A new world picture of ART activity


David Adamson presented details of global ART activity, which for the first time included formal data from China.

Published 07 July 2020

The addition of data from China to ICMART’s global registry monitoring has propelled China to the top of the world’s ART nations; China is now completing the same number of cycles as the entire region of Europe.

What a difference new registry data from China has made to the global picture of IVF. For now, on the second day of ESHRE’s virtual annual meeting, David Adamson, presenting his annual report on behalf of ICMART with preliminary data for 2016, had for the first time at his disposal comprehensive registry figures from China – and how the ART world now looks a different place.(1)

In his previous reports at ESHRE’s annual meetings Adamson had always maintained that the ICMART figures, which last year (for 2015) covered almost 1.8 million cycles, represented only around two-thirds of world activity in ART. The big data gaps were in the Middle East and Asia, and notably China. Thus, the world’s regional leader was – and always was – Europe, with almost 1 million cycles a year and representing some 50% of global activity.

But then came China, and with one input of data the whole picture has changed. Now, said Adamson, China is performing as many cycles per year as the entire European region and is by far the world’s most prolific nation in ART.

Despite the published results, China is not yet formally reporting its statistics - summary data, not cycle data – to ICMART. So the full global picture, explained Adamson, has now been developed with the preliminary registry data of ICMART, plus the input of activity in China based on the published report, plus a further estimate of unreported activity. This in 2016 amounted to 1,882,018 reported cycles, 906,840 cycles from, and 564,605 estimated cycles, a grand total of more than 3.3 million cycles. These are extraordinary numbers, and way beyond earlier estimates. ‘A very exciting development,’ said Adamson with some understatement.

What this means in terms of estimated world data is that China is now performing 27% of the entire world’s ART, exactly the same proportion as Europe, which up to now had led activity by far. It also means that just ten countries are now responsible for around 80% of world ART, with cycle numbers for 2016 as below:
* China 906,84o
* Japan 447,763
* USA 190,149
* Spain 131,219
* Russia 117,276
* France 103,987
* Germany 99,226
* Italy 73,442
* Australia 72,497
* UK 66,144

Adamson did not add the new China data into his usual ICMART estimate of total IVF babies born since 1978. Last year, in his review of 2015, he proposed a total of more than 8 million babies born so far, which surely, with the addition of one more year and cumulative deliveries from China (where the first IVF baby was born in 1988), must now be on its way to – or beyond - 10 million.

Looking back over the official reported cycles to ICMART, Adamson noted an overall annual increase in cycle numbers of 9.3% over 2015, although much of this year’s data collection and analysis has not yet been completed.

However, Adamson was able to conclude that many – but not all - of the outcomes reported from China were comparable to what is evident in ICMART reported cycles, notably a delivery rate of around 19% (although a higher FET rate, 38%, than found in ICMART results, 25%). There was also a higher availability rate in China than in overall ICMART data, of 657 cycles per million population over 430 per million in ICMART. The Chinese figures thus show that 1.57% of all infants born are now conceived by ART, against 0.39% in ICMART registry data. Moreover, with a twin delivery rate of 27.7% per fresh ET, the Chinese multiple rate is considerably higher than that found in the ICMART results (of around 20% and much lower in some countries). However, the Chinese figures show similar patterns of regional variability to other registries, with a concentration of clinics and activity in the well-developed regions of Eastern China.

Adamson described China’s first publication of registry data as ‘an excellent report’, adding that the ICMART global summaries will be ‘significantly more comprehensive with the inclusion of China data’.

* David Adamson began his presentation with a tribute to the late Karl Nygren, who died earlier this year following COVID-19 infection. Karl was elected chairman of ICMART at its first board meeting in 2003, having already been a founding chairman of ESHRE’s European IVF Monitoring Consortium.

1. Bai F, Wang DY, Qiu J, et al. Assisted reproductive technology service availability, efficacy and safety in mainland China: 2016. Hum Reprod 2020; doi:10.1093/humrep/dez245.

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