ANARA, GIERAF

Article published in the RBMO Review to answer the following question: What were the trends in utilization, outcomes and practices in assisted reproductive technology (ART) in Africa between 2013 and 2017?

DOI : https://doi.org/10.1016/j.rbmo.2020.06.021

Abstract

Research question
What were the trends in utilization, outcomes and practices in assisted reproductive technology (ART) in Africa between 2013 and 2017?

Design

Cycle-based data and retrospective summary data were collected cross-sectionally from voluntarily participating ART centres.

Results

During the 5-year period, 153,917 ART procedures were reported from 73 centres in 18 countries. ART utilization remained low in all countries and years. Autologous fresh ART was by far the most common intervention, with little change in the clinical pregnancy rate (CPR) per aspiration (34.9% in 2013; 31.7% in 2017) and a consistent preponderance of young women. Oocyte donation represented less than 10% of reported procedures. Although the transfer of multiple embryos prevailed, elective single-embryo transfer (eSET) resulted in a CPR of 43.2% per transfer in fresh autologous cycles, which was notably higher compared with non-elective SET cycles (16.6%) and all dual embryo transfers (DET; 37.3%). Compared with eSET, elective DET further increased the CPR by less than 5% while raising the multiple delivery rate by 33.4%. The majority of multiples were born preterm. Many pregnancies were, however, lost to follow-up, compromising the delivery and birth outcome data.

Conclusion

ART monitoring has been successfully established in Africa although progress must continue. Although data are not yet representative, best evidence indicates low access to ART. Perinatal outcome supports eSET, but other social determinants responsible for multiple embryo transfers are important factors to consider. Efforts must be directed at improving pregnancy follow-up. Registry data are integral to the widening of access to high-quality ART in Africa.

Key words : Africa, Assisted reproductive technology, Availability, Infertility, IVF/ICSI outcome, Registry