Canadian Assisted Reproductive Technologies Register Plus (CARTR - - PowerPoint PPT Presentation

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Canadian Assisted Reproductive Technologies Register Plus (CARTR Plus)

Canadian Fertility and Andrology Society

62nd Annual Meeting – Toronto September 22-24, 2016

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CARTR Plus presentation outline

• All ART treatment cycles 2011─2015
• Birth outcomes ─ 2014
• All ART treatment cycles ─ 2015
• Primary transfer rate
• Cumulative pregnancy rate
• Key messages

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List of abbreviations

CS Cycle start RET Oocyte retrieval ET Embryo transfer IVF In vitro fertilization FET Frozen embryo transfer PGS/PGD Preimplantation genetic screening/diagnosis IVM In vitro maturation OHSS Ovarian hyperstimulation syndrome eSET Elective single embryo transfer neSET Non-elective single embryo transfer eDET Elective double embryo transfer neDET Non-elective double embryo transfer

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Disclaimer

• This report is based on data submitted by assisted

reproductive technology clinics from across Canada to the CARTR Plus database. Although significant effort has been made to ensure the accuracy of the information presented in this report, neither the authors nor BORN Ontario nor any

• ther parties make any representation or warranties as to the

accuracy, reliability or completeness of the information contained herein.

• Permission is granted for the reproduction of these materials

solely for non‐commercial and educational purposes.

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Suggested citations

Canadian Assisted Reproductive Technologies Registry (CARTR)

• Plus. Final treatment cycle and pregnancy outcome data for
• 2014. Better Outcomes Registry & Network Ontario. Ottawa

ON, September 2016. Canadian Assisted Reproductive Technologies Registry (CARTR)

• Plus. Preliminary treatment cycle data for 2015. Better

Outcomes Registry & Network Ontario. Ottawa ON, September 2016.

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Notes

• All data current as of June 2016.
• Treatment cycle outcomes for 2015 cycle starts

– Based on 32 clinics (not exactly the same clinics as previous years)

• Birth outcomes for 2014 cycle starts

– Based on 34 clinics

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CARTR Plus records extracted June 2016

Total treatment records entered into CARTR Plus with a cycle start date between Jan 1, 2013 and Dec 31, 2015: n = 82,172

* Unacknowledged records were included if they were “submitted” or if they linked to an outcome

2014 Treatment cycles: n = 28,166 2015 Treatment cycles: n = 28,657 32 clinics

Birth outcomes 95.9% complete (8,706/9,082) per ongoing clinical pregnancy

34 clinics 2013 Treatment cycles: n = 25,349 31 clinics 34 clinics

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Notes

• These slides present descriptive estimates on which no formal

statistical tests have been carried out; therefore, differences across treatment cycles, patient characteristics or embryo transfer characteristics may not be statistically significant and should be interpreted cautiously

• Unless otherwise specified, denominators for birth outcomes

are based on the pregnancy level

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INTRODUCTION

All ART treatment cycles (fresh and frozen)

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Number of clinics

All ART treatment cycles types

5 7 11 7 30 6 7 11 7 31 6 7 10 11 34 6 5 14 7 32

5 10 15 20 25 30 35 40 <200 200–499 500–999 ≥1,000 TOTAL

Number of treatment cycles CARTR, 2012 CARTR Plus, 2013 CARTR Plus, 2014 CARTR Plus, 2015

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Number of cycles and clinical pregnancies

All ART treatment cycles types

23,997 19,811 7,030 6,368 25,782 21,054 7,714 6,982 25,349 19,785 7,704 7,693 28,166 20,886 8,241 8,236 28,657 20,843 8,236 7,435

5,000 10,000 15,000 20,000 25,000 30,000 Cycle starts Embryo transfer cycles Clinical pregnancies* Ongoing clinical pregnancies†

CARTR, 2011 CARTR, 2012 CARTR Plus, 2013 CARTR Plus, 2014 CARTR Plus, 2015

* Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy † Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound

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Number of multiple pregnancies

All ART treatment cycles types

6,368 1,350 6,982 1,217 7,693 1,166 8,236 1,037 7,435 905

1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000 Ongoing clinical pregnancies* Multiple pregnancies†

CARTR, 2011 CARTR, 2012 CARTR Plus, 2013 CARTR Plus, 2014 CARTR Plus, 2015

* Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound † Multiple pregnancy: ongoing clinical pregnancy with >1 fetal heart beat on ultrasound

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Percentage of multiple pregnancies

All ART treatment cycles types

21.2 17.4 15.2 12.6 12.2

5 10 15 20 25 30 CARTR, 2011 CARTR, 2012 CARTR Plus, 2013 CARTR Plus, 2014 CARTR Plus, 2015 Percent per ongoing clinical pregnancy (%)

Twin Triplet+

* Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound † Multiple pregnancy: ongoing clinical pregnancy with >1 fetal heart beat on ultrasound

1,278 1,152 1,121 Twin pregnancies 72 65 45 Triplet+ pregnancies 34 1,003 862 43

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BIRTH OUTCOMES FOR 2014

All ART treatment cycles (fresh and frozen)

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Birth outcomes success rates

All ART treatment cycles types (fresh and frozen), 2014

6,215 5,413 4,553

1,000 2,000 3,000 4,000 5,000 6,000 7,000 Live birth Singleton live birth Live birth Good perinatal outcome*

* Good perinatal outcome: singleton live birth at ≥37 weeks’ gestation and a birth weight ≥2,500 grams † Cycle starts, oocyte retrievals/thaws and embryo transfers with an unknown birth outcome were removed from the denominator (n=353)

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Birth outcomes success rates

All ART treatment cycles types (fresh and frozen), 2014

* Good perinatal outcome: singleton live birth at ≥37 weeks’ gestation and a birth weight ≥2,500 grams OCP - Ongoing clinical pregnancy: a clinical pregnancy with documentation of at least one fetal heart beat on ultrasound Cycle starts, oocyte retrievals/thaws and embryo transfers with an unknown birth outcome were removed from the denominator (n=353)

22.3 23.5 29.8 75.4 19.4 20.4 25.9 65.7 16.3 17.2 21.8 55.2

20 40 60 80 100 Per CS Per RET/THAW Per ET Per OCP Percent (%)

Live birth Singleton live birth Live birth Good perinatal outcome*

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Distribution of birth outcomes among ongoing clinical pregnancies

ART cycles using IVF and FET – own oocytes, 2014

Singleton live birth 66.1% Multiple live birth 10.6% Stillbirth 0.7% Miscarriage 18.7% Unknown 3.8% Singleton live birth 65.6% Multiple live birth 8.1% Stillbirth 0.7% Miscarriage 22.2% Unknown 3.5%

IVF – own oocytes n= 4,022 FET – own oocytes n= 3,281

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Birth outcome success rates

ART cycles using IVF – own oocytes, 2014

49 44 35 21 15 41 34 24 11 6 35 30 20 10 6 30 25 17 8 4 10 20 30 40 50 60

<35 35–37 38–40 41–42 ≥43

Percent per ET cycle (%) Patient age (years)

Ongoing clinical pregnancy Live birth Singleton live birth Live birth Good perinatal outcome*

* Good perinatal outcome: singleton live birth at ≥37 weeks’ gestation and a birth weight ≥2,500 grams

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Birth outcome success rates

ART cycles using FET – own oocytes, 2014

42 38 31 28 22 32 28 21 15 13 29 24 19 14 13 25 20 15 13 12 10 20 30 40 50 60

<35 35–37 38–40 41–42 ≥43

Percent per ET cycle (%) Age at time of oocyte retrieval (years)

Ongoing clinical pregnancy Live birth Singleton live birth Live birth Good perinatal outcome*

* Good perinatal outcome: singleton live birth at ≥37 weeks’ gestation and a birth weight ≥2,500 grams

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Proportion of miscarriage and stillbirth rates

ART cycles using IVF – own oocytes, 2014

41.0 5.9 0.37 30.9 8.3 0.26 12.3 9.5 0.14 31.1 7.6 0.27 10 20 30 40 50

Live birth MiscarriageƗ Stillbirth*

Percent per ET cycle (%)

<35 35–39 ≥40 OVERALL

* Stillbirths: birth outcome where no fetus(es) was born alive and at least one stillbirth at ≥ 20 weeks’ gestation Ɨ Miscarriage: birth outcome where all fetuses were a ‘pregnancy loss’ at <20 weeks’ gestation

Patient age (years)

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Proportion of miscarriage and stillbirth rates

ART cycles using FET – own oocytes, 2014

32.4 8.1 0.30 26.2 8.6 0.27 14.6 10.4 0.11 28.3 8.5 0.27 10 20 30 40 50

Live birth MiscarriageƗ Stillbirth*

Percent per ET cycle (%)

<35 35–39 ≥40 OVERALL

* Stillbirths: birth outcome where no fetus(es) was born alive and at least one stillbirth at ≥ 20 weeks’ gestation Ɨ Miscarriage: birth outcome where all fetuses were a ‘pregnancy loss’ at <20 weeks’ gestation

Age at time of oocyte retrieval (years)

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Percentage of birth outcomes by method of insemination

ART cycles using IVF – own oocytes, 2014

44.5 39.1 44.0 34.1 30.1 33.4 29.5 25.8 30.5 24.7 21.7 25.5 10 20 30 40 50 Conventional IVF only ICSI only Conventional IVF and ICSI Percent per ET cycle (%) Ongoing clinical pregnancy Live birth Singleton live birth Live birth - Good perinatal outcome*

* Good perinatal outcome: singleton live birth at ≥37 weeks’ gestation and a birth weight ≥2,500 grams † Conventional IVF and ICSI: a single ET cycle used both conventional IVF and ICSI

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Proportion singleton and multiple live births

Baby level - All ART treatment cycles types (fresh and frozen), 2014

97.3 57.3 59.7 2.6 41.4 39.0 1.31 1.31 20 40 60 80 100 1 embryo 2 embryos ≥3 embryos Percent (%) Singleton live birth Twin live birth Triplet+ live birth

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

Live births 3,537 3,125 305

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Proportion of preterm births by plurality

Baby level - All ART treatment cycles types (fresh and frozen), 2014

11 69 17 76 5 56 11 71 14 76 20 40 60 80 100

Singleton Multiple

Percent per live birth (%)

Fresh IVF – own oocytes* Fresh IVF – donor oocytes Natural/modified natural IVF* FET – own oocytes* FET – donor oocytes

* Own oocytes exclusively Preterm birth <37 weeks’ gestation Total number of live births were used as the denominator for these calculations.

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Birth outcomes by province

All ART treatment cycles types (fresh and frozen), 2014

18 25 17 21 15 17 10 20 30 40 50 Quebec Rest of Canada Percent per cycle start (%)

Live birth Singleton live birth Live birth Good perinatal outcome*

* 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)

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Birth outcomes by province

All ART treatment cycles types (fresh and frozen), 2014

27 32 26 26 22 22 10 20 30 40 50 Quebec Rest of Canada Percent per ET cycle (%)

Live birth Singleton live birth Live birth Good perinatal outcome*

* 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)

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Percentage of multiple live births by province

All ART treatment cycles types (fresh and frozen), 2014

3.4 12.8 10.1

10 20 30 Quebec Rest of Canada OVERALL Percent of ongoing clinical pregnancies (%)

Ongoing clinical pregnancy: documentation of at least one fetal heart beat on ultrasound Multiple birth: At least one live birth from a multiple pregnancy

Multiple births 77 725 802

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Percentage of multiple live births by province

Baby level - All ART treatment cycles types (fresh and frozen), 2014

6.0 29.8 22.3

10 20 30 40 Quebec Rest of Canada OVERALL Percent per live birth (%)

Ongoing clinical pregnancy: documentation of at least one fetal heart beat on ultrasound Multiple birth: At least one live birth from a multiple pregnancy

Multiple births 105 1,449 1,554

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TREATMENT CYCLES FOR 2015

All ART treatment cycles (fresh and frozen)

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Number of treatment cycles

2015

15,273 722 956 9,526 1,229 83 417 9,075 479 331 9,251 1,233 51 383

2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000

Fresh IVF – own

• ocytes*

Fresh IVF – donor

• ocytes

Natural/modified natural IVF* FET – own

• ocytes*

FET – donor

• ocytes

Frozen oocyte IVF – own oocytes* Frozen oocyte IVF – donor oocytes

Cycle starts / Embryo thaw cycles ET cycles

* Own oocytes exclusively

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Type of treatment cycle, per cycle start

All ART treatment cycles (fresh and frozen), 2015

0.4 1.2 1.8 37.5 59.2

20 40 60 80 IVM Oocyte banking Frozen oocyte IVF FET IVF Percent (%)

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Type of treatment cycle, per cycle start

All ART treatment cycles (fresh and frozen), 2015

0.4 1.2 1.5 0.3 4.3 33.2 3.3 2.5 53.3

20 40 60 80 IVM Oocyte banking Frozen oocyte IVF – donor oocytes Frozen oocyte IVF – own oocytes* FET – donor oocytes FET – own oocytes* Natural/modified natural IVF* Fresh IVF – donor oocytes Fresh IVF – own oocytes* Percent (%)

* Own oocytes exclusively

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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

* Own oocytes exclusively

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Reasons for treatment

All ART treatment cycles (fresh and frozen), 2015

0.7 0.9 0.9 2.9 3.2 4.3 5.0 6.1 7.0 7.6 11.7 14.4 17.4 18.0 31.6

5 10 15 20 25 30 35 Other reasons† Oocyte/embryo banking for non-cancer/non-medical reasons Oocyte/embryo banking for cancer treatment Other uterine factor No male partner Other female factor Other ovulatory disorder PGS/PGD Endometriosis PCOS Tubal factor Advanced female age Diminished ovarian reserve Unexplained infertility Male factor Percent per cycle start (%)

* Categories are not mutually exclusive † Other reasons include: gonadotoxic therapy, no female partner and peritoneal factor or severe adhesions

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Clinical pregnancy by type of treatment cycle

2015

24 39 11 37 39 13 53 40 58 30 38 40 22 58 10 20 30 40 50 60

Fresh IVF – own

• ocytes*

Fresh IVF – donor

• ocytes

Natural/modified natural IVF* FET – own oocytes* FET – donor

• ocytes

Frozen oocyte IVF –

• wn oocytes*

Frozen oocyte IVF – donor oocytes

Percent (%)

Per cycle start / embryo thaw cycle Per ET cycle

* Own oocytes exclusively † Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy

Clinical pregnancies 3,611 279 98 484 11 222 3,520

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Singleton ongoing clinical pregnancy by type of treatment cycle

2015

19 31 9 29 31 10 36 32 46 26 30 31 16 39 10 20 30 40 50 60

Fresh IVF – own

• ocytes*

Fresh IVF – donor

• ocytes

Natural/modified natural IVF* FET – own

• ocytes*

FET – donor

• ocytes

Frozen oocyte IVF – own oocytes* Frozen oocyte IVF – donor oocytes

Percent (%)

Per cycle start / embryo thaw cycle Per ET cycle

* Own oocytes exclusively † Singleton pregnancy: ongoing clinical pregnancy with only one fetal heart beat on ultrasound

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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

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Patient age

All ART treatment cycles (fresh and frozen), 2015

38.9 23.2 20.8 9.9 7.3

10 20 30 40 50 60 <35 35–37 38–40 41–42 ≥43 Percent per cycle start (%)

Patient age (years)

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TREATMENT CYCLES FOR 2015

ART cycles using IVF– own oocytes

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Stage of treatment and treatment outcomes

ART cycles using IVF – own oocytes, 2015

15,273 14,275 9,075 3,611 3,299 2,872

2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 Cycle starts (CS) Oocyte retrieval cycles (RET) Embryo transfer cycles (ET) Clinical pregnancies* Ongoing clinical pregnancies† Singleton pregnancies‡

998 cancelled: 6.5% per CS 21.6% per CS 23.1% per RET 36.4% per ET 18.8% per CS 20.1% per RET 31.6% per ET 23.6% per CS 25.3% per RET 39.8% per ET

* Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy † 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

5,200 no ET: 36.4% per RET

87.1% of ongoing clinical pregnancies

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Percentage of cancelled cycles

ART cycles using IVF – own oocytes, 2015

3.9 6.3 8.2 11.0 11.9 6.5

5 10 15 20 <35 35–37 38–40 41–42 ≥43 OVERALL Percent per cycle start (%)

Patient age (years)

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Reasons for cycle cancellation

ART cycles using IVF – own oocytes, 2015

0.8 1.9 0.8 3.9 3.5 13.6 79.0

10 20 30 40 50 60 70 80 90 Premature luteinization Patient error High ovarian response Patient personal reason Premature ovulation Other reasons† Low ovarian response Percent per cancelled cycle (%)

* Categories are not mutually exclusive † Other reasons include: patient illness, donor illness, donor personal reason, donor error, no access to ovaries, other (unspecified)

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Percentage of cycles with no embryo transfer

ART cycles using IVF – own oocytes, 2015

33.5 35.5 38.3 41.0 48.7 36.4

10 20 30 40 50 <35 35–37 38–40 41–42 ≥43 OVERALL Percent per oocyte retrieval cycle (%)

Patient age (years)

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Reasons for no embryo transfer

ART cycles using IVF – own oocytes, 2015

0.7 0.7 1.6 2.9 5.9 6.0 6.8 9.4 15.7 18.0 32.4

5 10 15 20 25 30 35 Inadequate uterine lining No sperm No utilizable oocytes No oocytes Freeze all, PGS Freeze all, other reason than OHSS risk or PGS/PGD Freeze all, PGD No normal fertilization No utilizable embryos Freeze all, OHSS risk Freeze all, other reason than OHSS risk (unknown PGS/PGD) Percent per oocyte retrieval cycle with no embryo transfer (%)

* Categories are mutually exclusive

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Method of insemination

ART cycles using IVF – own oocytes, 2015

21.0 70.1 5.2 2.8 0.9

10 20 30 40 50 60 70 80 Conventional IVF only ICSI only Conventional IVF and ICSI Not done Missing Percent per oocyte retrieval cycle (%)

Conventional IVF and ICSI: a single ET cycle used both conventional IVF and ICSI

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Number of embryos transferred

ART cycles using IVF – own oocytes, 2015

55.1 39.0 5.8

10 20 30 40 50 60 1 embryo 2 embryos ≥3 embryos Percent per ET cycle (%) eSET: 64.4% per ET=1

eSET eDET

eDET: 46.9% per ET=2

* 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

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Number of embryos transferred

ART cycles using IVF – own oocytes, 2015

68.4 30.7 1.0 52.0 43.8 4.2 32.7 48.1 19.2

10 20 30 40 50 60 70 1 embryo 2 embryos ≥3 embryos 1 embryo 2 embryos ≥3 embryos 1 embryo 2 embryos ≥3 embryos Percent per ET cycle (%)

eSET eDET eSET eSET eDET eDET <35 years 35–39 years ≥40 years Patient age (years)

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Embryo transfer day

ART cycles using IVF – own oocytes, 2015

4.8 42.4 0.3 51.3 1.1

10 20 30 40 50 60 Day 1 or 2 Day 3 Day 4 Day 5 Day 6 or 7 Percent per ET cycle (%)

* Excludes records with missing embryo transfer day

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Clinical pregnancy and implantation rate

ART cycles using IVF – own oocytes, 2015

47.4 42.5 33.3 22.9 14.3 39.8 40.1 33.6 23.7 14.3 7.9 30.1

10 20 30 40 50 60 <35 35–37 38–40 41–42 ≥43 OVERALL Percent (%)

Patient age (years)

Clinical pregnancy, per ET cycle Implantation rate

* 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

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Clinical pregnancy and implantation rate

ART cycles using IVF – own oocytes, 2015

41.3 39.0 31.4 39.8 42.2 25.5 13.5 30.1

10 20 30 40 50 60 1 2 ≥3 OVERALL Percent (%)

Number of embryos transferred

Clinical pregnancy, per ET cycle Implantation rate

* 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

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Clinical pregnancy and implantation rate by eSET/eDET

ART cycles using IVF – own oocytes, 2015

48.8 27.6 45.1 33.5 39.8 49.9 28.3 30.4 21.2 30.1

10 20 30 40 50 60 Elective single embryo transfer (eSET) Non-elective single embryo transfer Elective double embryo transfer (eDET) Non-elective double embryo transfer OVERALL Percent (%) 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 * 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

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Clinical pregnancy and implantation rate

ART cycles using IVF – own oocytes, 2015

20.3 33.7 47.2 39.8 13.7 23.6 38.9 30.1

10 20 30 40 50 60 Day 2 Day 3 Day 5 OVERALL Percent (%)

Embryo transfer day

Clinical pregnancy, per ET cycle Implantation rate

* 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

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Proportion of cycles resulting in an ongoing clinical pregnancy

ART cycles using IVF – own oocytes, 2015

44.5 39.2 29.3 18.2 10.4 36.4

10 20 30 40 50 60 <35 35–37 38–40 41–42 ≥43 OVERALL Percent per ET cycle (%)

Patient age (years)

Singleton pregnancy Multiple pregnancy

* 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

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Percentage of multiple pregnancies

ART cycles using IVF – own oocytes, 2015

12.0 11.9 17.1 11.8 21.9 12.9

10 20 30 40 <35 35–37 38–40 41–42 ≥43 OVERALL Percent per ongoing clinical pregnancy (%)

Patient age (years)

* Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound † Multiple pregnancy: ongoing clinical pregnancy with >1 fetal heart beat on ultrasound

Multiple pregnancies 207 98 96 19 7 427

S

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Proportion of cycles resulting in an ongoing clinical pregnancy

ART cycles using IVF – own oocytes, 2015

38.0 35.5 27.1 36.4

10 20 30 40 50 60 1 2 ≥3 OVERALL Percent per ET cycle (%)

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 * 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

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Percentage of multiple

ART cycles using IVF – own oocytes, 2015

2.6 27.1 25.9 12.9

10 20 30 40 1 2 ≥3 OVERALL Percent per ongoing clinical pregnancy (%)

Number of embryos transferred

Multiple pregnancies 49 341 37 427

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 * Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound † Multiple pregnancy: ongoing clinical pregnancy with >1 fetal heart beat on ultrasound

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Proportion of cycles resulting in an ongoing clinical pregnancy by plurality and eSET/eDET

ART cycles using IVF – own oocytes, 2015

45.2 24.8 41.4 30.3 36.4

10 20 30 40 50 60 Elective single embryo transfer (eSET) Non-elective single embryo transfer Elective double embryo transfer (eDET) Non-elective double embryo transfer OVERALL Percent per ET cycle (%) 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 * 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

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Percentage of multiple pregnancies by eSET/eDET

ART cycles using IVF – own oocytes, 2015

2.8 2.0 30.8 22.7 12.9

10 20 30 40 Elective single embryo transfer (eSET) Non-elective single embryo transfer Elective double embryo transfer (eDET) Non-elective double embryo transfer OVERALL Percent per ongoing clinical 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 * Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound † Multiple pregnancy: ongoing clinical pregnancy with >1 fetal heart beat on ultrasound

Multiple pregnancies 40 9 212 129 427

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Proportion of cycles resulting in an ongoing clinical pregnancy

ART cycles using IVF – own oocytes, 2015

17.7 30.0 43.9 36.4

10 20 30 40 50 60 Day 2 Day 3 Day 5 OVERALL Percent per ET cycle (%)

Embryo transfer day

Singleton pregnancy Multiple pregnancy

* 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

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Percentage of multiple pregnancies

ART cycles using IVF – own oocytes, 2015

7.8 14.7 12.3 12.9

10 20 30 40 Day 2 Day 3 Day 5 OVERALL Percent per ongoing clinical pregnancy (%)

Embryo transfer day

* Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound † Multiple pregnancy: ongoing clinical pregnancy with >1 fetal heart beat on ultrasound

Multiple pregnancies 6 169 251 427

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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)† Singleton‡ Multiple‡ 3,299 2,872 427 21.6 18.8 2.8 36.4 31.6 4.7 91.4 79.5 11.8 87.1 12.9 Multiple pregnancy‡ Twins Triplet or higher 427 407 20 2.8 4.7 11.8 12.9

* Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy † 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

95.3% of multiple pregnancies were twin gestations

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Oocyte retrieval, embryo transfer, clinical pregnancy and singleton pregnancy

ART cycles using IVF – own oocytes, 2015

96 94 92 89 88 93 64 60 57 52 45 59 30 26 19 12 6 24 25 21 14 8 4 19 20 40 60 80 100 <35 35–37 38–40 41–42 ≥43 OVERALL Percent per CS (%)

Patient age (years) Retrieval Embryo transfer Clinical pregnancy* Singleton pregnancy†

* Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy † Singleton pregnancy: ongoing clinical pregnancy with only one fetal heart beat on ultrasound

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TREATMENT CYCLES FOR 2015

ART cycles using FET – own oocytes

64

Stage of treatment and treatment outcomes

ART cycles using FET – own oocytes, 2015

9,526 9,251 3,520 3,129 2,802

2,000 4,000 6,000 8,000 10,000 Embryo thaw cycles Embryo transfer cycles (ET) Clinical pregnancies* Ongoing clinical pregnancies† Singleton pregnancies‡

37.0% per thaw 38.1% per ET

* Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy † 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

32.8% per thaw 33.8% per ET 29.4% per thaw 30.3% per ET 275 no ET: 2.9% per thaw

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Percentage of no embryo transfer

ART cycles using FET – own oocytes, 2015

2.7 2.9 3.3 3.7 3.8 2.9

2 4 6 8 10 <35 35–37 38–40 41–42 ≥43 OVERALL Percent per embryo thaw cycle (%)

Age at time of oocyte retrieval (years)

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Number of embryos transferred

ART cycles using FET – own oocytes, 2015

71.3 27.0 1.7

10 20 30 40 50 60 70 80 1 embryo 2 embryos ≥3 embryos Percent per ET cycle (%) eSET: 42.8% per ET=1

eSET eDET

eDET: 45.5% per ET=2

* 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

67

Number of embryos transferred

ART cycles using FET – own oocytes, 2015

75.3 23.9 0.8 69.8 28.4 1.8 55.7 37.7 6.5

10 20 30 40 50 60 70 80 1 embryo 2 embryos ≥3 embryos 1 embryo 2 embryos ≥3 embryos 1 embryo 2 embryos ≥3 embryos Percent per ET cycle (%) eSET eDET eSET eSET eDET eDET

<35 years 35–39 years ≥40 years Age at time of oocyte retrieval (years)

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Method of embryo cryopreservation

ART cycles using FET – own oocytes, 2015

89.3 10.6 0.1

20 40 60 80 100 Vitrification Slow freezing Mixed Percent per embryo thaw cycle (%)

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Clinical pregnancy and implantation rate

ART cycles using FET – own oocytes, 2015

41.2 38.3 33.0 24.9 18.8 38.1 36.9 33.6 26.3 18.0 11.6 32.7

10 20 30 40 50 <35 35–37 38–40 41–42 ≥43 OVERALL Percent (%)

Age at time of oocyte retrieval (years)

Clinical pregnancy, per ET cycle Implantation rate

* 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

70

Clinical pregnancy and implantation rate

ART cycles using FET – own oocytes, 2015

36.3 43.3 30.8 38.1 37.0 28.9 13.6 32.7

10 20 30 40 50 1 2 ≥3 OVERALL Percent (%)

Number of embryos transferred

Clinical pregnancy, per ET cycle Implantation rate

* 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

71

Clinical pregnancy and implantation rate by eSET/eDET

ART cycles using FET – own oocytes, 2015

43.0 31.2 47.0 40.2 38.1 44.1 31.7 32.2 26.2 32.7

10 20 30 40 50 Elective single embryo transfer (eSET) Non-elective single embryo transfer Elective double embryo transfer (eDET) Non-elective double embryo transfer OVERALL Percent (%) 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 * 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

72

Proportion of cycles resulting in an ongoing clinical pregnancy

ART cycles using FET – own oocytes, 2015

36.7 34.4 28.4 21.7 17.5 33.8

10 20 30 40 50 <35 35–37 38–40 41–42 ≥43 OVERALL Percent per ET cycle (%)

Age at time of oocyte retrieval (years)

Singleton pregnancy Multiple pregnancy

* 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

73

Percentage of multiple pregnancies

ART cycles using FET – own oocytes, 2015

10.9 10.1 9.9 9.8 10.5

10 20 30 40 <35 35–37 38–40 41–42 ≥43 OVERALL Percent per ongoing clinical pregnancy (%)

Age at time of oocyte retrieval (years)

* Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound † Multiple pregnancy: ongoing clinical pregnancy with >1 fetal heart beat on ultrasound

Multiple pregnancies 202 76 39 10 327

74

Proportion of cycles resulting in an ongoing clinical pregnancy

ART cycles using FET – own oocytes, 2015

32.4 38.1 27.7 33.8

10 20 30 40 50 1 2 ≥3 OVERALL Percent per ET cycle (%)

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 * 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

75

Percentage of multiple pregnancies

ART cycles using FET – own oocytes, 2015

1.7 29.2 29.6 10.5

10 20 30 40 1 2 ≥3 OVERALL Percent per ongoing clinical pregnancy (%)

Number of embryos transferred

Multiple pregnancies 37 277 13 327

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 * Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound † Multiple pregnancy: ongoing clinical pregnancy with >1 fetal heart beat on ultrasound

76

Proportion of cycles resulting in an ongoing clinical pregnancy by plurality and eSET/eDET

ART cycles using FET – own oocytes, 2015

39.0 27.5 41.5 35.2 33.8

10 20 30 40 50 60 Elective single embryo transfer (eSET) Non-elective single embryo transfer Elective double embryo transfer (eDET) Non-elective double embryo transfer OVERALL Percent per ET cycle (%) 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 * 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

77

Percentage of multiple pregnancies by eSET/eDET

ART cycles using FET – own oocytes, 2015

1.8 1.6 31.1 27.4 10.2

10 20 30 40 Elective single embryo transfer (eSET) Non-elective single embryo transfer Elective double embryo transfer (eDET) Non-elective double embryo transfer OVERALL Percent per ongoing clinical 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 * Ongoing clinical pregnancy: clinical pregnancy with ≥1 fetal heart beat on ultrasound † Multiple pregnancy: ongoing clinical pregnancy with >1 fetal heart beat on ultrasound

Multiple pregnancies 20 17 146 131 327

78

Treatment outcomes

ART cycles using FET – own oocytes, 2015 Treatment outcome Number % per embryo thaw % per ET % per CP % per OCP Clinical pregnancy (CP)* 3,520 37.0 38.0 Ongoing clinical pregnancy (OCP)† Singleton‡ Multiple‡ 3,129 2,802 327 32.8 29.4 3.4 33.8 30.3 3.5 88.9 79.6 9.3 89.5 10.5 Multiple pregnancy‡ Twins Triplet or higher 327 311 16 3.4 3.5 9.3 10.5

* Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy † 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

95% of multiple pregnancies were twin gestations

79

Embryo transfer, clinical pregnancy and singleton clinical pregnancy

ART cycles using FET – own oocytes, 2015

97 97 97 96 96 97 40 37 32 24 18 37 32 30 25 19 17 29 20 40 60 80 100 <35 35–37 38–40 41–42 ≥43 OVERALL Percent per embryo thaw cycle (%)

Age at time of oocyte retrieval (years) Embryo transfer Clinical pregnancy* Singleton pregnancy†

* Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy † Singleton pregnancy: ongoing clinical pregnancy with only one fetal heart beat on ultrasound

80

OVERALL SUMMARY

81

Clinical pregnancy by age at time of oocyte retrieval and type of treatment cycle

2015

30 39 13 40 41 24 39 10 36 33 13 28 6 24 37 24 39 10 37 39 10 20 30 40 50 60

Fresh IVF – own oocytes* Fresh IVF – donor oocytes Natural/modified natural IVF* FET – own oocytes* FET – donor oocytes

Percent per CS/embryo thaw cycle (%)

<35 35–39 ≥40 OVERALL

* Own oocytes exclusively † Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy

82

Clinical pregnancy by age at time of oocyte retrieval and type of treatment cycle

2015

47 62 36 41 41 40 48 29 37 33 24 36 19 25 37 40 58 30 38 40 10 20 30 40 50 60 70

Fresh IVF – own oocytes* Fresh IVF – donor oocytes Natural/modified natural IVF* FET – own oocytes* FET – donor oocytes

Percent per ET cycle (%)

<35 35–39 ≥40 OVERALL

* Own oocytes exclusively † Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy

83

Implantation rate

2015

30 50 29 33 34 19 46 10 20 30 40 50 60

Fresh IVF – own

• ocytes*

Fresh IVF – donor

• ocytes

Natural/modified natural IVF* FET – own

• ocytes*

FET – donor

• ocytes

Frozen oocyte IVF – own oocytes* Frozen oocyte IVF – donor oocytes

Percent (%)

* Own oocytes exclusively † Implantation rate: number of gestational sacs observed on ultrasound, divided by the total number of embryos transferred

Type of treatment cycle

84

Implantation rate by age at time of oocyte retrieval and type

• f treatment cycle

2015

40 54 35 37 36 30 36 29 32 28 15 24 18 18 31 30 50 29 33 34 10 20 30 40 50 60

Fresh IVF – own oocytes* Fresh IVF – donor oocytes Natural/modified natural IVF* FET – own oocytes* FET – donor oocytes

Percent (%)

<35 35–39 ≥40 OVERALL

* Own oocytes exclusively † Implantation rate: number of gestational sacs observed on ultrasound, divided by the total number of embryos transferred

85

Singleton ongoing clinical pregnancy by age at time of

• ocyte retrieval and type of treatment cycle

2015

25 30 13 32 33 18 37 8 29 24 9 28 6 19 28 19 31 9 29 31 10 20 30 40 50 60

Fresh IVF – own oocytes* Fresh IVF – donor oocytes Natural/modified natural IVF* FET – own oocytes* FET – donor oocytes

Percent per CS/embryo thaw cycle (%)

<35 35–39 ≥40 OVERALL

* Own oocytes exclusively † Singleton pregnancy: ongoing clinical pregnancy with only one fetal heart beat on ultrasound

86

Singleton ongoing clinical pregnancy by age at time of

• ocyte retrieval and type of treatment cycle

2015

39 47 34 33 33 31 46 23 30 25 17 36 19 20 28 32 46 26 30 31 10 20 30 40 50 60

Fresh IVF – own oocytes* Fresh IVF – donor oocytes Natural/modified natural IVF* FET – own oocytes* FET – donor oocytes

Percent per ET cycle (%)

<35 35–39 ≥40 OVERALL

* Own oocytes exclusively † Singleton pregnancy: ongoing clinical pregnancy with only one fetal heart beat on ultrasound

87

PRIMARY TRANSFER RATE

88

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

89

Primary transfer clinical pregnancy rate

IVF and FET – using own oocytes, 2013, 2014 and 2015

48.6 36.1 42.1 20 40 60 80 <35 ≥35 OVERALL Percent per primary transfer (%) Patient age (years)

* Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy

Clinical pregnancy 5,560 4,468 10,028

90

Primary transfer clinical pregnancy rate

IVF and FET – using own oocytes, 2013, 2014 and 2015

47.1 52.3 35.3 34.8 38.4 32.6 41.8 43.9 32.8 20 40 60 80 1 embryo 2 embryos ≥3 embryos 1 embryo 2 embryos ≥3 embryos 1 embryo 2 embryos ≥3 embryos Percent per primary transfer (%)

* Clinical pregnancy: clinical intrauterine, heterotopic, or ectopic pregnancy

<35 years ≥35 years OVERALL Patient age (years)

91

CUMULATIVE PREGNANCY RATE

92

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

93

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

94

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

95

Cumulative pregnancy rate, per cycle start

All ART treatment cycles types (fresh and frozen), 2013, 2014 and 2015

30.0 51.6 64.9 73.1 30.0 43.7 52.8 58.9 10 20 30 40 50 60 70 80 90 100 1 2 3 4 Probability of clinical pregnancy (%) Cycle number Optimistic Conservative

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.

96

Cumulative pregnancy rate, per batch of oocytes retrieved

IVF and FET – using own oocytes, 2013, 2014 and 2015

36.2 60.9 77.2 87.4 36.2 44.1 46.1 46.6 10 20 30 40 50 60 70 80 90 100 1 2 3 4 Probability of clinical pregnancy (%) Batch number Optimistic Conservative

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.

97

Optimistic cumulative pregnancy rate, per batch of oocytes retrieved

IVF and FET – using own oocytes, 2013, 2014 and 2015

42.4 66.6 81.5 90.1 31.5 55.7 72.6 84.1 10 20 30 40 50 60 70 80 90 100 1 2 3 4 Probability of clinical pregnancy (%) Cycle number <35 years ≥35 years

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.

98

Conservative cumulative pregnancy rate, per batch of oocytes retrieved

IVF and FET – using own oocytes, 2013, 2014 and 2015

42.4 52.8 55.6 56.2 31.5 37.7 39.1 39.4 10 20 30 40 50 60 70 80 90 100 1 2 3 4 Probability of clinical pregnancy (%) Cycle number <35 years ≥35 years

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. .

99

Cumulative pregnancy rate, per batch of oocytes retrieved

IVF and FET – using own oocytes, 2013, 2014 and 2015

42.4 66.6 81.5 90.1 31.5 55.7 72.6 84.1

20 40 60 80 100 Probability of clinical pregnancy (%)

Optimistic cumulative pregnancy rate

42.4 52.8 55.6 56.2 31.5 37.7 39.1 39.4

20 40 60 80 100 1 2 3 4 Probability of clinical pregnancy (%)

Batch number

Conservative cumulative pregnancy rate

<35 years ≥35 years

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.

100

CLOSING REMARKS

101

Key messages

Ontario (linked birth registry)

• 96.3% capture of birth outcomes per ongoing clinical

pregnancy Rest of Canada

• 96.0% capture of birth outcomes per ongoing clinical

pregnancy

102

Key messages

• Increased proportion:

– freeze all cycles – PGS/PGD

• Decreased multiple pregnancy rate

– Increase in the proportion of single embryo transfers

103

THANK YOU!

Andrea Lanes, Epidemiologist alanes@bornontario.ca Shelley Dougan, Complex Perinatal Lead sdougan@bornontario.ca Yanfang (Mary) Guo, Data Analyst yguo@bornontario.ca Moya Johnson, Coordinator – CARTR Plus mojohnson@bornontario.ca

• Dr. Ann Sprague, Scientific Manager

asprague@bornontario.ca Acknowledgment

• Dr. Deshayne Fell

Marlene Elliott Jordana Leader

• Dr. Marie-Claude Léveillé