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