What were the utilization, practices and outcomes of assisted reproductive technology (ART) in Africa in 2018 and 2019?
Cycle-based data (CBD) and retrospective summary data were collected cross-sectionally from voluntarily participating ART centres.
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.
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.
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Paversan Archary is Clinical Assistant of the African Network and Registry for ART, and regional contributor to the International Committee for Monitoring ART. He is a clinician and academic researcher at 2 Military Hospital, and Groote Schuur Hospital, University of Cape Town. His work and research focus on ART data surveillance in Africa.
Registry data from ART procedures (2018, 2019; 18 countries) from the African Network and Registry for ART, integral to widening access to quality care in Africa. The findings of sound ART effectiveness, including in cases of single embryo transfer, a young patient population and high multiple pregnancy rates, are evident.
Published online: January 26, 2023
Accepted: January 18, 2023
Received in revised form: January 13, 2023
Received: August 31, 2022Declaration: The authors report no financial or commercial conflicts of interest.
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