China confirmed as world's most prolific ART nation

Published 18 February 2020

A first comprehensive report on ART activity in China shows that more than 900,000 ART cycles were performed in 2016, far more than recorded in Japan or USA.

What has long seemed likely has now been confirmed. China is the world's most active country in assisted reproduction. An unprecedented analysis from the National Health Commission reports a total of 906,840 ART cycles (IVF, ICSI, FET, PGT) performed in 2016, the majority (525,034 cycles) in the Eastern sector (which includes Beijing, Shanghai and Guandong).(1) In addition there were more than 150,000 donor insemination cycles completed country-wide.

The 906,840 ART cycles, which were provided by 323 clinics supplying data, broke down as 375,770 fresh IVF and 154,948 fresh ICSI cycles, 367,146 FET thawing cycles, and 8976 PGT treatment cycles. Interestingly, the Chinese protocol seems to favour IVF over ICSI, in direct contrast to the pattern now seen in Europe and the USA (roughly two-thirds ICSI and one-third IVF). In 2016, the year of this analysis, 138,553 cycles were reported to the national registry of Spain, Europe's pace-setter in ART, 284,385 cycles reported from 448 clinics in the USA (in 2017) and 424,151 cycles from Japan. The latest disclosures thus mean that ART activity in China is significantly greater than in any other country. Speaking on behalf of ICMART at last year's ESHRE annual meeting David Adamson put China's ART activity at 'about 700,000 cycles', an estimate somewhat below what is now actually happening and a reflection of how little we know of what's going on.

The authors of this paper now report that 98.7% of all China's licensed clinics supplied data, and describe a steep escalation in ART activity since China's first IVF baby was born (in 1988) - but especially over the past few years. For example, as a mark of availability there were 360 cycles per million inhabitants in 2013, yet 657 cycles in 2016 (again with concentrations in the Eastern sector). There were 311,309 ART babies born in 2016, which accounted for 1.69% of total births, a rate, say the authors, almost the same as the Centers for Disease Control (CDC) calculated for the USA in 2016. They describe this increase - especially in the Eastern sector - as 'remarkable', such that the availability of ART in these regions 'has exceeded that of many countries and regions in Europe in 2014'. This trend, they add, is partly explained by patients looking to the large public hospitals in the eastern big cities for ART - though 2015 did see the opening of China's first IVF clinic in Tibet.

To date, ART services in China have not been covered by any national medical insurance system, although local reimbursement schemes for families with no child are said to be available in certain provinces. In 2016, says the report, China's two-child policy 'was fully implemented', with ART then recognised as 'a necessary and beneficial complementary technology in maternal and child health services for couples with infertility'. Thus, as a safe and effective technology for infertility, ART 'remains the focus of Chinese government regulation'.

For routine IVF the paper also reported a clinical pregnancy rate per oocyte retrieval of 23.2%, and delivery rate of 18.7%; for ICSI the PR and DR were 20.5% and 16.7% respectively; and for FET per thawing cycles the PR and DR were 48.2% and 37.6%. However, the rate of twin deliveries was high - 27.9% for IVF, 27.2% for ICSI and 24.2% for FET.

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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