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Middle East Fertility Society Journal, Vol. 9, No. 3, 2004, pp. 181-186 EDITORIAL The Middle East IVF Registry for the year 2000 Ragaa Mansour, M.D., Ph.D. The EgyptianIVF-ETCenter, Maadi, Cairo, Egypt Code Number: mf04033 ABSTRACT The International Committee for monitoring ART (ICMART) conducted a workshop in Cairo in order to disseminate tools for data collection and train people to develop national and regional IVF registries. All IVF centers in the Middle East were invited. The program was designed to provide an overview on the already existing national and regional registry models and also to formulate a plan of action to establish the Middle East IVF registry. One hundred and thirty nine infertility specialists representing 97 IVF centers from 14 countries in the Middle East participated in the workshop. The forms for data collection prepared by ICMART were distributed to all centers. Thirty two centers from 8 countries completed the forms for IVF results for the year 2000. In total, data were collected from 1,778 IVF cycles, 14,562 ICSI cycles, and 1030 frozen thawed cycles and 45 GIFT cycles. The clinical pregnancy rates per pick-up were 31.6% in IVF and 27.4% in ICSI. The singleton delivery rate was 67%, twin delivery rate was 27.4% and triplet or high order was 5.2%. The total number of babies born were 621 in IVF, 3,576 in ICSI, 165 from frozen thawed cycles and 14 from oocyte donation. Ovarian hyperstimulation syndrome occurred in 1.68% of all cycles. Key Words: IVF, registry, Middle East, results, ICSI. INTRODUCTION Since the beginning of in vitro fertilization (IVF), and all related assisted reproduction techniques (ART), the number of babies born has now reached over one million. Just like any new modality of treatment, it is essential to evaluate the efficacy and safety. Particularly in ART it is more demanding to do so because this specialty is related to reproduction and early human life. That is why the International Committee for Monitoring ART (ICMART) was established. ICMART has already developed techniques for data collection, has published five world reports on the outcome of ART, and is committed to regular publications. In order to disseminate tools for data collection and train people in different areas to develop their own national and regional registries, ICMART in coordination with WHO has decided to conduct regional workshops where need is identified. Unfortunately we did not have any ART registry for the Middle East, although our area contains a large number of ART centers; some of which are among the 5 largest centers in the world. In Egypt we have finally succeeded in completing our national registry for three successive years, 1999, 2000 and 2001(Mansour RT, 2003). It was timely and highly needed to establish the Middle East ART registry. MATERIALS AND METHODS In order to bring together most of the IVF centers in the Middle East, and establish the first IVF registry for the area, a workshop was organized in Cairo in October 5-7, 2003. The workshop was organized in collaboration with ICMART and WHO. The aim of this workshop was to provide the participants with an understanding of the need for national and regional ART registries and helping them to do so by providing the appropriate methodology and tools. The objectives were to: 1- Understand the need for a national and regional ART registry and the potential benefits for patients, clinicians, and the public health in general. 2- Gain familiarity with national or regional registry systems in other countries and recognize the strength and limitations of the different models. 3- Understand the basic principles and elements that should recognize any ART registry irrespective to its format. 4- Use ICMART tools (e.g. forms, definition). 5- Perform a national need assessment to identify key individuals in their region for the development of national/ regional registries and develop networks and contacts. 6- Formulate and present a plan of action including detailed steps towards the development of a national and regional registry. All IVF centers in the Middle East were contacted and invited to participate in the workshop. The program was divided into three days and was designed to provide an overview of the already existing national and regional registry models and the principles essential to any type of ART registry. Documents distributed to participants included:
It was also very important to make separate groups for each country in the Middle East. That was a very good idea to bring different centers from each country to meet together with one of the ICMART members. It was an essential strategy to formulate plans of action. Finally a general plan for the Middle East IVF registry was to be presented. RESULTS One hundred and thirty nine infertility specialists representing 97 IVF centers from 14 countries in the Middle East and North Africa participated in the workshop. It was agreed that establishing a Middle East IVF registry was a necessity. The forms prepared by ICMART were distributed to all participants to collect IVF data for the year 2000. Thirty two centers from eight countries completed the forms and participated in the first Middle East IVF registry. They were 18 centers from Egypt, 5 centers from Saudi Arabia, two centers from Jordan, two centers from Lebanon, and two centers from Tunisia, and one center from each of United Emirates, Bahrain, and one from an unidentified country. The size of the centers as indicated by the number of cycles per year is shown in Table 1. There are three centers performing more than 1000 cycles per year, 7 large centers performing from 500 to 999 cycles per year and 9 medium centers performing from 200-499 cycles per year, 9 centers performing from 100-199 cycles per year and 4 centers performing less than 100 cycles per year. The total number of cycles, embryos transferred and clinical pregnancies are identified in Table 2. A total of 14562 ICSI cycles and only 1778 IVF cycles were performed. The embryo transfer stage was reached in 95.8% of ovum pick-up cycles. The clinical pregnancy rate was 28% per pick-up. Only 45 cycles of GIFT were performed. The frozen thawed cycles are shown in Table 3. Only 1030 frozen thawed cycles were reported which shows the limited availability of this service. Oocyte donation is only performed in one center from Lebanon and data are shown in Table 4. The women's age at the start of treatment is shown in Table 5. The indications for performing IVF and ICSI are shown in Table 6. The complications resulting from treatment are shown in Table 7. Ovarian hyperstimulation syndrome was reported in 1.68% of all cycles. The deliveries from single and multiple pregnancies are shown in Table 8. Singleton deliveries represented only 67% and the rest were multiples. Perinatal mortality in relation to treatment and multiple deliveries are shown in Table 9. Malformations are shown Table 10. DISCUSSION The present report, the IVF registry for the year 2000, is the first one to cover IVF data from the Middle East. The total number of centers that participated was 32 centers from eight countries. This represents about one third of all centers in the Middle East. A large proportion of the centers that did not participate did not have data because they started their activity after the year 2000, and they decided to participate in the next report. The workshop that was held in Cairo in October 5-7, 2003, and was conducted by the ICMART, was very instrumental in helping to establish the Middle East IVF registry. It was very well attended, as the number of ART centers that participated was 97, which represented about 91% of all centers in the Middle East. It was overwhelmingly agreed upon the necessity to establish an ART registry for the Middle East, and 98.4% of the participants agreed to submit their data directly. The majority of the participants (60.7%) preferred the Middle East IVF registry to be an autonomous organization not associated with any society. The forms prepared by ICMART were distributed to the participants to be used for data collection. The total number of ART cycles reported for the year 2000 was 17,428 (14562 ICSI, 1778 IVF, 1030 frozen thawed, 18 oocyte donation cycles, and 45 GIFT). The latest world IVF results (Adamson et al., 2002) reporting on data for 1998 recorded 388,000 ART procedures world-wide. In a total of 16,340 IVF and ICSI cycles in this report, the clinical pregnancy rate per pick-up was 28%. In Europe the mean pregnancy rate per transfer in IVF was 28.4% and 28.7% in ICSI (Nyboe Andersen et al., 2004). Regarding the size of centers as indicated by the number of cycles, there were three big centers performing more than 1000 cycles per year, seven centers performing from 500-999 cycles per year, 9 centers performing from 200-499 cycles, 9 centers performing from 100-199 cycles and 4 centers performing less than 100 cycles per year. ICSI represented 89% of all cycles and IVF was only 11%. This was a significant predominance of the practice of ICSI as compared to IVF in the Middle East. It reflects the prevalence of male factor either alone (51.8%) or in combination with other factors (19.6%) as compared to female factor as the only cause of infertility, which represented only 16.7%. Unexplained infertility and other factors represented 13.2% of all causes of infertility and it seems that ICSI was the preferred line of treatment for these cases as well. In Europe, the proportion of standard IVF to ICSI procedure was more or less close to each other (56% standard IVF and 44% ICSI). However, in some European countries, ICSI was more prevalent (Nyboe Andersen et al., 2004). Age of women at retrieval showed that 11% of women were >40 years old and the rest of the patients were more or less equally distributed between the other age groups. The multiple pregnancy rates were very high (32.6%) and only 67% of all deliveries were singletons. Twin deliveries constituted 27.4% of all deliveries and triplets or higher order deliveries were 5.2%. This is a reflection of the number of embryos transferred. A large proportion (39.4%) of the patients received 3 embryos, 16.9% of the patients received 4 embryos, and 5.6% received 5 embryos and even 4.3% received 6 embryos or more per transfer. This is an indication of the need to reduce the number of embryos transferred. The limited availability of cryopreservation is the main factor behind the wide-spread practice of transferring more than 3 embryos. Another important factor is the financial constraints, and the lack of medical insurance coverage of any kind to ART. It is difficult for most of the patients to afford repeating the cycle. It has been demonstrated that multiple births are associated with a high risk to both mothers and infants (Senat et al., 1998) such as haemorrhage, hypertension, premature delivery, low birth weight, infant mortality and long-term disability (Kiely et al., 1992). Compared to Europe, the overall occurrence of multiple deliveries after IVF and ICSI was 26.9% in 2000. The triplet deliveries have been reduced from 3.6% in 1997, to 2.3% in 1998-1999, and to 2.0% in 2000 (Nyboe Andersen et al., 2004). In the United States, the ART surveillance for 2001 indicated that 46% of children born were twins and 8% were triplet and higher order multiples (Wright et al., 2004). Complications as a result of the treatment were mainly in the form of ovarian hyperstimulation syndrome, which occurred in 1.68% of the cases. Active measures have to be taken in order to reduce its incidence. Bleeding and infection were rare (0.12% and 0.04%). Data on malformations and follow-up of children were missing from most of the reports. We hope to achieve a better coverage in the next reports. It must be mentioned that the reporting on data was voluntary and the completed forms were sent anonymously (some centers identified themselves). It is considered a good start, however in the future, methods for data accreditation will be adopted. REFERENCES
List of IVF centers that participated in Middle East IVF Registry for the year 2000 Bahrain Defense Force Hospital Bahrain Adam International Hospital Egypt Alex Sydney Kiel Center Egypt Alexandria ICSI Center Egypt Assaf Fertility Center Egypt Cairo Fertility Center Egypt Egypt Air Hospital Egypt El-Rowad Alexandria Center Egypt Faris Medical Center Egypt Hawa Mansoura Center Egypt International Fertility Center Egypt International Fertility IVF Center Egypt Mansoura Integrated Fertility Center Egypt MiamiMedicalCenter for IVF & ICSI Egypt Mohsen khairy Center Egypt Nile Badrawy Hospital Egypt Nozha International Hospital Egypt The Egyptian IVF-ET Center Egypt The Egyptian/German Center for IVF/ICSI Egypt Al-Amal Maternity Hospital Jordan Farah IVF Jordan Centre Belego Libanaise D’infertilite (CBLI) Lebanon Hammoud Hospital Lebanon Bakhsh Hospital Saudi Arabia Dr. Samir Abbas Medical Center Saudi Arabia KingFahdNationalGuardHospital (NGHA) Saudi Arabia KingFaisalSpecialistHospital & Research Centre Saudi Arabia Shorouk Al Hada Polyclinic Saudi Arabia Centre de Medecine de la Reproduction et de Diagnostic Prenatal (CMRDP) Tunisia IVF Center Aziza Othmana Hospital Tunisia Abu Dhabi Gyn., Fertility & Genetics Centre United Arab Emirates Copyright © Middle East Fertility Society |
