Assisted reproductive technology in Australia and New Zealand 2009

  This is the fifteenth annual report on the use of assisted reproductive technologies (ARTs) in Australia and New Zealand. The report presents data on ART treatment and donor insemination cycles undertaken in 2009, and the resulting pregnancies and baby outcomes. Use of ART treatment cycles There were 70,541 ART treatment cycles reported in Australia and New Zealand in 2009, a 13.9% increase on 2008 and a 48.0% increase on 2005. Of these, 92.4% were in Australian fertility centres and 7.6% were in New Zealand fertility centres. Women used their own oocytes/embryos in more than 95%of treatments (autologous), and 33.8% of all cycles used frozen/thawed embryos. It is estimated that more than 35,000 women undertook autologous ART treatment in Australia and New Zealand in 2009. On average, 1.8 fresh and/or thaw cycles per woman were performed in 2009. Treatment outcomes and number of babies  Of the 70,541 treatment cycles, 22.6% resulted in a clinical pregnancy, and 17.2% resulted in a live delivery (the birth of at least one liveborn baby). There were 12,127 live deliveries resulting in 13,114 liveborn babies including 9,732 singletons at term of normal birthweight. Women’s age and parity  The average age of women undergoing autologous cycles was 35.8 years, about the same as the average age (35.7 years) in 2008. One in four (26.8%) autologous fresh cycles undertaken in 2009 was in women aged 40 years or older. The average age of women undergoing ART treatment using donor oocytes/embryos was 40.8 years. Almost one-quarter (24.5%) of cycles were undertaken by women who had previously given birth. Advancing women’s age is associated with the decrease in the live delivery rates. Of autologous fresh cycles, the live delivery rate per initiated cycle was 26.8% for cycles in women aged 30–34 years. It decreased to less than 1% for cycles in women aged over 44 years. Of autologous thaw cycles, the live delivery rate per initiated cycle fell from 20.1% of cycles in women aged 30–34 years to 2.4% of cycles in women aged over 44 years. Transfer of cryopreserved embryos  Of the 22,472 frozen/thawed embryo transfer cycles, 18.3% involved the transfer of embryos that had been cryopreserved using an ultra-rapid method (vitrification). One-third of thaw cycles where a blastocyst (day 5–6 embryo) was transferred used vitrified blastocysts, compared to 1.7% of cycles where a cleavage embryo (day 2–3 embryo) was transferred. Multiple births  A continuing trend in ART treatment has been the reduction in the rate of multiple birth deliveries from 14.1% in 2005 to 8.2% in 2009. This reduction was achieved by a shift in practice by clinicians and patients to single embryo transfer, with the proportion of single embryo transfer cycles increasing from 48.3% in 2005 to 69.7% in 2009. Importantly, this substantial decrease in the multiple delivery rate was achieved while clinical pregnancy rates remained stable at around 23% per cycle. Authors: Yueping A. Wang, Alan Macaldowie, Irene Hayward, Georgina M. Chambers and Elizabeth A Sullivan. Image: Nina Matthews Photography / flick

Assisted reproduction technology in Australia and New Zealand 2006

Assisted Reproduction Technology in Australia and New Zealand 2006 presents information on all assisted reproduction technology (ART) treatments that took place in 2006 and the resulting pregnancies and births. It is the fifth report using data from the Australian and New Zealand Assisted Reproduction Database (ANZARD) implemented in 2002. The report presents specific data on clinical pregnancies and live births, and how they vary by treatment type, cause of infertility, women’s age and number of embryos transferred. Also included is information on birth outcomes such as multiple birth, gestational age, birthweight, and perinatal mortality. The report will be particularly useful to healthcare professionals, governments, academics and researchers with an interest in ART treatment and outcomes and for people undergoing or considering treatment through ART

Assisted reproductive technology in Australia and New Zealand 2007

This is the thirteenth annual report on the use of ART in Australia and New Zealand, and presents data on women who underwent ART treatments in 2007, and the resulting pregnancies and baby outcomes. Assisted reproductive technologies (ART) — such as in vitro fertilisation (IVF) — are a group of procedures used to assist women to become pregnant. ART usually involves removing oocytes (eggs) from a woman’s ovaries, fertilising them in the laboratory and then transferring the resulting embryo(s) back into a woman’s uterus. Over the last five years, the number of ART procedures has increased on average by over 10% per year in Australia and New Zealand. Latest estimates indicate that 3.1% and 1.8% of babies born in Australia and New Zealand respectively are as a result of ART treatment. In 2007, there were 56,817 assisted reproductive technology (ART) treatment cycles undertaken in Australian and New Zealand. Of these cycles, 17.4% resulted in a live delivery (the birth of at least one liveborn baby). In total, 10,856 liveborn babies were born following ART treatment undertaken in 2007. The most important recent trend in ART treatment has been the reduction in the rate of twins and triplets births, with the multiple delivery rate falling from 18.7% in 2003 to 10.0% in 2007. This trend has been associated with an increase in the proportion of ART treatment cycles using single embryo transfer, from 32.0% in 2003 to 63.7% in 2007. Authored by Wang YA, Chambers G, Dieng M & Sullivan EA

Assisted reproduction technology in Australia and New Zealand 2005

This report presents data on success rates based on live delivery and how they vary by treatment type, women\u27s age and number of embryos transferred. Also included is information on birth outcomes such as multiple birth, gestational age, birthweight, and perinatal mortality

Efficacy, pregnancy and birth outcomes following IVF treatments in different age groups and with different time for embryo transfer and freezing in Australia and New Zealand, 2002–2008

Background: The successful or adverse outcomes of assisted reproductive technology (ART) treatment are primarily determined by woman&#146;s age and number of embryos transferred. However, it is not clear how each additional year of woman&#146;s age impacts the ART treatment outcomes. Inconsistent findings about the relationship between ART treatment outcomes and number of embryos transferred and stage of embryo development still exist in the literature. Differences in the findings relate to what outcome is chosen and how it is measured. The objective of this PhD thesis is to inform infertile patients, fertility professionals and the general population regarding fertility awareness, the optimal goal of an ART treatment and the best population-based clinical practice model. It aims to investigate the age-specific live delivery rate by single year increments, to compare perinatal outcomes of babies following single embryo transfer (SET) with double embryo transfer (DET), to propose a new indicator &#147;healthy baby&#148; as the optimal goal for an ART treatment, and to build a clinical practice model that maximises the likelihood of a &#147;healthy baby&#148;. Materials and methods: The thesis includes five coherent studies using population data extracted from the Australian and New Zealand Assisted Reproduction Database. Pregnancy, live delivery, and &#147;healthy baby&#148; (term liveborn singleton of normal birthweight without congenital anomaly) were used to measure the success of an ART treatment. Results: For patients aged &#8805;35 years, the likelihood of pregnancy and live delivery decreased by each additional year of age. It is appropriate for women aged <43 years to initiate a fresh ART treatment. Singletons following SET had lower odds of adverse perinatal outcomes than those following DET. For fresh cycles in patients aged <35 years, selective transfer of a single blastocyst resulted in a higher rate of &#147;healthy baby&#148; than the transfer of a single cleavage embryo. For thaw cycles, a higher likelihood of a &#147;healthy baby&#148; following transfer of a single blastocyst cultured from thawed cleavage embryos was observed. Transfers of fresh blastocysts and blastocysts cultured from thawed cleavage embryos reduced the risk of miscarriage. Conclusions: This PhD thesis suggests that, from a population perspective, to minimise adverse outcomes in parallel with maximising births of a &#147;healthy baby&#148;, the optimum clinical practice model for younger patients is the selective transfer of a single blastocyst in a fresh cycle and a single blastocyst cultured from thawed cleavage embryos in subsequent thaw cycles. It confirmed the importance of community-based education regarding fertility potential and the benefits of early fertility assessment and ART treatment where clinically indicated. It provided evidence that the continuing increase in SET would improve the overall birth outcomes of ART treatment

Assisted reproductive technology in Australia and New Zealand 2008

In 2008, there were 61,929 assisted reproductive technology (ART) treatment cycles undertaken in Australia and New Zealand. Of these cycles, 17.2% resulted in a live delivery (the birth of at least one liveborn baby). In total, 11,528 liveborn babies were born following ART treatment undertaken in 2008. The most important trend in ART treatment has been the increase of single embryo transfer, from 40.5% in 2004 to 67.8% in 2008. This trend has resulted in significant reduction of multiple delivery rate, from 16.4% in 2004 to 8.4% in 2008

The urban-remote divide for Indigenous perinatal outcomes

Objective: To determine whether remoteness category of residence of Indigenous women affects the perinatal outcomes of their newborn infants. Design and participants: A population-based study of 35240 mothers identified as Indigenous and their 35658 babies included in the National Perinatal Data Collection in 2001-2004. Main outcome measures: Australian Standard Geographical Classification remoteness category, birthweight, Apgar score at 5 minutes, stillbirth, gestational age and a constructed measure of perinatal outcomes of babies called "healthy baby" (live birth, singleton, 37-41 completed weeks' gestation, 2500-4499 g birthweight, and an Apgar score at 5 minutes ≥ 7). Results: The proportion of healthy babies in remote, regional and city areas was 74.9%, 77.7% and 77.6%, respectively. After adjusting for age, parity, smoking and diabetes or hypertension, babies born to mothers in remote areas were less likely to satisfy the study criteria of being a healthy baby (adjusted odds ratio [AOR], 0.87; 95% CI, 0.81-0.93) compared with those born in cities. Babies born to mothers living in remote areas had higher odds of being of low birthweight (AOR, 1.09; 95% CI, 1.01-1.19) and being born with an Apgar score < 7 at 5 minutes (AOR, 1.63; 95% CI, 1.39-1.92). Conclusions: Only three in four babies born to Indigenous mothers fell into the "healthy baby" category, and those born in more remote areas were particularly disadvantaged. These findings demonstrate the continuing need for urgent and concerted action to address the persistent perinatal inequity in the Indigenous population

The urban-remote divide for Indigenous perinatal outcomes

Objective: To determine whether remoteness category of residence of Indigenous women affects the perinatal outcomes of their newborn infants. Design and participants: A population-based study of 35 240 mothers identified as Indigenous and their 35 658 babies included in the National Perinatal Data Collection in 2001–2004. Main outcome measures: Australian Standard Geographical Classification remoteness category, birthweight, Apgar score at 5 minutes, stillbirth, gestational age and a constructed measure of perinatal outcomes of babies called “healthy baby” (live birth, singleton, 37–41 completed weeks’ gestation, 2500–4499 g birthweight, and an Apgar score at 5 minutes ≥7). Results: The proportion of healthy babies in remote, regional and city areas was 74.9%, 77.7% and 77.6%, respectively. After adjusting for age, parity, smoking and diabetes or hypertension, babies born to mothers in remote areas were less likely to satisfy the study criteria of being a healthy baby (adjusted odds ratio [AOR], 0.87; 95% CI, 0.81–0.93) compared with those born in cities. Babies born to mothers living in remote areas had higher odds of being of low birthweight (AOR, 1.09; 95% CI, 1.01–1.19) and being born with an Apgar score < 7 at 5 minutes (AOR, 1.63; 95% CI, 1.39–1.92). Conclusions: Only three in four babies born to Indigenous mothers fell into the “healthy baby” category, and those born in more remote areas were particularly disadvantaged. These findings demonstrate the continuing need for urgent and concerted action to address the persistent perinatal inequity in the Indigenous population

Hepatitis B virus surface antigen (HBsAg)-positive and HBsAg-negative hepatitis B virus infection among mother-teenager pairs 13 years after neonatal hepatitis B virus vaccination

It is unclear whether a mother who is negative for hepatitis B virus surface antigen (HBsAg) but positive for hepatitis B virus (HBV) is at potential risk for mother-to-child transmission of HBV. This study, using a paired mother-teenager population, aimed to assess whether maternal HBsAg-negative HBV infection (hnHBI) is a significant source of child HBV infection (HBI). A follow-up study with blood collection has been conducted on the 93 mother-teenager pairs from the initial 135 pregnant womannewborn pairs 13 years after neonatal HBV vaccination. Serological and viral markers of HBV have been tested, and phylogenetic analysis of HBV isolates has been done. The HBI prevalence was 1.9% (1 hnHBI/53) for teenage children of non-HBI mothers, compared with 16.7% (1 hnHBI/6) for those of hnHBI mothers and 2.9% (1 HBsAg-positive HBV infection [ hpHBI]/34) for those of hpHBI mothers. Similar viral sequences have been found in one pair of whom both the mother and teenager have had hnHBI. In comparison with the hpHBI cases, those with hnHBI had a lower level of HBV load and a higher proportion of genotype-C strains, which were accompanied by differentiated mutations (Q129R, K141E, and Y161N) of the "a" determinant of the HBV surface gene. Our findings suggest that mother-to-teenager transmission of hnHBI can occur among those in the neonatal HBV vaccination program. Copyright © 2013, American Society for Microbiology. All Rights Reserved