Springer-Verlag, Berlin, Heidelberg, New York.
  2. Von Wolff M, Dian D. Fertility preservation in women with malignant tumors and gonadotoxic treatments. Dtsch Arztebl Int. 2012;109:220–6.
  3. De Geyter C, Sterthaus O, Miny P, Wenzel F, Lapaire O, De Geyter M, Sartorius G. First successful pregnancy in Switzerland after prospective sex determination of the embryo through the separation of X-chromosome bearing spermatozoa. Swiss Med Wkly. 2013;142:w13718.
  4. Gerris J, De Neubourg D, Mangelschots K, Van Royen E, Vercruyssen M, Barudy-Vasquez J, et al. Elective single day 3 embryo transfer halves the twinning rate without decrease in the ongoing pregnancy rate of an IVF/ICSI programme. Hum Reprod. 2002;17:2626–31.
  5. Thurin A, Hausken J, Hillensjö T, Jablonowska B, Pinborg A, Strandell A, Bergh C. Elective single-embryo transfer versus double-embryo transfer in in vitro fertilization. N Engl J Med. 2004;351:2392–402.
  6. Van Bensdorp AJ, Slappendel E, Koks C, Oosterhuis J, Hoek A, Hompes P, Broekmans F, Verhoeve H, de Bruin JP, van Weert JM, Traas M, Maas J, Beckers N, Repping S, Mol BW, van der Veen F, van Wely M. The INeS study: prevention of multiple pregnancies: a randomised controlled trial comparing IUI COH versus IVF e SET versus MNC IVF in couples with unexplained or mild male subfertility. BMC Womens Health. 2009;9:35.
  7. De Geyter C. (2012) Assisted reproductive medicine in Switzerland. Swiss Med Wkly. 2012;142:w13569.
  8. Germond M, Senn A. A law affecting medically assisted procreation is on the way in Switzerland. J Assist Reprod Genet. 1996;16:341–3.
  9. Wunder D, Neurohr EM, Faouzi M, Birkhäuser MH. Origin and outcome of multiple pregnancies in Bern, Switzerland, 1995–2006 and the current proposal of the Swiss Parliament to revise the Swiss law of reproductive medicine: Switzerland quo vadis? Swiss Med Wkly. 2013;143:w13864.
  10. Van den Bergh M, Hohl MK, De Geyter Ch., Stalberg AM, Limoni C. Ten years of Swiss National IVF Register FIVNAT-CH. Are we making progress? Reprod Biomed Online. 2005;11:632–40.
  11. Sunkara SK, Rittenberg V, Raine-Fenning N, Bhattacharya S, Zamora J, Coomarasamy A. Association between the number of eggs and live birth in IVF treatment: an analysis of 400 135 treatment cycles. Hum Reprod. 2011;26:1768–74.
  12. La Marca A, Giulini S, Tirelli A, Bertucci E, Marsella T, Xella S, Volpe A. Anti-Müllerian hormone measurement on any day of the menstrual cycle strongly predicts ovarian response in assisted reproductive technology. Hum Reprod. 2007;22:766–71.
  13. Andersen AN, Witjes H, Gordon K, Mannaerts B; Xpect investigators. Predictive factors of ovarian response and clinical outcome after IVF/ICSI following a rFSH/GnRH antagonist protocol with or without oral contraceptive pre-treatment. Hum Reprod. 2011;26:3413–23.
  14. Weghofer A, Kim A, Barad DH, Gleicher N. Follicle stimulating hormone and anti-Müllerian hormone per oocyte in predicting in vitro fertilization pregnancy in high responders: a cohort study. PLoS One 2012;7:e34290.
  15. Anckaert E, Smitz J, Schiettecatte J, Klein BM, Arce JC. The value of anti-Mullerian hormone measurement in the long GnRH agonist protocol: association with ovarian response and gonadotrophin-dose adjustments. Hum Reprod. 2012;27:1829–39.
  16. Arce JC, La Marca A, Mirner Klein B, Nyboe Andersen A, Fleming R. Antimüllerian hormone in gonadotropin releasing-hormone antagonist cycles: prediction of ovarian response and cumulative treatment outcome in good-prognosis patients. Fertil Steril. 2013;99:1644–53.
  17. Ocal P, Sahmay S, Cetin M, Irez T, Guralp O, Cepni I. Serum anti-Müllerian hormone and antral follicle count as predictive markers of OHSS in ART cycles. J Assist Reprod Genet. 2011;28:1197–203.
  18. Lee TH, Liu CH, Huang CC, Wu YL, Shih YT, Ho HN, et al. Serum anti-Müllerian hormone and estradiol levels as predictors of ovarian hyperstimulation syndrome in assisted reproduction technology cycles. Hum Reprod. 2011;23:160–7.
  19. Yovich J, Stanger J, Hinchliffe P. Targeted gonadotrophin stimulation using the PIVET algorithm markedly reduces the risk of OHSS. Reprod Biomed Online. 2012;24:281–92.
  20. Olivennes F, Howles CM, Borini A, Germond M, Trew G, Wikland M, et al.; CONSORT study group. Individualizing FSH dose for assisted reproduction using a novel algorithm: the CONSORT study. Reprod Biomed Online. 2009;18:195–204.
  21. Yates AP, Rustamov O, Roberts SA, Lim HY, Pemberton PW, Smith A, Nardo LG. Anti-Mullerian hormone-tailored stimulation protocols improve outcomes whilst reducing adverse effects and costs of IVF. Hum Reprod. 2011;26:2353–62.
  22. La Marca A, Papaleo E, Grisendi V, Argento C, Giulini S, Volpe A. Development of a nomogram based on markers of ovarian reserve for the individualisation of the follicle-stimulating hormone starting dose in in vitro fertilisation cycles. BJOG. 2012;119:1171–9.
  23. Oliveira JB, Baruffi RL, Petersen CG, Mauri AL, Nascimento AM, Vagnini L, Ricci J, Cavagna M, Franco JG Jr. A new ovarian response prediction index (ORPI): implications for individualised controlled ovarian stimulation. Reprod Biol Endocrinol. 2012;10:94.
  24. Rustamov O, Smith A, Roberts SA, Yates AP, Fitzgerald C, Krishnan M, et al. Anti-Mullerian hormone: poor assay reproducibility in a large cohort of subjects suggests sample instability. Hum Reprod. 2012;27:3085–91.
  25. Al-Inany HG, Youssef MA, Aboulghar M, Broekmans F, Sterrenburg M, Smit J, et al. Gonadotrophin-releasing hormone antagonists for assisted reproductive technology. Cochrane Database Syst Rev 2011;CD001750.
  26. Griesinger G, Schultz L, Bauer T, Broessner A, Frambach T, Kissler S. Ovarian hyperstimulation syndrome prevention by gonadotropin-releasing hormone agonist triggering of final oocyte maturation in a gonadotropin-releasing hormone antagonist protocol in combination with a “freeze-all” strategy: a prospective multicentre study. Fertil Steril. 2011;95:2029–33.
  27. Kedem A, Tsur A, Haas J, Yerushalmi GM, Hourvitz A, Machtinger R, Orvieto R. Is the modified natural in vitro fertilization cycle justified in patients with “genuine” poor response to controlled ovarian hyperstimulation? Fertil Steril. 2014 Mar 25.
  28. Fehr P, Nygren KP, De Geyter C. Effect of different embryo transfer strategies on the outcome of assisted reproduction. Ther Umsch. 2009;66:825–9.