Tervishoiuteenuse osutaja tsiviilõiguslik vastutus sünnieelsete kahjustuste kaasustes

Väitekirja elektrooniline versioon ei sisalda publikatsioonePereplaneerimist saab tänapäeval pidada iseenesestmõistetavaks. See võimaldab vanematel ajastada oma isiklikke eesmärke ja olla valmis tagama lapse heaoluks parimad tingimused. Enamiku inimeste jaoks on lapse saamine ilmselt üheks kõige õnnelikumaks hetkeks nende elus. Mõnikord võib aga ootamatu lapsevanemaks saamine olla lausa niivõrd ebasoovitud sündmus, et vanemad tunnevad, et neile on lapse saamisega tekitatud kahju. Pereplaneerimise osas valikute tegemisel on vanemad paljuski sõltuvad tervishoiuteenustest ja arstilt saadavast teabest. Arst saab läbi viia protseduurid raseduse ennetamiseks ja raseduse katkestamiseks, samuti teha vajalikud uuringud, et anda vanematele teavet planeeritava või oodatava lapse (potentsiaalse) tervisliku seisundi kohta. Vanematel on arstilt saadava teabe õigsuse osas kõrged ootused, sest sellele teabele tuginedes saavad nad otsustada lapse saamise üle. Ravi- või diagnoosiviga eelnimetatud protseduuride läbiviimisel võib tuua kaasa soovimatu raseduse või puudega lapse sünni. Siiski on selge, et arst ei saa vastutada iga soovimatu raseduse või puudega lapse sünni korral. Ometi on soovimatust rasedusest või puudega lapse sünnist tingitud kahju hüvitamise nõuded tervishoiuteenuse osutajate vastu pannud kohtud üle maailma seisma silmitsi nendes kaasustes sisalduvate eetiliste dilemmadega ja langetama raskeid otsuseid. Väitekirjas on sünnieelsete kahjustuste kaasustena käsitletud soovimatut rasedust (ingl. k. wrongful conception), puudega lapse sündi (ingl. k. wrongful birth) ja nn soovimatu elu kaasust (ingl. k. wrongful life). Nendes kaasustes heidetakse tervishoiuteenuse osutajale ette seda, et tervishoiuteenuse osutaja hooletuse (ravivea või diagnoosivea ja sellest tuleneva teabe andmise kohustuse rikkumise) tõttu on vanemad kaotanud võimaluse langetada õigeaegselt otsus raseduse katkestamiseks, millega oleks olnud võimalik vältida lapse saamisest tingitud kulusid. Kui soovimatu raseduse ja puudega lapse sünni kaasustes on nõude esitajaks vanem(ad), siis nn soovimatu elu kaasuses on nõude esitajaks laps ise. Kuna Eestis pole tänaseni ühtegi kohtulahendit sünnieelsete kahjustuste kaasustes, on seda huvitavam analüüsida, millise lahenduse võiksid need kaasused saada Eesti õiguse alusel, kui vastav vaidlus peaks kohtu ette jõudma. Väitekirja eesmärgiks on selgitada välja, kas ja millises ulatuses peaks tervishoiuteenuse osutaja vastutama Eesti tsiviilõiguse järgi nendes kaasustes, et tagatud oleks nii lapse, tema vanemate kui ka tervishoiuteenuse osutaja huvidega arvestamine.The benefit of family planning is nowadays considered self-evident. It enables parents to appropriately time their personal goals and be ready to provide the child with the best conditions for his or her well-being. For most, the birth of a child is one of the happiest moments in one’s life. For others becoming pregnant and giving birth may be so undesirable that parents feel they have suffered damage because of the birth of the child. In their choices regarding family planning, parents are in many ways dependent on the health-care services and the information they receive from the health-care provider. The health-care provider can perform the procedures to prevent the pregnancy or terminate the pregnancy; also perform the necessary testing to give the parents information regarding the (potential) condition of the future child’s health. The parents have high expectations regarding the accuracy of such information, because with the necessary information at hand, parents can make a decision as to the continuation or otherwise of pregnancy. Medical error or misdiagnosis on the part of the health-care provider in the aforementioned procedures may result in unwanted pregnancy or the birth of a disabled child. However, it is clear that the health care provider cannot be liable for every unsuccessful medical attempt to prevent the pregnancy or the birth of a disabled child. Nevertheless, even in the case of negligent acts by health-care providers, the obligation to compensate for the damages due to unwanted pregnancy or the birth of a disabled child has made courts across the world face uncomfortable decisions over ethical dilemmas. In this dissertation, the cases of prenatal damages include the cases of wrongful conception, wrongful birth and wrongful life. In these cases, due to medical error or misdiagnosis (and the consequent failure to inform the patient), the parents lose the possibility to timely make a decision to terminate the pregnancy and thus prevent the damage arising from the birth of an unplanned child. The cases of wrongful conception and wrongful birth involve the parent’s or parents’ claim against the health care provider. However, in the case or wrongful life, the child issues the claim against the health care provider. As there is an absence of case law in Estonia for cases of prenatal damages, it is thus interesting to analyse how Estonian courts would solve the claims under Estonian law if such claims were to be put before the court. The aim of this dissertation is to ascertain whether and to what extent the health-care provider should be liable for damages under Estonian civil law in these cases, considering an outcome that seeks to balance the interests of the child, his or her parents and the health-care provider

Endometrioosi ja kehalise aktiivsuse mõju naiste viljakusele

Väitekirja elektrooniline versioon ei sisalda publikatsiooneTänapäeval on viljatus reproduktiiveas inimeste hulgas tavaline probleem. Aina enam naisi lükkab laste saamist edasi, kuna esmalt soovitakse saavutada majanduslik kindlustatus, paraku väheneb vanusega munarakkude arv ja tõuseb viljatuse risk. Ka günekoloogilised haigused, nagu endometrioos suurendavad viljatuse tekke tõenäosust. Ei ole teada, kuidas täpselt endometrioos viljatust põhjustab ja endometrioosiga seotud viljatuse ravi on keeruline, koosnedes peamiselt kirurgilisest ravist, hormonaalsest ravist või nende kombinatsioonist ning sageli on vajalik kasutada ka in vitro viljastamise (IVF) protseduuri. Uute endometrioosi diagnoosimise- ja ravivõimaluste leidmist takistavad ka ebapiisavad teadmised selle haiguse patogeneesi molekulaarsetest mehhanismidest. Viljatuse ravi edukus IVF abil oleneb nii viljatuse põhjusest, partnerite vanusest, sugurakkude ja embrüote kvaliteedist, endomeetriumi retseptiivsusest kui ka valitud raviskeemi sobivusest. Viljatusravi tulemust võivad mõjutada ka elustiilifaktorid, näiteks füüsiline aktiivsus. Antud doktoritöös uuriti endometrioosi erinevate raviskeemide ja füüsilise aktiivsuse mõju IVF ravi edukusele viljatusravi läbivatel patsientidel, ning hinnati endomeetriumi retseptiivsust ja molekulaarsete muutuste ulatust endometrioosi korral. Uuringus leiti, et naised vähendavad oluliselt oma füüsilist aktiivsust kunstliku viljastamise ajal. Füüsilise aktiivsuse määr ei olnud küll seotud rasestumisega edukusega, aga füüsiliselt aktiivsematel naistel õnnestus munasarjade stimulatsiooni järgselt saada rohkem munarakke ja embrüoid võrreldes nendega, kes vähendasid viljatusravi ajal oma füüsilist aktiivsust. Uuring näitas ka, et endometrioosi korral võib viljatuse ravis kasutada laparoskoopia, hormoonravi ja IVF kombineeritud raviskeemi. Endomeetriumi retseptiivsusega seotud geenide ekspressioon ei olnud endometrioosist mõjutanud. Molekulaarsed uuringud näitasid, et endomeetriumi ja endometrioosikollete rakud reageerivad tsütotoksilistele ühenditele erinevalt, mis võib tuleneda endometrioosi patogeneesis osalevate geenide erinevast ekspressioonitasemest.Infertility is nowadays a common disorder among individuals of reproductive age. Women are postponing childbearing, mainly due to sociological factors, which leads to age-related decline in oocyte numbers and increases the risk of infertility. In addition, gynaecological diseases, such as endometriosis, increase the risk of infertility. Causes of endometriosis-associated infertility are unclear and the treatment mainly consists of medical or surgical approaches or combination of both, and in vitro fertilization (IVF) is often needed. Insufficient knowledge on the molecular mechanisms of endometriosis pathogenesis also hinders the search for new ways to diagnose and treat endometriosis. Success of infertility treatment depends on the cause of infertility, female and male age, gamete and embryo quality, endometrial receptivity, and suitability of the chosen treatment regimen. Lifestyle factors, such as physical activity during the IVF treatment may also affect the outcome of the procedure. The current study focused on the role of endometriosis treatment and physical activity in infertility treatment outcome and tried to unveil the molecular mechanisms behind endometriosis development. This study showed that women significantly decreased physical activity after starting the IVF treatment. The level of physical activity was not associated with pregnancy success, but physically more active women obtained higher numbers of oocytes and embryos in their treatment cycle. Endometriosis-related research showed that the combined treatment approach (laparoscopy, hormonal therapy and IVF) is suitable for endometriosis-associated infertility. Expression of genes associated with endometrial receptivity is not affected in women with endometriosis. Molecular studies revealed that endometrial cells in eutopic and ectopic locations react differently to treatment with cytotoxic compounds, a phenomenon that may be related to the altered expression of several genes involved in endometriosis pathogenesis.https://www.ester.ee/record=b551193

Damages Subject to Compensation in Cases of Wrongful Birth: A Solution to Suit Estonia

In cases of wrongful birth, parents seek compensation for any damage related to birth of a disabled child. The claim is made against the health-care provider for negligent failure to detect foetal defects, which has as a consequence loss of the opportunity of the parents to decide to terminate the pregnancy in a timely manner. Case law on this topic is absent in Estonia. Accordingly, the article proposes a reasoned solution for Estonian law on the question of recoverable damages in cases of wrongful birth through analysis of Estonian, German, and United States legal literature and case law. The grounds for the health-care provider’s liability under the Estonian Law of Obligations Act are analysed. The main focus is on analysis of compensation for the disabled child’s maintenance costs and non-pecuniary damage. Among other factors, the article examines the ethics dilemma of avoiding the birth of a disabled child, limits to compensation, and the extent of the damages due

Creation of basic components in smart home solution

Tehnoloogia areng on viimasel kümnendil olnud hüppeline ning tegemist ei ole enam ammu valdkonnaga, mis kuulub pelgalt spetsialistide kitsale ringkonnale. Nutiseadmed on kättesaadavad kõigile ja nende abil on võimalik muuta igaühe igapäevaelu oluliselt lihtsamaks ning mugavamaks. Lisaks mugavuse kriteeriumile on üheks olulisimaks märksõnaks ka kodu turvalisus, mis on tagatud uuenduslike lukustussüsteemide, valvekaamerate jms. näol. Turvalisuse tagamist võib pidada üheks olulisimaks eesmärgiks nutikodu loomise kontekstis. Käesoleva lõputöö eesmärgiks on luua toimiv nutikodu lahendus, mille abil on võimalik muuta igapäevaelu mugavamaks ning mis täidaks ühtlasi turvalisuse eesmärke. Turvalisus on tagatud eelkõige läbi selle, et nutikodu rakenduse abil on võimalik igal ajal hallata kodus toimuvat läbi turvaseadmete (kaamerad, valvestusseade, andurid jms). Nutikodu on loodud reaalse eramu näitel. Lõputöö raames valmis kasutusvalmis nutikodu lahendus, mis koosneb veebiliidesest, telefonirakendusest, valve- ja kaamerasüsteemist ning temperatuuri- ja niiskuseandurist

Tervishoiuteenuse osutaja deliktiõiguslik vastutus

http://tartu.ester.ee/record=b2612614~S1*es

ART in Europe, 2016 : results generated from European registries by ESHRE

STUDY QUESTION: What are the reported data on cycles in ART, IUI and fertility preservation (FP) interventions in 2016 as compared to previous years, as well as the main trends over the years? SUMMARY ANSWER: The 20th ESHRE report on ART and IUI shows a progressive increase in reported treatment cycle numbers in Europe, with a decrease in the number of transfers with more than one embryo causing a reduction of multiple delivery rates (DR), as well as higher pregnancy rates and DR after frozen embryo replacement (FER) compared to fresh IVF and ICSI cycles, while the outcomes for IUI cycles remained stable. WHAT IS KNOWN ALREADY: Since 1997, ART aggregated data generated by national registries, clinics or professional societies have been collected, analysed by the European IVF-monitoring Consortium (EIM) and reported in 19 manuscripts published in Human Reproduction and Human Reproduction Open. STUDY DESIGN, SIZE, DURATION: Yearly collection of European medically assisted reproduction (MAR) data by EIM for ESHRE. The data on treatments performed between 1 January and 31 December 2016 in 40 European countries were provided by either National Registries or registries based on personal initiatives of medical associations and scientific organizations. PARTICIPANTS/MATERIALS, SETTING, METHODS: In all, 1347 clinics offering ART services in 40 countries reported a total of 918 159 treatment cycles, involving 156 002 with IVF, 407 222 with ICSI, 248 407 with FER, 27 069 with preimplantation genetic testing, 73 927 with egg donation (ED), 654 with IVM of oocytes and 4878 cycles with frozen oocyte replacement (FOR). European data on IUI using husband/partner’s semen (IUI-H) and donor semen (IUI-D) were reported from 1197 institutions offering IUI in 29 and 24 countries, respectively. A total of 162 948 treatments with IUI-H and 50 467 treatments with IUI-D were included. A total of 13 689 FP interventions from 11 countries including oocyte, ovarian tissue, semen and testicular tissue banking in pre-and postpubertal patients were reported. MAIN RESULTS AND THE ROLE OF CHANCE: In 20 countries (18 in 2015) with a total population of approximately 325 million inhabitants, in which all ART clinics reported to the registry, a total of 461 401 treatment cycles were performed, corresponding to a mean of 1410 cycles per million inhabitants (range 82–3088 per million inhabitants). In the 40 reporting countries, after IVF the clinical pregnancy rates (PR) per aspiration and per transfer in 2016 were similar to those observed in 2015 (28.0% and 34.8% vs 28.5% and 34.6%, respectively). After ICSI, the corresponding rates were also similar to those achieved in 2015 (25% and 33.2% vs 26.2% and 33.2%). After FER with own embryos, the PR per thawing is still on the rise, from 29.2% in 2015 to 30.9% in 2016. After ED, the PR per fresh embryo transfer was 49.4% (49.6% in 2015) and per FOR 43.6% (43.4% in 2015). In IVF and ICSI together, the trend towards the transfer of fewer embryos continues with the transfer of 1, 2, 3 and 4 embryos in 41.5%, 51.9%, 6.2% and 0.4% of all treatments, respectively (corresponding to 37.7%, 53.9%, 7.9% and 0.5% in 2015). This resulted in a proportion of singleton, twin and triplet DRs of 84.8%, 14.9% and 0.3%, respectively (compared to 83.1%, 16.5% and 0.4%, respectively in 2015). Treatments with FER in 2016 resulted in twin and triplet DR of 11.9% and 0.2%, respectively (vs 12.3% and 0.3% in 2015). After IUI, the DRs remained similar at 8.9% after IUI-H (7.8% in 2015) and at 12.4% after IUI-D (12.0% in 2015). Twin and triplet DRs after IUI-H were 8.8% and 0.3%, respectively (in 2015: 8.9% and 0.5%) and 7.7% and 0.4% after IUI-D (in 2015: 7.3% and 0.6%). The majority of FP interventions included the cryopreservation of ejaculated sperm (n¼7877 from 11 countries) and of oocytes (n¼4907 from eight countries). LIMITATIONS, REASONS FOR CAUTION: As the methods of data collection and levels of completeness of reported data vary among European countries, the results should be interpreted with caution. A number of countries failed to provide adequate data about the number of initiated cycles and deliveries. WIDER IMPLICATIONS OF THE FINDINGS: The 20th ESHRE report on ART and IUI shows a continuous increase of reported treatment numbers and MAR-derived livebirths in Europe. Being already the largest data collection on MAR in Europe, continuous efforts to stimulate data collection and reporting strive for future quality control of the data, transparency and vigilance in the field of reproductive medicine.The study has no external funding and all costs were covered by ESHRE.peer-reviewe

Oocyte and ovarian tissue cryopreservation in European countries : statutory background, practice, storage and use

STUDY QUESTION: What is known in Europe about the practice of oocyte cryopreservation (OoC), in terms of current statutory background, funding conditions, indications (medical and ‘non-medical’) and specific number of cycles? SUMMARY ANSWER: Laws and conditions for OoC vary in Europe, with just over half the responding countries providing this for medical reasons with state funding, and none providing funding for ‘non-medical’ OoC. WHAT IS ALREADY KNOWN: The practice of OoC is a well-established and increasing practice in some European countries, but data gathering on storage is not homogeneous, and still sparse for use. Ovarian tissue cryopreservation (OtC) is only practiced and registered in a few countries. STUDY DESIGN, SIZE, AND DURATION: A transversal collaborative survey on OoC and OtC, was designed, based on a country questionnaire containing information on statutory or professional background and practice, as well as available data on ovarian cell and tissue collection, storage and use. It was performed between January and September 2015. PARTICIPANTS/MATERIALS, SETTING AND METHODS: All ESHRE European IVF Monitoring (EIM) consortium national coordinators were contacted, as well as members of the ESHRE committee of national representatives, and sent a questionnaire. The form included national policy and practice details, whether through current existing law or code of practice, criteria for freezing (age, health status), availability of funding and the presence of a specific register. The questionnaire also included data on both the number of OoC cycles and cryopreserved oocytes per year between 2010 and 2014, specifically for egg donation, fertility preservation for medical disease, ‘other medical’ reasons as part of an ART cycle, as well as for ‘non-medical reasons’ or age-related fertility decline. Another question concerning data on freezing and use of ovarian tissue over 5 years was added and sent after receiving the initial questionnaire. MAIN RESULTS AND THE ROLE OF CHANCE: Out of 34 EIM members, we received answers regarding OoC regulations and funding conditions from 27, whilst 17 countries had recorded data for OoC, and 12 for OtC. The specific statutory framework for OoC and OtC varies from absent to a strict frame. A total of 34 705 OoC cycles were reported during the 5-year-period, with a continuous increase. However, the accurate description of numbers was concentrated on the year 2013 because it was the most complete. In 2013, a total of 9126 aspirations involving OoC were reported from 16 countries. Among the 8885 oocyte aspirations with fully available data, the majority or 5323 cycles (59.9%) was performed for egg donation, resulting in the highest yield per cycle, with an average of 10.4 oocytes frozen per cycle. OoC indication was ‘serious disease’ such as cancer in 10.9% of cycles, other medical indications as ‘part of an ART cycle’ in 16.1%, and a non-medical reason in 13.1%. With regard to the use of OoC, the number of specifically recorded frozen oocyte replacement (FOR) cycles performed in 2013 for all medical reasons was 14 times higher than the FOR for non-medical reasons, using, respectively, 8.0 and 8.4 oocytes per cycle. Finally, 12 countries recorded storage following OtC and only 7 recorded the number of grafted frozen/thawed tissues. LIMITATIONS, REASONS FOR CAUTION: Not all countries have data regarding OoC collection, and some data came from voluntary collaborating centres, rather than a national authority or register. Furthermore, the data related to use of OoC were not included for two major players in the field, Italy and Spain, where numbers were conflated for medical and non-medical reasons. Finally, the number of cycles started with no retrieval is not available. Data are even sparser for OtC. WIDER IMPLICATIONS OF THE FINDINGS: There is a need for ART authorities and professional bodies to record precise data for practice and use of OoC (and OtC), according to indications and usage, in order to reliably inform all stakeholders including women about the efficiency of both methods. Furthermore, professional societies should establish professional standards for access to and use of OoC and OtC, and give appropriate guidance to all involved. STUDY FUNDING/COMPETING INTEREST(S): The study was supported by ESHRE. There are no conflicts of interest.peer-reviewe

ART in Europe, 2017: results generated from European registries by ESHRE

© The Author(s) 2021. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.Study question: What are the data on ART and IUI cycles, and fertility preservation (FP) interventions reported in 2017 as compared to previous years, as well as the main trends over the years? Summary answer: The 21st ESHRE report on ART and IUI shows the continual increase in reported treatment cycle numbers in Europe, with a decrease in the proportion of transfers with more than one embryo causing an additional slight reduction of multiple delivery rates (DR) as well as higher pregnancy rates (PR) and DR after frozen embryo replacement (FER) compared to fresh IVF and ICSI cycles, while the number of IUI cycles increased and their outcomes remained stable. What is known already: Since 1997, ART aggregated data generated by national registries, clinics or professional societies have been gathered and analyzed by the European IVF-monitoring Consortium (EIM) and communicated in a total of 20 manuscripts published in Human Reproduction and Human Reproduction Open. Study design size duration: Data on European medically assisted reproduction (MAR) are collected by EIM for ESHRE on a yearly basis. The data on treatments performed between 1 January and 31 December 2017 in 39 European countries were provided by either National Registries or registries based on personal initiatives of medical associations and scientific organizations. Participants/materials setting methods: Overall, 1382 clinics offering ART services in 39 countries reported a total of 940 503 treatment cycles, including 165 379 with IVF, 391 379 with ICSI, 271 476 with FER, 37 303 with preimplantation genetic testing (PGT), 69 378 with egg donation (ED), 378 with IVM of oocytes, and 5210 cycles with frozen oocyte replacement (FOR). A total of 1273 institutions reported data on 207 196 IUI cycles using either husband/partner's semen (IUI-H; n = 155 794) or donor semen (IUI-D; n = 51 402) in 30 countries and 25 countries, respectively. Thirteen countries reported 18 888 interventions for FP, including oocyte, ovarian tissue, semen and testicular tissue banking in pre- and postpubertal patients. Main results and the role of chance: In 21 countries (20 in 2016) in which all ART clinics reported to the registry, 473 733 treatment cycles were registered for a total population of approximately 330 million inhabitants, allowing a best-estimate of a mean of 1435 cycles performed per million inhabitants (range: 723-3286).Amongst the 39 reporting countries, the clinical PR per aspiration and per transfer in 2017 were similar to those observed in 2016 (26.8% and 34.6% vs 28.0% and 34.8%, respectively). After ICSI the corresponding rates were also similar to those achieved in 2016 (24% and 33.5% vs 25% and 33.2% in 2016). When freeze all cycles were removed, the clinical PRs per aspiration were 30.8% and 27.5% for IVF and ICSI, respectively.After FER with embryos originating from own eggs the PR per thawing was 30.2%, which is comparable to 30.9% in 2016, and with embryos originating from donated eggs it was 41.1% (41% in 2016). After ED the PR per fresh embryo transfer was 49.2% (49.4% in 2016) and per FOR 43.3% (43.6% in 2016).In IVF and ICSI together, the trend towards the transfer of fewer embryos continues with the transfer of 1, 2, 3 and ≥4 embryos in 46.0%, 49.2%, 4.5% and in 0.3% of all treatments, respectively (corresponding to 41.5%, 51.9%. 6.2% and 0.4% in 2016). This resulted in a reduced proportion of twin DRs of 14.2% (14.9% in 2016) and stable triplet DR of 0.3%. Treatments with FER in 2017 resulted in a twin and triplet DR of 11.2% and 0.2%, respectively (vs 11.9% and 0.2% in 2016).After IUI, the DRs remained similar at 8.7% after IUI-H (8.9% in 2016) and at 12.4% after IUI-D (12.4.0% in 2016). Twin and triplet DRs after IUI-H were 8.1% and 0.3%, respectively (in 2016: 8.8% and 0.3%) and 6.9% and 0.2% after IUI-D (in 2016: 7.7% and 0.4%). Amongst 18 888 FP interventions in 13 countries, cryopreservation of ejaculated sperm (n = 11 112 vs 7877 from 11 countries in 2016) and of oocytes (n = 6588 vs 4907 from eight countries in 2016) were the most frequently reported. Limitations reasons for caution: As the methods of data collection and levels of reporting vary amongst European countries, interpretation of results should remain cautious. Some countries were unable to deliver data about the number of initiated cycles and deliveries. Wider implications of the findings: The 21st ESHRE report on ART, IUI and FP interventions shows a continuous increase of reported treatment numbers and MAR-derived livebirths in Europe. Being already the largest data collection on MAR in Europe, efforts should continue to optimize data collection and reporting with the perspective of improved quality control, transparency and vigilance in the field of reproductive medicine. Study funding/competing interests: The study has received no external funding and all costs are covered by ESHRE. There are no competing interests.info:eu-repo/semantics/publishedVersio

ART in Europe, 2019 : results generated from European registries by ESHRE

Study question: What are the data and trends on ART and IUI cycle numbers and their outcomes, and on fertility preservation (FP) interventions, reported in 2019 as compared to previous years? Summary answer: The 23rd ESHRE report highlights the rising ART treatment cycles and children born, alongside a decline in twin deliveries owing to decreasing multiple embryo transfers; fresh IVF or ICSI cycles exhibited higher delivery rates, whereas frozen embryo transfers (FET) showed higher pregnancy rates (PRs), and reported IUI cycles decreased while maintaining stable outcomes. What is known already: ART aggregated data generated by national registries, clinics, or professional societies have been gathered and analyzed by the European IVF-Monitoring (EIM) Consortium since 1997 and reported in a total of 22 manuscripts published in Human Reproduction and Human Reproduction Open. Study design, size, duration: Data on medically assisted reproduction (MAR) from European countries are collected by EIM for ESHRE each year. The data on treatment cycles performed between 1 January and 31 December 2019 were provided by either national registries or registries based on initiatives of medical associations and scientific organizations or committed persons in one of the 44 countries that are members of the EIM Consortium. Participants/materials, setting, methods: Overall, 1487 clinics offering ART services in 40 countries reported, for the second time, a total of more than 1 million (1 077 813) treatment cycles, including 160 782 with IVF, 427 980 with ICSI, 335 744 with FET, 64 089 with preimplantation genetic testing (PGT), 82 373 with egg donation (ED), 546 with IVM of oocytes, and 6299 cycles with frozen oocyte replacement (FOR). A total of 1169 institutions reported data on IUI cycles using either husband/partner's semen (IUI-H; n = 147 711) or donor semen (IUI-D; n = 51 651) in 33 and 24 countries, respectively. Eighteen countries reported 24 139 interventions in pre- and post-pubertal patients for FP, including oocyte, ovarian tissue, semen, and testicular tissue banking. Main results and the role of chance: In 21 countries (21 in 2018) in which all ART clinics reported to the registry 476 760 treatment cycles were registered for a total population of approximately 300 million inhabitants, allowing the best estimate of a mean of 1581 cycles performed per million inhabitants (range: 437-3621). Among the reporting countries, for IVF the clinical PRs per aspiration slightly decreased while they remained similar per transfer compared to 2018 (21.8% and 34.6% versus 25.5% and 34.1%, respectively). In ICSI, the corresponding PRs showed similar trends compared to 2018 (20.2% and 33.5%, versus 22.5% and 32.1%) When freeze-all cycles were not considered for the calculations, the clinical PRs per aspiration were 28.5% (28.8% in 2018) and 26.2% (27.3% in 2018) for IVF and ICSI, respectively. After FET with embryos originating from own eggs, the PR per thawing was at 35.1% (versus 33.4% in 2018), and with embryos originating from donated eggs at 43.0% (41.8% in 2018). After ED, the PR per fresh embryo transfer was 50.5% (49.6% in 2018) and per FOR 44.8% (44.9% in 2018). In IVF and ICSI together, the trend toward the transfer of fewer embryos continues with the transfer of 1, 2, 3, and ≥4 embryos in 55.4%, 39.9%, 2.6%, and 0.2% of all treatments, respectively (corresponding to 50.7%, 45.1%, 3.9%, and 0.3% in 2018). This resulted in a reduced proportion of twin delivery rates (DRs) of 11.9% (12.4% in 2018) and a similar triplet DR of 0.3%. Treatments with FET in 2019 resulted in twin and triplet DR of 8.9% and 0.1%, respectively (versus 9.4% and 0.1% in 2018). After IUI, the DRs remained similar at 8.7% after IUI-H (8.8% in 2018) and at 12.1% after IUI-D (12.6% in 2018). Twin and triplet DRs after IUI-H were 8.7% and 0.4% (in 2018: 8.4% and 0.3%) and 6.2% and 0.2% after IUI-D (in 2018: 6.4% and 0.2%), respectively. Eighteen countries (16 in 2018) provided data on FP in a total number of 24 139 interventions (20 994 in 2018). Cryopreservation of ejaculated sperm (n = 11 592 versus n = 10 503 in 2018) and cryopreservation of oocytes (n = 10 784 versus n = 9123 in 2018) were most frequently reported. Limitations, reasons for caution: Caution with the interpretation of results should remain as data collection systems and completeness of reporting vary among European countries. Some countries were unable to deliver data about the number of initiated cycles and/or deliveries. Wider implications of the findings: The 23rd ESHRE data collection on ART, IUI, and FP interventions shows a continuous increase of reported treatment numbers and MAR-derived livebirths in Europe. Although it is the largest data collection on MAR in Europe, further efforts toward optimization of both the collection and the reporting, from the perspective of improving surveillance and vigilance in the field of reproductive medicine, are awaited. Study funding/competing interest(s): The study has received no external funding and all costs are covered by ESHRE. There are no competing interests. Keywords: ICSI; IUI; IVF; data collection; egg donation; fertility preservation; frozen embryo transfer; registry; surveillance; vigilance.peer-reviewe