8/7/2019 IVI_MedITEX

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ONE MILLION CYCLES IN THE GERMAN IVF-REGISTRYK. Bühler

Chairman of the German IVF Registry [Deutsches IVF-Register, D·I·R]

Centre for Gynaecological Endocrinology & Reproductive MedicineLangenhagen (Hanover) & Wolfsburg

www.ivf-germany.com *** www.deutsches-ivf-register.de 

INTRODUCTION:

Systematic data collection in the field of IVF treatment has been established in Germany since nearly 30 years. In 1982the year when the first IVF baby was born in Germany, 5 centres put their results together showing transparency of thisnew treatment option in treatment of fertility problems. In 1996, 71 centres participated, a reorganisation was performedata transfer is only possible by electronic way allowing prospective data collection and on-line control of plausibility ofdata. Prospectivity was defined as announcing the treatment cycle at least at day 7 of stimulation. In 1998, the GermanMedical Association declared it mandatory for all centres to participate at the Deutsches IVF-Register. Since 1982 till 2(incl.) all in all 1.048.745 are collected. 90% of the "fresh" cycles are collected prospectively, so showing good data quaand reliability allowing powerful statistical evaluations of the daily practice in ART treatment in Germany 1).

ce 1996, a year a "Yearbook" is published and can be seen by every one at theistries homepage; in 2010, the annual 2009 was also published for the first time

English (http://www.kup.at/kup/pdf/9318.pdf ).

data collection software, the participants can use the RecDate program whichls all needs for the electronic organisation & surveillance of an IVF centremmercially available: http://www.meditex-software.com/index.php/en/products/ software ) or the electronic questionnaire developed by the registry itself. The reale communication with the registry is effected by a "DIRdll-interface" by which theusibility and prospectively control is performed instantly. Since 1996 the registrynanced by the members and in this time they paid > 1,6 Mill €.

RESULTS:

fig. 2

18,1

18,6

25,0

23,3

17,0

20,0

23,0

26,0

1 997 19 98 1 999 20 00 2 001 2 00 2 2 003 2 00 4 20 05 2 00 6 20 07 2 00 8 20 09

IVF IC SI TESE- IC SI C ryo

fig. 3

Data collection is performed cycle-by-cycle; the results are published in ananonymous way; only the regionalmedical associations know the centrespecific results.

Fig. 1 shows how the yearly OPU rates developed in Germany over theyears. It is obvious how political decisions can influence the frequenciesof ART treatment (): in the year 2000 the NHS didn't pay for ICSItreatment; in 2004 the couples have to pay of the costs themselves.The clinical PR depending from age and numbers of embryostransferred is shown in fig. 2 . With these > 500.000 cycles it can clearlybe demonstrated that after the age of 33 years of the treated womenthere is a clear decrease in chances to get pregnant.

Concerning miscarriage rates (fig. 3 ) there is a slight decrease over theyears, but the rates after transfer from cryopreserved and thawedoocytes in the 2-PN stage is all the time 3-5 percent points higher.

With further studiesit must be clarified ifthis is due to thecryopreservationprocess or due tothe fact thatnormally the bestlooking oocytes areused for the freshtransfer.

At least, twice a year every centre receives by the registry so called centreprofiles (fig 4a / 4b ) in which for about 120 items the centre specific data arecompared with the results of al centres. So every centre is enabled to see theown position for every item on the national filed.

Bals-Pratsch, K Bühler, J Krüssel, et al.: "Extended Analyses of the German IVF Registry (D·I·R): Andrological Aspects, Medical-Economical Assumptions Related tift From IVF to ICSI and Stimulation with Gonadotropins." J Reproduktionsmed Endokrinol 2010; 7: 40–4.Ludwig, T. Rabe, K. Bühler, et al.: "Wirksamkeit von rekombinantem humanem FSH im Vergleich zu urinärem hMG nach Downregulation im langen Protokoll – Einalyse von 24.764 ART-Zyklen in Deutschland." J Reproduktionsmed Endokrinol 2004; 1: 284–8

With such profiles the registry is able to exert aneducational effect also. So, D·I·R could convinced thecentres to reduce the number of transferred embryosand continuously a decrease can be observed: in IVFand ICSI cycles a reduction of 18,5% to 19,5% from1997 to 2009 yielding in a reduction of triplets borncompared to all children born after ART procedures ofnearly -80% (fig 5a / 5b ).

NCLUSION:

gistries are necessary to show great transparency relating to all acts performed in the field of reproductive medicine. With such a great data base and due tourate, continuous & prospective data capture reliable conclusions can be drawn, especially regarding the daily use of these procedures. Compared to RCT in oury work we dispose very seldom over the "ideal patient". The German IVF Registry (D·I·R) is established as a standard for quality control & assurance, both withinvidual centres and nationwide in the context of data capture for the IVF register 2).

- 18,5% - 19,5% - 11,1% - 78 %

fig. 5b

n = 769.064

fig. 1

fig. 5a

fig.4a

fig.4a

fig. 4b

fig. 4b