Proportion singleton and multiple live births Baby level - All ART treatment cycles types (fresh and frozen), 2014 2.6 1.31 1.31 100 80 39.0 41.4 Percent (%) 60 40 20 97.3 57.3 59.7 0 1 embryo 2 embryos ≥3 embryos Singleton live birth Twin live birth Triplet+ live birth 3,125 Live births 3,537 305 23 Singleton live birth: one live birth Twin live birth: two births and at least one live birth Triplet+ live birth: three or more births and at least one live birth
Proportion of preterm births by plurality Baby level - All ART treatment cycles types (fresh and frozen), 2014 100 80 76 76 71 69 Percent per live birth (%) 60 56 40 17 20 14 11 11 5 0 Singleton Multiple Fresh IVF – own oocytes* Fresh IVF – donor oocytes Natural/modified natural IVF* FET – own oocytes* FET – donor oocytes 24 * Own oocytes exclusively Preterm birth <37 weeks’ gestation Total number of live births were used as the denominator for these calculations.
Birth outcomes by province All ART treatment cycles types (fresh and frozen), 2014 50 40 Percent per cycle start (%) 30 25 21 20 18 17 17 15 10 0 Quebec Rest of Canada Live birth Singleton live birth Live birth Good perinatal outcome* 25 * Good perinatal outcome: singleton live birth at ≥37 weeks’ gestation and a birth weight ≥2,500 grams Cycle starts, and embryo transfers with an unknown birth outcome were removed from the denominator (n=353)
Birth outcomes by province All ART treatment cycles types (fresh and frozen), 2014 50 40 Percent per ET cycle (%) 32 30 27 26 26 22 22 20 10 0 Quebec Rest of Canada Live birth Singleton live birth Live birth Good perinatal outcome* 26 * Good perinatal outcome: singleton live birth at ≥37 weeks’ gestation and a birth weight ≥2,500 grams Cycle starts, and embryo transfers with an unknown birth outcome were removed from the denominator (n=353)
Percentage of multiple live births by province All ART treatment cycles types (fresh and frozen), 2014 30 Percent of ongoing clinical pregnancies (%) 20 12.8 10.1 10 3.4 0 Quebec Rest of Canada OVERALL Multiple 77 725 802 births 27 Ongoing clinical pregnancy: documentation of at least one fetal heart beat on ultrasound Multiple birth: At least one live birth from a multiple pregnancy
Percentage of multiple live births by province Baby level - All ART treatment cycles types (fresh and frozen), 2014 40 29.8 30 Percent per live birth (%) 22.3 20 10 6.0 0 Quebec Rest of Canada OVERALL Multiple 105 1,449 1,554 births 28 Ongoing clinical pregnancy: documentation of at least one fetal heart beat on ultrasound Multiple birth: At least one live birth from a multiple pregnancy
TREATMENT CYCLES FOR 2015 All ART treatment cycles (fresh and frozen) 29
Number of treatment cycles 2015 16,000 15,273 14,000 12,000 10,000 9,526 9,251 9,075 8,000 6,000 4,000 2,000 1,229 1,233 956 722 479 417 383 331 83 51 0 Fresh IVF – own Fresh IVF – donor Natural/modified FET – own FET – donor Frozen oocyte IVF Frozen oocyte IVF oocytes* oocytes natural IVF* oocytes* oocytes – own oocytes* – donor oocytes Cycle starts / Embryo thaw cycles ET cycles 30 * Own oocytes exclusively
Type of treatment cycle, per cycle start All ART treatment cycles (fresh and frozen), 2015 IVF 59.2 FET 37.5 Frozen oocyte IVF 1.8 Oocyte banking 1.2 IVM 0.4 0 20 40 60 80 Percent (%) 31
Type of treatment cycle, per cycle start All ART treatment cycles (fresh and frozen), 2015 Fresh IVF – own oocytes* 53.3 Fresh IVF – donor oocytes 2.5 Natural/modified natural IVF* 3.3 FET – own oocytes* 33.2 FET – donor oocytes 4.3 Frozen oocyte IVF – own oocytes* 0.3 Frozen oocyte IVF – donor oocytes 1.5 Oocyte banking 1.2 IVM 0.4 0 20 40 60 80 Percent (%) 32 * Own oocytes exclusively
Type of treatment cycle, per cycle start All ART treatment cycles (fresh and frozen), 2015 Type of treatment cycle Number Percent IVF – own oocytes* 15,273 53.3 IVF – donor oocytes 722 2.52 Natural/modified natural IVF* 956 3.34 FET – own oocytes* 9,526 33.2 FET – donor oocytes 1,229 4.29 Frozen oocyte IVF – own oocytes* 83 0.29 Frozen oocyte IVF – donor oocytes 417 1.46 Oocyte banking 333 1.16 IVM 118 0.41 TOTAL TREATMENT CYCLES 28,657 33 * Own oocytes exclusively
Reasons for treatment All ART treatment cycles (fresh and frozen), 2015 Male factor 31.6 Unexplained infertility 18.0 Diminished ovarian reserve 17.4 14.4 Advanced female age Tubal factor 11.7 PCOS 7.6 Endometriosis 7.0 PGS/PGD 6.1 Other ovulatory disorder 5.0 4.3 Other female factor No male partner 3.2 Other uterine factor 2.9 Oocyte/embryo banking for cancer treatment 0.9 Oocyte/embryo banking for non-cancer/non-medical reasons 0.9 0.7 Other reasons† 0 5 10 15 20 25 30 35 Percent per cycle start (%) 34 * Categories are not mutually exclusive † Other reasons include: gonadotoxic therapy, no female partner and peritoneal factor or severe adhesions
Clinical pregnancy by type of treatment cycle 2015 58 60 58 53 50 40 40 39 39 38 40 37 Percent (%) 30 30 24 22 20 13 11 10 0 Fresh IVF – own Fresh IVF – donor Natural/modified FET – own oocytes* FET – donor Frozen oocyte IVF – Frozen oocyte IVF – oocytes* oocytes natural IVF* oocytes own oocytes* donor oocytes Per cycle start / embryo thaw cycle Per ET cycle Clinical 3,611 279 98 3,520 484 11 222 pregnancies 35 * Own oocytes exclusively † Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy
Singleton ongoing clinical pregnancy by type of treatment cycle 2015 60 50 46 39 40 36 Percent (%) 32 31 31 31 30 29 30 26 19 20 16 10 9 10 0 Fresh IVF – own Fresh IVF – donor Natural/modified FET – own FET – donor Frozen oocyte IVF Frozen oocyte IVF oocytes* oocytes natural IVF* oocytes* oocytes – own oocytes* – donor oocytes Per cycle start / embryo thaw cycle Per ET cycle * Own oocytes exclusively 36 † Singleton pregnancy: ongoing clinical pregnancy with only one fetal heart beat on ultrasound
Specialized services All ART treatment cycles (fresh and frozen), 2015 Description Number of cycles Gestational carrier 533 Pre-implantation genetic screening and/or diagnosis (PGS/PGD) 2,355 Oocyte or embryo banking due to cancer treatment 190 Oocyte or embryo banking due to non-cancer/non-medical reasons 266 Any use of donor oocytes or embryos 2,383 Frozen oocyte IVF 500 37
Patient age All ART treatment cycles (fresh and frozen), 2015 60 50 Percent per cycle start (%) 38.9 40 30 23.2 20.8 20 9.9 10 7.3 0 <35 35 – 37 38 – 40 41 – 42 ≥43 Patient age (years) 38
TREATMENT CYCLES FOR 2015 ART cycles using IVF – own oocytes 39
Stage of treatment and treatment outcomes ART cycles using IVF – own oocytes, 2015 16,000 15,273 14,275 14,000 12,000 10,000 9,075 8,000 87.1% of ongoing 6,000 clinical pregnancies 3,611 3,299 4,000 2,872 2,000 0 Cycle starts (CS) Oocyte retrieval Embryo transfer Clinical Ongoing clinical Singleton cycles (RET) cycles (ET) pregnancies* pregnancies† pregnancies‡ 998 cancelled: 5,200 no ET: 23.6% per CS 21.6% per CS 18.8% per CS 6.5% per CS 36.4% per RET 25.3% per RET 23.1% per RET 20.1% per RET 39.8% per ET 36.4% per ET 31.6% per ET * Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy 40 † Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound ‡ Singleton pregnancy: ongoing clinical pregnancy with only one fetal heart beat on ultrasound
Percentage of cancelled cycles ART cycles using IVF – own oocytes, 2015 20 15 Percent per cycle start (%) 11.9 11.0 10 8.2 6.5 6.3 5 3.9 0 <35 35 – 37 38 – 40 41 – 42 ≥43 OVERALL Patient age (years) 41
Reasons for cycle cancellation ART cycles using IVF – own oocytes, 2015 Low ovarian response 79.0 Other reasons† 13.6 Premature ovulation 3.5 Patient personal reason 3.9 0.8 High ovarian response Patient error 1.9 Premature luteinization 0.8 0 10 20 30 40 50 60 70 80 90 Percent per cancelled cycle (%) 42 * Categories are not mutually exclusive † Other reasons include: patient illness, donor illness, donor personal reason, donor error, no access to ovaries, other (uns pecified)
Percentage of cycles with no embryo transfer ART cycles using IVF – own oocytes, 2015 48.7 50 41.0 Percent per oocyte retrieval cycle (%) 38.3 40 36.4 35.5 33.5 30 20 10 0 <35 35 – 37 38 – 40 41 – 42 ≥43 OVERALL Patient age (years) 43
Reasons for no embryo transfer ART cycles using IVF – own oocytes, 2015 Freeze all, other reason than OHSS risk (unknown PGS/PGD) 32.4 Freeze all, OHSS risk 18.0 No utilizable embryos 15.7 No normal fertilization 9.4 Freeze all, PGD 6.8 Freeze all, other reason than OHSS risk or PGS/PGD 6.0 Freeze all, PGS 5.9 No oocytes 2.9 No utilizable oocytes 1.6 No sperm 0.7 Inadequate uterine lining 0.7 0 5 10 15 20 25 30 35 Percent per oocyte retrieval cycle with no embryo transfer (%) 44 * Categories are mutually exclusive
Method of insemination ART cycles using IVF – own oocytes, 2015 80 70.1 70 Percent per oocyte retrieval cycle (%) 60 50 40 30 21.0 20 10 5.2 2.8 0.9 0 Conventional IVF only ICSI only Conventional IVF and Not done Missing ICSI 45 Conventional IVF and ICSI: a single ET cycle used both conventional IVF and ICSI
Number of embryos transferred ART cycles using IVF – own oocytes, 2015 60 55.1 50 39.0 Percent per ET cycle (%) 40 30 20 10 5.8 eSET eDET 0 1 embryo 2 embryos ≥3 embryos eSET: eDET: 64.4% per ET=1 46.9% per ET=2 46 * Excludes records with missing number of embryos transferred † Elective single ( eSET) and double (eDET) embryo transfer: transfer of one embryo (eSET) or two embryos (eDET), selected from a larger cohort of available embryos
Number of embryos transferred ART cycles using IVF – own oocytes, 2015 68.4 70 60 52.0 48.1 50 Percent per ET cycle (%) 43.8 40 32.7 30.7 30 19.2 20 10 4.2 1.0 eSET eDET eSET eDET eSET eDET 0 1 embryo 2 embryos ≥3 1 embryo 2 embryos ≥3 1 embryo 2 embryos ≥3 embryos embryos embryos <35 years 35 – 39 years ≥40 years 47 Patient age (years)
Embryo transfer day ART cycles using IVF – own oocytes, 2015 60 51.3 50 42.4 Percent per ET cycle (%) 40 30 20 10 4.8 1.1 0.3 0 Day 1 or 2 Day 3 Day 4 Day 5 Day 6 or 7 48 * Excludes records with missing embryo transfer day
Clinical pregnancy and implantation rate ART cycles using IVF – own oocytes, 2015 60 50 47.4 42.5 40.1 39.8 40 33.6 33.3 Percent (%) 30.1 30 23.7 22.9 20 14.3 14.3 7.9 10 0 <35 35 – 37 38 – 40 41 – 42 ≥43 OVERALL Patient age (years) Clinical pregnancy, per ET cycle Implantation rate 49 * Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy † Implantation rate: number of gestational sacs observed on ultrasound, divided by the total number of embryos transferred
Clinical pregnancy and implantation rate ART cycles using IVF – own oocytes, 2015 60 50 42.2 41.3 39.8 39.0 40 Percent (%) 31.4 30.1 30 25.5 20 13.5 10 0 1 2 ≥3 OVERALL Number of embryos transferred Clinical pregnancy, per ET cycle Implantation rate 50 * Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy † Implantation rate: number of gestational sacs observed on ultrasound, divided by the total number of embryos transferred
Clinical pregnancy and implantation rate by eSET/eDET ART cycles using IVF – own oocytes, 2015 60 49.9 48.8 50 45.1 39.8 40 33.5 Percent (%) 30.4 30.1 28.3 27.6 30 21.2 20 10 0 Elective single embryo Non-elective single Elective double embryo Non-elective double OVERALL transfer (eSET) embryo transfer transfer (eDET) embryo transfer Clinical pregnancy, per ET cycle Implantation rate NOTE: In rare cases, a single embryo may divide and produce twins or triplets. For this reason, a small percentage of multiple pregnancies can result from a single embryo transfer 51 * Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy † Implantation rate: number of gestational sacs observed on ultrasound, divided by the total number of embryos transferred
Clinical pregnancy and implantation rate ART cycles using IVF – own oocytes, 2015 60 47.2 50 39.8 38.9 40 33.7 Percent (%) 30.1 30 23.6 20.3 20 13.7 10 0 Day 2 Day 3 Day 5 OVERALL Embryo transfer day Clinical pregnancy, per ET cycle Implantation rate 52 * Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy † Implantation rate: number of gestational sacs observed on ultrasound, divided by the total number of embryos transferred
Proportion of cycles resulting in an ongoing clinical pregnancy ART cycles using IVF – own oocytes, 2015 60 50 44.5 Percent per ET cycle (%) 39.2 40 36.4 29.3 30 18.2 20 10.4 10 0 <35 35 – 37 38 – 40 41 – 42 ≥43 OVERALL Patient age (years) Singleton pregnancy Multiple pregnancy 53 * Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound † Singleton pregnancy: ongoing clinical pregnancy with only one fetal heart beat on ultrasound; multiple pregnancy: ongoing clinical pregnancy with >1 fetal heart beat
Percentage of multiple pregnancies ART cycles using IVF – own oocytes, 2015 40 Percent per ongoing clinical pregnancy (%) 30 21.9 20 17.1 12.9 12.0 11.9 11.8 10 S 0 <35 35 – 37 38 – 40 41 – 42 ≥43 OVERALL Patient age (years) Multiple 207 98 96 19 7 427 pregnancies 54 * Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound † Multiple pregnancy: ongoing clinical pregnancy with >1 fetal heart beat on ultrasound
Proportion of cycles resulting in an ongoing clinical pregnancy ART cycles using IVF – own oocytes, 2015 60 50 Percent per ET cycle (%) 38.0 40 36.4 35.5 30 27.1 20 10 0 1 2 ≥3 OVERALL Number of embryos transferred Singleton pregnancy Multiple pregnancy NOTE: In rare cases, a single embryo may divide and produce twins or triplets. For this reason, a small percentage of multiple pregnancies can result from a single embryo transfer 55 * Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound † Singleton pregnancy: ongoing clinical pregnancy with only one fetal heart beat on ultrasound; multiple pregnancy: ongoing clinical pregnancy with >1 fetal heart beat
Percentage of multiple ART cycles using IVF – own oocytes, 2015 40 Percent per ongoing clinical pregnancy (%) 30 27.1 25.9 20 12.9 10 2.6 0 1 2 ≥3 OVERALL Number of embryos transferred Multiple 49 341 37 427 pregnancies NOTE: In rare cases, a single embryo may divide and produce twins or triplets. For this reason, a small percentage of multiple pregnancies can result from a single embryo transfer 56 * Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound † Multiple pregnancy: ongoing clinical pregnancy with >1 fetal heart beat on ultrasound
Proportion of cycles resulting in an ongoing clinical pregnancy by plurality and eSET/eDET ART cycles using IVF – own oocytes, 2015 60 50 45.2 41.4 Percent per ET cycle (%) 40 36.4 30.3 30 24.8 20 10 0 Elective single embryo Non-elective single Elective double embryo Non-elective double OVERALL transfer (eSET) embryo transfer transfer (eDET) embryo transfer Singleton pregnancy Multiple pregnancy NOTE: In rare cases, a single embryo may divide and produce twins or triplets. For this reason, a small percentage of multiple pregnancies can result from a single embryo transfer 57 * Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound † Singleton pregnancy: ongoing clinical pregnancy with only one fetal heart beat on ultrasound; multiple pregnancy: ongoing clinical pregnancy with >1 fetal heart beat
Percentage of multiple pregnancies by eSET/eDET ART cycles using IVF – own oocytes, 2015 40 Percent per ongoing clinical pregnancy (%) 30.8 30 22.7 20 12.9 10 2.8 2.0 0 Elective single embryo Non-elective single Elective double embryo Non-elective double OVERALL transfer (eSET) embryo transfer transfer (eDET) embryo transfer Multiple 40 9 212 129 427 pregnancies NOTE: In rare cases, a single embryo may divide and produce twins or triplets. For this reason, a small percentage of multiple pregnancies can result from a single embryo transfer 58 * Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound † Multiple pregnancy: ongoing clinical pregnancy with >1 fetal heart beat on ultrasound
Proportion of cycles resulting in an ongoing clinical pregnancy ART cycles using IVF – own oocytes, 2015 60 50 43.9 Percent per ET cycle (%) 40 36.4 30.0 30 17.7 20 10 0 Day 2 Day 3 Day 5 OVERALL Embryo transfer day Singleton pregnancy Multiple pregnancy 59 * Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound † Singleton pregnancy: ongoing clinical pregnancy with only one fetal heart beat on ultrasound; multiple pregnancy: ongoing clinical pregnancy with >1 fetal heart beat
Percentage of multiple pregnancies ART cycles using IVF – own oocytes, 2015 40 Percent per ongoing clinical pregnancy (%) 30 20 14.7 12.9 12.3 10 7.8 0 Day 2 Day 3 Day 5 OVERALL Embryo transfer day Multiple 6 169 251 427 pregnancies 60 * Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound † Multiple pregnancy: ongoing clinical pregnancy with >1 fetal heart beat on ultrasound
Treatment outcomes ART cycles using IVF – own oocytes, 2015 Treatment outcome Number % per CS % per ET % per CP % per OCP Clinical pregnancy (CP) * 3,611 23.6 39.8 Ongoing clinical pregnancy (OCP) † 3,299 21.6 36.4 91.4 Singleton‡ 2,872 18.8 31.6 79.5 87.1 Multiple‡ 427 2.8 4.7 11.8 12.9 Multiple pregnancy‡ 427 2.8 4.7 11.8 12.9 Twins 407 95.3% of multiple pregnancies were twin gestations Triplet or higher 20 * Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy 61 † Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound ‡ Singleton pregnancy: ongoing clinical pregnancy with only one fetal heart beat on ultrasound; multiple pregnancy: ongoing clinical pregnancy with >1 fetal heart beat
Oocyte retrieval, embryo transfer, clinical pregnancy and singleton pregnancy ART cycles using IVF – own oocytes, 2015 96 100 94 93 92 89 88 80 64 Percent per CS (%) 60 59 57 60 52 45 40 30 26 25 24 21 19 19 20 14 12 8 6 4 0 <35 35 – 37 38 – 40 41 – 42 ≥43 OVERALL Patient age (years) Retrieval Embryo transfer Clinical pregnancy* Singleton pregnancy† 62 * Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy † Singleton pregnancy: ongoing clinical pregnancy with only one fetal heart beat on ultrasound
TREATMENT CYCLES FOR 2015 ART cycles using FET – own oocytes 63
Stage of treatment and treatment outcomes ART cycles using FET – own oocytes, 2015 10,000 9,526 9,251 8,000 6,000 4,000 3,520 3,129 2,802 2,000 0 Embryo thaw cycles Embryo transfer cycles Clinical pregnancies* Ongoing clinical Singleton pregnancies‡ (ET) pregnancies† 275 no ET: 37.0% per thaw 32.8% per thaw 29.4% per thaw 2.9% per thaw 38.1% per ET 33.8% per ET 30.3% per ET * Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy 64 † Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound ‡ Singleton pregnancy: ongoing clinical pregnancy with only one fetal heart beat on ultrasound
Percentage of no embryo transfer ART cycles using FET – own oocytes, 2015 10 8 Percent per embryo thaw cycle (%) 6 3.8 3.7 4 3.3 2.9 2.9 2.7 2 0 <35 35 – 37 38 – 40 41 – 42 ≥43 OVERALL Age at time of oocyte retrieval (years) 65
Number of embryos transferred ART cycles using FET – own oocytes, 2015 80 71.3 70 60 Percent per ET cycle (%) 50 40 27.0 30 20 10 eSET eDET 1.7 0 1 embryo 2 embryos ≥3 embryos eSET: eDET: 42.8% per ET=1 45.5% per ET=2 66 * Elective single (eSET) and double (eDET) embryo transfer: transfer of one embryo (eSET) or two embryos (eDET), selected from a larger cohort of available embryos
Number of embryos transferred ART cycles using FET – own oocytes, 2015 80 75.3 69.8 70 60 55.7 Percent per ET cycle (%) 50 37.7 40 28.4 30 23.9 20 6.5 10 1.8 0.8 eSET eDET eSET eDET eSET eDET 0 1 embryo 2 embryos ≥3 1 embryo 2 embryos ≥3 1 embryo 2 embryos ≥3 embryos embryos embryos <35 years 35 – 39 years ≥40 years Age at time of oocyte retrieval (years) 67
Method of embryo cryopreservation ART cycles using FET – own oocytes, 2015 100 89.3 80 Percent per embryo thaw cycle (%) 60 40 20 10.6 0.1 0 Vitrification Slow freezing Mixed 68
Clinical pregnancy and implantation rate ART cycles using FET – own oocytes, 2015 50 41.2 38.3 38.1 40 36.9 33.6 33.0 32.7 Percent (%) 30 26.3 24.9 18.8 18.0 20 11.6 10 0 <35 35 – 37 38 – 40 41 – 42 ≥43 OVERALL Age at time of oocyte retrieval (years) Clinical pregnancy, per ET cycle Implantation rate 69 * Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy † Implantation rate: number of gestational sacs observed on ultrasound, divided by the total number of embryos transferred
Clinical pregnancy and implantation rate ART cycles using FET – own oocytes, 2015 50 43.3 38.1 40 37.0 36.3 32.7 30.8 28.9 Percent (%) 30 20 13.6 10 0 1 2 ≥3 OVERALL Number of embryos transferred Clinical pregnancy, per ET cycle Implantation rate 70 * Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy † Implantation rate: number of gestational sacs observed on ultrasound, divided by the total number of embryos transferred
Clinical pregnancy and implantation rate by eSET/eDET ART cycles using FET – own oocytes, 2015 50 47.0 44.1 43.0 40.2 38.1 40 32.7 32.2 31.7 31.2 Percent (%) 30 26.2 20 10 0 Elective single embryo Non-elective single Elective double embryo Non-elective double OVERALL transfer (eSET) embryo transfer transfer (eDET) embryo transfer Clinical pregnancy, per ET cycle Implantation rate NOTE: In rare cases, a single embryo may divide and produce twins or triplets. For this reason, a small percentage of multiple pregnancies can result from a single embryo transfer 71 * Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy † Implantation rate: number of gestational sacs observed on ultrasound, divided by the total number of embryos transferred
Proportion of cycles resulting in an ongoing clinical pregnancy ART cycles using FET – own oocytes, 2015 50 40 36.7 34.4 33.8 Percent per ET cycle (%) 28.4 30 21.7 20 17.5 10 0 <35 35 – 37 38 – 40 41 – 42 ≥43 OVERALL Age at time of oocyte retrieval (years) Singleton pregnancy Multiple pregnancy 72 * Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound † Singleton pregnancy: ongoing clinical pregnancy with only one fetal heart beat on ultrasound; multiple pregnancy: ongoing clinical pregnancy with >1 fetal heart beat
Percentage of multiple pregnancies ART cycles using FET – own oocytes, 2015 40 Percent per ongoing clinical pregnancy (%) 30 20 10.9 10.5 10.1 9.9 9.8 10 0 <35 35 – 37 38 – 40 41 – 42 ≥43 OVERALL Age at time of oocyte retrieval (years) Multiple 202 76 39 10 0 327 pregnancies 73 * Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound † Multiple pregnancy: ongoing clinical pregnancy with >1 fetal heart beat on ultrasound
Proportion of cycles resulting in an ongoing clinical pregnancy ART cycles using FET – own oocytes, 2015 50 38.1 40 33.8 Percent per ET cycle (%) 32.4 30 27.7 20 10 0 1 2 ≥3 OVERALL Number of embryos transferred Singleton pregnancy Multiple pregnancy NOTE: In rare cases, a single embryo may divide and produce twins or triplets. For this reason, a small percentage of multiple pregnancies can result from a single embryo transfer 74 * Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound † Singleton pregnancy: ongoing clinical pregnancy with only one fetal heart beat on ultrasound; multiple pregnancy: ongoing clinical pregnancy with >1 fetal heart beat
Percentage of multiple pregnancies ART cycles using FET – own oocytes, 2015 40 Percent per ongoing clinical pregnancy (%) 29.6 29.2 30 20 10.5 10 1.7 0 1 2 ≥3 OVERALL Number of embryos transferred Multiple 37 277 13 327 pregnancies NOTE: In rare cases, a single embryo may divide and produce twins or triplets. For this reason, a small percentage of multiple pregnancies can result from a single embryo transfer 75 * Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound † Multiple pregnancy: ongoing clinical pregnancy with >1 fetal heart beat on ultrasound
Proportion of cycles resulting in an ongoing clinical pregnancy by plurality and eSET/eDET ART cycles using FET – own oocytes, 2015 60 50 41.5 Percent per ET cycle (%) 39.0 40 35.2 33.8 27.5 30 20 10 0 Elective single embryo Non-elective single Elective double embryo Non-elective double OVERALL transfer (eSET) embryo transfer transfer (eDET) embryo transfer Singleton pregnancy Multiple pregnancy NOTE: In rare cases, a single embryo may divide and produce twins or triplets. For this reason, a small percentage of multiple pregnancies can result from a single embryo transfer 76 * Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound † Singleton pregnancy: ongoing clinical pregnancy with only one fetal heart beat on ultrasound; multiple pregnancy: ongoing clinical pregnancy with >1 fetal heart beat
Percentage of multiple pregnancies by eSET/eDET ART cycles using FET – own oocytes, 2015 40 Percent per ongoing clinical pregnancy (%) 31.1 30 27.4 20 10.2 10 1.8 1.6 0 Elective single embryo Non-elective single Elective double embryo Non-elective double OVERALL transfer (eSET) embryo transfer transfer (eDET) embryo transfer Multiple 20 17 146 131 327 pregnancies NOTE: In rare cases, a single embryo may divide and produce twins or triplets. For this reason, a small percentage of multiple pregnancies can result from a single embryo transfer 77 * Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound † Multiple pregnancy: ongoing clinical pregnancy with >1 fetal heart beat on ultrasound
Treatment outcomes ART cycles using FET – own oocytes, 2015 Treatment outcome Number % per % per ET % per CP % per OCP embryo thaw Clinical pregnancy (CP) * 3,520 37.0 38.0 Ongoing clinical pregnancy (OCP) † 3,129 32.8 33.8 88.9 Singleton‡ 2,802 29.4 30.3 79.6 89.5 Multiple‡ 327 3.4 3.5 9.3 10.5 Multiple pregnancy‡ 327 3.4 3.5 9.3 10.5 Twins 311 95% of multiple pregnancies were twin gestations Triplet or higher 16 * Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy 78 † Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound ‡ Singleton pregnancy: ongoing clinical pregnancy with only one fetal heart beat on ultrasound; multiple pregnancy: ongoing clinical pregnancy with >1 fetal heart beat
Embryo transfer, clinical pregnancy and singleton clinical pregnancy ART cycles using FET – own oocytes, 2015 97 97 97 97 100 96 96 80 Percent per embryo thaw cycle (%) 60 40 37 37 40 32 32 30 29 25 24 19 18 17 20 0 <35 35 – 37 38 – 40 41 – 42 ≥43 OVERALL Age at time of oocyte retrieval (years) Embryo transfer Clinical pregnancy* Singleton pregnancy† 79 * Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy † Singleton pregnancy: ongoing clinical pregnancy with only one fetal heart beat on ultrasound
OVERALL SUMMARY 80
Clinical pregnancy by age at time of oocyte retrieval and type of treatment cycle 2015 60 50 Percent per CS/embryo thaw cycle (%) 41 40 39 39 39 39 40 37 37 36 33 30 28 30 24 24 24 20 13 13 10 10 10 6 0 Fresh IVF – own oocytes* Fresh IVF – donor oocytes Natural/modified natural FET – own oocytes* FET – donor oocytes IVF* <35 35 – 39 ≥40 OVERALL 81 * Own oocytes exclusively † Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy
Clinical pregnancy by age at time of oocyte retrieval and type of treatment cycle 2015 70 62 58 60 48 47 50 Percent per ET cycle (%) 41 41 40 40 40 38 40 37 37 36 36 33 30 29 30 25 24 19 20 10 0 Fresh IVF – own oocytes* Fresh IVF – donor oocytes Natural/modified natural FET – own oocytes* FET – donor oocytes IVF* <35 35 – 39 ≥40 OVERALL 82 * Own oocytes exclusively † Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy
Implantation rate 2015 60 50 50 46 40 34 Percent (%) 33 30 29 30 19 20 10 0 Fresh IVF – own Fresh IVF – donor Natural/modified FET – own FET – donor Frozen oocyte IVF Frozen oocyte IVF oocytes* oocytes natural IVF* oocytes* oocytes – own oocytes* – donor oocytes Type of treatment cycle 83 * Own oocytes exclusively † Implantation rate: number of gestational sacs observed on ultrasound, divided by the total number of embryos transferred
Implantation rate by age at time of oocyte retrieval and type of treatment cycle 2015 60 54 50 50 40 40 37 36 36 35 34 Percent (%) 33 32 31 30 30 29 29 30 28 24 18 20 18 15 10 0 Fresh IVF – own oocytes* Fresh IVF – donor oocytes Natural/modified natural FET – own oocytes* FET – donor oocytes IVF* <35 35 – 39 ≥40 OVERALL 84 * Own oocytes exclusively † Implantation rate: number of gestational sacs observed on ultrasound, divided by the total number of embryos transferred
Singleton ongoing clinical pregnancy by age at time of oocyte retrieval and type of treatment cycle 2015 60 Percent per CS/embryo thaw cycle (%) 50 40 37 33 32 31 31 30 29 29 28 28 30 25 24 19 19 18 20 13 9 9 8 10 6 0 Fresh IVF – own oocytes* Fresh IVF – donor oocytes Natural/modified natural FET – own oocytes* FET – donor oocytes IVF* <35 35 – 39 ≥40 OVERALL 85 * Own oocytes exclusively † Singleton pregnancy: ongoing clinical pregnancy with only one fetal heart beat on ultrasound
Singleton ongoing clinical pregnancy by age at time of oocyte retrieval and type of treatment cycle 2015 60 50 47 46 46 Percent per ET cycle (%) 39 40 36 34 33 33 32 31 31 30 30 28 30 26 25 23 20 19 20 17 10 0 Fresh IVF – own oocytes* Fresh IVF – donor oocytes Natural/modified natural FET – own oocytes* FET – donor oocytes IVF* <35 35 – 39 ≥40 OVERALL 86 * Own oocytes exclusively † Singleton pregnancy: ongoing clinical pregnancy with only one fetal heart beat on ultrasound
PRIMARY TRANSFER RATE 87
Primary transfer • Cohort: – Patients with first IVF cycle in CARTR Plus and no documented prior treatment cycle using own oocytes – The first treatment cycle with an embryo transfer • IVF with own oocytes • FET with own oocytes 88
Primary transfer clinical pregnancy rate IVF and FET – using own oocytes, 2013, 2014 and 2015 80 Percent per primary transfer (%) 60 48.6 42.1 40 36.1 20 0 <35 ≥35 OVERALL Patient age (years) Clinical 5,560 4,468 10,028 pregnancy 89 * Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy
Primary transfer clinical pregnancy rate IVF and FET – using own oocytes, 2013, 2014 and 2015 80 Percent per primary transfer (%) 60 52.3 47.1 43.9 41.8 38.4 40 35.3 34.8 32.8 32.6 20 0 1 embryo 2 embryos ≥3 1 embryo 2 embryos ≥3 1 embryo 2 embryos ≥3 embryos embryos embryos <35 years ≥35 years OVERALL 90 Patient age (years) * Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy
CUMULATIVE PREGNANCY RATE 91
Cumulative pregnancy rate • Definition: – The number of clinical pregnancies resulting from one or more ART cycles, including the cycle when fresh embryos are transferred and all related subsequent frozen/thawed embryo transfer cycles if the fresh embryo transfer did not result in a pregnancy • Rationale: – Estimates cumulative success with ongoing treatment, rather than success per individual stage of the treatment process 92
Cumulative pregnancy rate • Several options for calculation: – Per patient: treatment cycle outcomes can be linked for a patient throughout the database – Per batch of oocytes collected: treatment cycles that used frozen oocytes or embryos can be linked to the IVF cycle where the oocytes were collected 93
Cumulative pregnancy rate • Optimistic: – Assumes that women who did not return for subsequent treatment cycles had the same chance of a clinical pregnancy as those who did return for treatment • Conservative: – Assumes that women who did not return for subsequent treatment cycles did not have a clinical pregnancy Malizia BA et al., NEJM 2009; 360: 236-243 94
Cumulative pregnancy rate, per cycle start All ART treatment cycles types (fresh and frozen), 2013, 2014 and 2015 100 90 80 Probability of clinical pregnancy (%) 73.1 64.9 70 60 51.6 58.9 50 52.8 40 43.7 30.0 30 30.0 20 10 0 1 2 3 4 Cycle number Optimistic Conservative 95 Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy Optimistic: Assumes that women who did not return for subsequent treatment cycles had the same chance of a clinical pregnancy as those who did return for treatment. Conservative: Assumes that women who did not return for subsequent treatment cycles did not have a clinical pregnancy.
Cumulative pregnancy rate, per batch of oocytes retrieved IVF and FET – using own oocytes, 2013, 2014 and 2015 100 87.4 90 77.2 80 Probability of clinical pregnancy (%) 70 60.9 60 50 36.2 46.6 46.1 40 44.1 36.2 30 20 10 0 1 2 3 4 Batch number Optimistic Conservative 96 Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy Optimistic: Assumes that women who did not return for subsequent treatment cycles had the same chance of a clinical pregnancy as those who did return for treatment. Conservative: Assumes that women who did not return for subsequent treatment cycles did not have a clinical pregnancy.
Optimistic cumulative pregnancy rate, per batch of oocytes retrieved IVF and FET – using own oocytes, 2013, 2014 and 2015 100 90.1 90 81.5 80 Probability of clinical pregnancy (%) 84.1 66.6 70 72.6 60 50 55.7 42.4 40 30 31.5 20 10 0 1 2 3 4 Cycle number <35 years ≥35 years 97 Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy Optimistic: Assumes that women who did not return for subsequent treatment cycles had the same chance of a clinical pregnancy as those who did return for treatment.
Conservative cumulative pregnancy rate, per batch of oocytes retrieved IVF and FET – using own oocytes, 2013, 2014 and 2015 100 90 80 Probability of clinical pregnancy (%) 70 56.2 55.6 60 52.8 50 42.4 40 39.4 39.1 37.7 30 31.5 20 10 0 1 2 3 4 Cycle number <35 years ≥35 years 98 Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy Conservative: Assumes that women who did not return for subsequent treatment cycles did not have a clinical pregnancy. .
Cumulative pregnancy rate, per batch of oocytes retrieved IVF and FET – using own oocytes, 2013, 2014 and 2015 Optimistic cumulative pregnancy rate 90.1 100 Probability of clinical pregnancy (%) 81.5 80 66.6 84.1 60 72.6 42.4 55.7 40 20 31.5 0 Conservative cumulative pregnancy rate 100 Probability of clinical pregnancy (%) 80 56.2 55.6 52.8 60 42.4 40 39.4 39.1 37.7 20 31.5 0 1 2 3 4 Batch number <35 years ≥35 years 99 Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy Optimistic: Assumes that women who did not return for subsequent treatment cycles had the same chance of a clinical pregnancy as those who did return for treatment. Conservative: Assumes that women who did not return for subsequent treatment cycles did not have a clinical pregnancy.
CLOSING REMARKS 100
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