lunes, 27 de junio de 2016

World ART figures show unexplained differences in ICSI usage

 

This month we publish the latest world ART figures in the ICMART World Report on Assisted Reproductive Technologies 2008-2009-2010. In the three years the report covers, almost 4.5 million ART cycles have been initiated (in the 61 countries contributing data). These resulted in more than one million babies (25.7% live birth per cycle started). Collecting and validating the data must have been a gargantuan effort and Silke Dyer and her many co-authors have to be commended for this on behalf of the whole world ART community. 

Apart from giving numerical insights, the report (even more important!) provides benchmarks for ART procedures. And one of those benchmarks for me is very disturbing: notwithstanding the fact that it has been shown over and over again that IVF gives better results than ICSI in couples with non-male infertility, we perform too much ICSI: on average about twice as many ICSI cycles are initiated as IVF. The incidence of severe male infertility cannot explain this discrepancy. I was puzzled by this finding, however I was dumbfounded by the regional differences. In Asia ‘only’ 1.4 times as much ICSI as IVF is performed, in North America 2.7 as much, in South America 6 times as much, and in the Middle East even 60 (yes, sixty) times as much. In Europe, the figures vary from as low as 0.8-1.1 in the Nordic countries to 9 times as much ICSI as IVF in Spain, to a (blimey!) 25-fold ICSI excess in Poland. 

It’s not like the ‘therapeutic illusion’ of old: the patient who will get better without treatment will also do so with treatment. No, this treatment hurts a couple’s chances. In the three years under review, ICSI on faulty indications has prevented at least 25,000 couples from getting pregnant.

**JLH (Hans) Evers, Editor-in-Chief Human Reproduction