Advertisement

Dynamic view of assisted reproduction in Turkey from 1996–2020: Trends and changes in patient characteristics, clinical and laboratory practices

  • Kayhan Yakin
    Correspondence
    Corresponding author: Kayhan Yakin, American Hospital, Women's Health Centre, Guzelbahce Sokak No: 20, Nisantasi, 34365, Sisli, Istanbul, Turkey.
    Affiliations
    Koç University School of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey

    American Hospital, Women's Health Centre, Istanbul, Turkey
    Search for articles by this author
  • Bulent Urman
    Affiliations
    Koç University School of Medicine, Department of Obstetrics and Gynecology, Istanbul, Turkey

    American Hospital, Women's Health Centre, Istanbul, Turkey
    Search for articles by this author
  • Basak Balaban
    Affiliations
    American Hospital, Women's Health Centre, Istanbul, Turkey
    Search for articles by this author
Published:December 17, 2021DOI:https://doi.org/10.1016/j.rbmo.2021.12.010

      ABSTRACT

      Research question

      What are the trends and changes in patient demographics and practices in assisted reproduction treatment (ART) in Turkey over 25 years?

      Design

      Data regarding patient demographics, cycle characteristics and clinical outcome of 29541 cycles in 22867 women who underwent ART between 1996 and 2020 were analyzed according to the calendar years. Regression and interrupted time series analysis were used to assess changes in patient characteristics, trends and effects of interventions on outcome.

      Results

      From 1996 to 2020, the average age of women undergoing ART increased from 32.1 to 36.0 years (r=0.96), the proportion of women over 40 tripled (9% versus 28.7% (r=.97) and the average duration of infertility at presentation dropped from 8.4 to 4 years (r=-0.98) (p<.0001, for all). Diminished ovarian reserve became the major indication by 2015. GnRH antagonists dominated ovarian stimulation by 2009. The average number of oocytes retrieved decreased from 11.5 to 7.8 (r=-0.86, p<.0001). Blastocyst stage transfers gradually increased, comprising 51% of all transfers in 2020 (r=0.86, p<0.0001). The mean number of embryos transferred decreased from 3.9 to 1.5. Clinical pregnancy rates per embryo transfer remained stable for fresh transfers (range: 31.6% - 43.9%) but increased from 13% to 30.3% in frozen-thawed transfers. The estimate of effect of blastocyst vitrification was significant (p=0.001). The multiple birth rate declined from 30.4% to 7.1%.

      Conclusions

      Remarkable changes were seen in patient demographics, treatment indications, clinical and laboratory practices. Increased utilization of single embryo transfer and improvements in cryopreservation techniques helped maintain high clinical pregnancy rates while reducing multiple births.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal

      Subscribe:

      Subscribe to Reproductive BioMedicine Online
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      Biography

      Kayhan Yakın has received his medical degree from the Hacettepe University School of Medicine and his PhD in Reproductive Medicine from the Koc University Graduate School of Heath Sciences. Since 1998, he has been working on reproductive medicine and assisted reproduction. His major areas of research are reproductive biology, endocrinology and genetics, endometriosis and endoscopic surgery.
      Key message
      Turkey has witnessed substantial changes in patient demographic as well as clinical and laboratory practices over 25 years. Despite managing a constantly aging infertile population, increased utilization of single embryo transfer at the blastocyst stage and improvements in cryopreservation techniques helped maintain high clinical pregnancy rates while reducing multiple births.