At present "reproductive tourists" travel to Italy to take advantage of its lack of regulations for IVF techniques, but this could be reversed if the Italian senate ratifies proposals that would encourage multiple pregnancies, according to Dr Karl Nygren, Associate Professor of Obstetrics and Gynaecology at Sofiahemmet Hospital in Stockholm, Sweden.
On Wednesday 3 July he will tell the annual meeting of the European Society of Human Reproduction and Embryology in Vienna that more European countries are moving towards a reduction in the numbers of embryos transferred to a woman's womb in each cycle, and that this is having no effect on the number of resulting pregnancies, which are continuing to rise gradually1.
"It is very good news that trends are continuing to move towards more effective and safer treatments in Europe," he said. "These trends prove that it is not necessary to transfer several embryos at one time into a woman's womb in order to achieve a successful pregnancy. For instance, in Sweden doctors never transfer three or more embryos at one time, yet we have one of the highest pregnancy rates per transfer in Europe at 36%.
"In the light of these findings it seems doubly unfortunate for the Italians to be proposing to take a retrograde step which could result in women becoming pregnant with triplets2. Their proposals would lead to a reduction in efficacy and would endanger the safety of the mothers and babies. Once Italian women realise this they will go to other countries for ART – a womb drain that would reverse the current direction in reproductive tourism."
Dr Nygren and Dr Anders Nyboe Andersen, Head of the Fertility Clinic at the Rigshospitalet at Copenhagen University Hospital, Denmark, will be presenting the third ESHRE report on ART in Europe which contains data from 1999 to 2000 – the most recent figures available.
During this period, 500 clinics in 21 countries contributed data to the report. Four countries have joined since the previous year: Ireland, Poland, Slovenia and the Ukraine. The report now covers all of Western Europe, with the exception of Austria (which is due to join next year) and Luxembourg (which has no ART clinics).
In the three years since 1997, the numbers of treatment cycles has increased by 24%, from 203,225 to 249,624. Three countries, Germany, France and UK, account for nearly half of all those cycles. This compares with the USA where there are close to 100,000 cycles a year.
Denmark still tops the league table for availability of ART treatment; there were 1659 treatment cycles per million inhabitants in 1999, 1407 in Finland, 1383 in Iceland (where there is only one clinic), 973 in Sweden, 915 in the Netherlands, and 882 in France. By comparison, in the USA there are approximately 250 cycles per million.
Countries that have the highest proportion of three or more embryos transferred in each cycle include the Ukraine (77.9%), Hungary (75.3%), Spain (75%), Ireland (69.8%), Russia (68%), Italy (57.8%) and Portugal (56.7%). Yet some of these countries had low pregnancy success rates. By contrast, Sweden and Finland have the lowest proportion of triple embryo transfers (4.5% and 5.4% respectively), but were among the countries with the highest pregnancy success rate – Sweden's pregnancy rate per embryo transfer was 36% for IVF, and Finland's was 29.6%.
Dr Nyboe Andersen will tell the conference: "This is the third year that we have reported data on ART in Europe, and we are delighted that more countries have joined in European monitoring. This is the only way to detect trends – it is not possible to do so when looking at figures from one or a very few countries. Our report shows some encouraging trends. In Europe as a whole, the average pregnancy rates per embryo transfer have increased to 27%, but the average numbers of multiple deliveries has decreased to 26%. There has been a trend towards a reduction in the numbers of embryos transferred in each cycle. This is very good news. Overall, the report provides evidence that the quantity and quality of ART in Europe is increasing."
- "ART in Europe, 1999 – third ESHRE report" by Dr Karl Nygren and Dr Anders Nyboe Andersen.
- The Lower House of the Italian Parliament has put forward proposals to the Senate saying that the freezing of oocytes and sperm is acceptable, but not the freezing of embryos – currently the most effective way of preserving surplus embryos. Members propose to limit the number of oocytes that can be inseminated to three, and say that all embryos resulting from the insemination must be transferred to the patient at one time. This means that a woman would be at risk of giving birth to triplets, with all the resulting risks to mothers and babies.
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