Abstract
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.
KEYWORDS
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Reproductive BioMedicine OnlineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Direct maternal morbidity and the risk of pregnancy-related deaths, stillbirths, and neonatal deaths in South Asia and sub-Saharan Africa: A population-based prospective cohort study in 8 countries.PLoS medicine. 2021; 18e1003644https://doi.org/10.1371/journal.pmed.1003644
- Funding and public reporting strategies for reducing multiple pregnancy from fertility treatments.Fertil. Steril. 2020; 114: 715-721https://doi.org/10.1016/j.fertnstert.2020.08.1405
- International Committee for Monitoring Assisted Reproductive Technologies World Report: assisted reproductive technology, 2014.Hum. Reprod. 2021; 36: 2921-2934https://doi.org/10.1093/humrep/deab198
- Assisted reproductive technologies in Africa: first results from the African Network and Registry for Assisted Reproductive Technology, 2013.Reprod. Biomed. Online. 2019; 38: 216-224https://doi.org/10.1016/j.rbmo.2018.11.001
- Assisted reproductive technology in Africa: a 5-year trend analysis from the African Network and Registry for ART.Reprod. Biomed. Online. 2020; 41 (1): 604-615https://doi.org/10.1016/j.rbmo.2020.06.021
- Zegers-Hochschild, F. ART utilization: an indicator of access to infertility care.Reprod. Biomed. Online. 2020; 41 (1): 6-9https://doi.org/10.1016/j.rbmo.2020.03.007
- Infertility around the globe: new thinking on gender, reproductive technologies and global movements in the 21st century.Hum Reprod Update. 2015; 21: 411-426https://doi.org/10.1093/humupd/dmv016
- Preimplantation genetic testing for aneuploidy: are we examining the correct outcomes?.Hum. Reprod. 2020; 35: 2408-2412https://doi.org/10.1093/humrep/deaa224
- Accelerate progress—sexual and reproductive health and rights for all: report of the Guttmacher–Lancet Commission.Lancet. 2018; 391: 2642-2692https://doi.org/10.1016/S0140-6736(18)30293-9
- The impact of religion and culture on medically assisted reproduction in the Middle East and Europe.Reprod. Biomed. Online. 2021; 43: 421-433https://doi.org/10.1016/j.rbmo.2021.06.002
- Time to death and its determinants among under-five children in Sub-Saharan Africa using the recent (2010–2018) demographic and health survey data: country-based shared frailty analyses.BMC Pediatr. 2021; 21: 515https://doi.org/10.1186/s12887-021-02950-3
- Infertility Fact Sheet.WHO, Geneva2020 (Accessible at)
- 2017: results generated from European registries by ESHRE.Hum. Reprod. Open. 2021; 2021: hoab026https://doi.org/10.1093/hropen/hoab026
- The International Glossary on Infertility and Fertility Care, 2017.Hum. Reprod. 2017; 32: 1786-1801https://doi.org/10.1093/humrep/dex234
- Assisted reproductive technologies in Latin America: the Latin American Registry. 2019.Reprod. BioMed. 2022; (OnlineMar 12)https://doi.org/10.1016/j.rbmo.2022.02.026
Biography
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.
Key message
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.
Article info
Publication history
Published online: January 26, 2023
Accepted:
January 18,
2023
Received in revised form:
January 13,
2023
Received:
August 31,
2022
Declaration: The authors report no financial or commercial conflicts of interest.Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.
