Assisted reproductive technology in Europe, 1997. Results generated from European registers by ESHRE. European IVF-Monitoring Programme (EIM), for the European Society of Human Reproduction and Embryology (ESHRE)

European results of assisted reproductive techniques from treatments initiated during 1997 are presented in this first ESHRE report. Data were collected from 18 European countries, usually from already-existing national registers. A total of 482 clinics from these 18 countries reported 203 893 cycles. In 10 countries with complete registration, 133215 cycles were performed in a population of 174 million, corresponding to 765 cycles per million inhabitants. After IVF and intracytoplasmic sperm injection (ICSI), the distribution of transfer of one, two, three and four or more embryos was 11.5, 35.9, 38.4 and 14.3% respectively. Huge differences existed between countries. For IVF, the clinical pregnancy rate per transfer was 26.1%, and the delivery rate per embryo transfer 20.9%. For ICSI, the corresponding rates were 26.4% and 21.5%. Singleton, twin, triplet and quadruplet delivery rates for IVF were 70.4, 25.8, 3.6 and 0.2% respectively, giving a total multiple delivery rate for IVF of 29.6%. After ICSI, the corresponding rates were 71.7, 25.2, 2.9 and 0.1%, amounting to a total multiple delivery rate of 28.2%. The range of triplet delivery rates after IVF range from 0.4% to 11.9% among countries.     

A multi-centre cohort study of the physical health of 5-year-old children conceived after intracytoplasmic sperm injection, in vitro fertilization and natural conception

BACKGROUND: Over a million children have been born from assisted conception worldwide. Newer techniques being introduced appear less and less 'natural', such as intracytoplasmic sperm injection (ICSI), but there is little information on these children beyond the neonatal period. METHODS: 540 ICSI conceived 5-year-old children from five European countries were comprehensively assessed, along with 538 matched naturally conceived children and 437 children conceived with standard IVF. RESULTS: Of the 540 ICSI children examined, 63 (4.2%) had experienced a major congenital malformation. Compared with naturally conceived children, the odds of a major malformation were 2.77 (95% CI 1.41-5.46) for ICSI children and 1.80 (95% CI 0.85-3.81) for IVF children; these estimates were little affected by adjustment for socio-demographic factors. The higher rate observed in the ICSI group was due partially to an excess of malformations in the (boys') urogenital system. In addition, ICSI and IVF children were more likely than naturally conceived children to have had a significant childhood illness, to have had a surgical operation, to require medical therapy and to be admitted to hospital. A detailed physical examination revealed no further substantial differences between the groups, however. CONCLUSIONS: Singleton ICSI and IVF 5-year-olds are more likely to need health care resources than naturally conceived children. Assessment of singleton ICSI and IVF children at 5 years of age was generally reassuring, however, we found that ICSI children presented with more major congenital malformations and both ICSI and IVF children were more likely to need health care resources than naturally conceived children. Ongoing monitoring of these children is therefore required.     

The influence of assisted reproduction on family functioning and children's socio-emotional development: results from a European study

BACKGROUND: ICSI is used with increasing frequency, but there is less information about the children born following this method of assisted reproduction than other forms of IVF. Some authors have suggested that it may contribute to more family stress than IVF. METHODS: ICSI conceived children were compared with IVF conceived children and naturally conceived (NC) controls. They were selected in five European countries: Belgium, Denmark, Greece, Sweden and the UK, and seen for psychological testing and a paediatric examination when they were 5 years old. In all countries, except Greece, mothers and fathers were asked to complete questionnaires about parental well-being, family relationships, parenting and child behaviour. RESULTS: Very few differences were found between the ICSI and NC group or the ICSI and IVF group. The only significant differences were that mothers in the ICSI conceived group reported fewer hostile or aggressive feelings towards the child and higher levels of commitment to parenting than the mothers of NC children. CONCLUSIONS: The study confirms the results of previous work with IVF families. This should be encouraging for families using these techniques in the future.     

Assisted reproductive technology in Europe, 1999. Results generated from European registers by ESHRE

European results of assisted reproductive techniques from treatments initiated during 1999, are presented in this third report. Data were collected mainly from pre-existing national registers. From 22 countries 538 clinics reported 258 460 cycles: IVF 125 370, ICSI 95 221, frozen embryo replacement (FER) 34 002 and oocyte donations (OD) 3867. In eight countries, where all clinics reported to the register, a total of 99 629 cycles was performed in a population of nearly 106 million, corresponding to 943 cycles per million inhabitants and 3.9 cycles per 1000 women aged 15-49 years. After IVF and ICSI the distribution of transfer of 1, 2, 3 and >or=4 or more embryos was 11.9, 39.2, 39.6 and 9.3% respectively. Huge differences existed between countries. For IVF the clinical pregnancy rate per aspiration and per transfer was 24.2 and 27.7% respectively. For ICSI the corresponding rates were 26.1 and 27.9%. These figures represent relative increases by 2.2 to 5.2% compared with 1998. The distribution of singleton, twin, triplet and quadruplet deliveries for IVF and ICSI combined was 73.7, 24.0, 2.2 and 0.1%. This gives a total multiple delivery rate of 26.3%. Triplet deliveries after IVF and ICSI ranged from 0.3-7.0% between countries. Compared with 1998, the number of reported cycles increased by 11% and the clinical pregnancy rate per transfer increased from 27.0 to 27.7% after IVF and from 26.8 to 27.9% after ICSI. Multiple deliveries after IVF and ICSI remained unchanged at 26.3% in 1999.     

Assisted reproductive technology in Europe, 2000. Results generated from European registers by ESHRE

European results of assisted reproductive techniques from treatments initiated during 2000 are presented in this fourth annual report. Data were collected mainly from pre-existing national registers. From 22 countries, 569 clinics reported 279 267 cycles: IVF 126 961, ICSI 99 976, frozen embryo replacement (FER) 45 800 and oocyte donations (OD) 6530. In nine countries where all clinics reported to the register, a total of 142 174 cycles were performed in a population of 166 million, corresponding to 856 cycles per million inhabitants. After IVF and ICSI, the distribution of transfer of one, two, three and >or=4 embryos was 12.1, 46.7, 33.3 and 6.8%, respectively. Huge differences existed between countries. For IVF, the clinical pregnancy rate per aspiration and per transfer was 24.7 and 28.4%, respectively. For ICSI, the corresponding rates were 26,6% and 28,7%. These figures represent increases of 0.7 and 0.8% compared with 1999. The distribution of singleton, twin, triplet and quadruplet deliveries for IVF and ICSI combined was 73.6, 24.4, 2.0 and 0.04%. This gives a total multiple delivery rate of 26.4%. The range of triplet deliveries after IVF and ICSI ranged from 0.3 to 7.0% between countries. Compared with 1999, the number of reported cycles was increased by 8% and the clinical pregnancy rate per transfer was increased by 0.7% after IVF and by 0.8% after ICSI. The total multiple delivery rates after IVF and ICSI remain unchanged during the last 4 years.     

What is the most relevant standard of success in assisted reproduction? Singleton live births should also include preterm births

An intensive debate is ongoing in this journal concerning themost appropriate endpoint after assisted reproduction techniques.The endpoint suggested by the first authors was Birth Emphasizinga Successful Singleton at Term (BESST). We have evaluated themost appropriate endpoint from different perspectives: patients,public, health authorities, obstetric and IVF clinics. We findsingleton live birth highly relevant as an outcome parameteras multiple pregnancies are the main factor responsible forthe overall poorer obstetric and neonatal outcome in IVF pregnancies,and multiple pregnancies are mostly an avoidable iatrogeniccomplication. However, our proposal is that both preterm andterm singletons should be included since the prematurity rateis an outcome that is largely uninfluenced by the IVF clinics.In conclusion, we propose singleton live birth per cycle initiatedas the most appropriate main outcome after assisted reproduction.Prematurity should in addition be reported separately as a secondaryoutcome.     

Assisted reproductive technology in Europe, 2001. Results generated from European registers by ESHRE

European results of assisted reproductive techniques from treatments initiated during 2001 are presented in this fifth report. Data were collected mainly from already existing national registers. From 23 countries, 579 clinics reported 289 690 cycles with: IVF 120 946, ICSI 114 378, frozen embryo transfer (FER) 47 195 and egg donation (ED) 7171. Overall this represents a 4% increase since the year 2000. For the first time, results on European data on intra-uterine inseminations (IUIs) were reported from 15 countries. A total of 67 124 cycles [IUI husband'sperm (IUI-H) 52 949 and IUI donor sperm (IUI-D) 14 185] were included. In 12 countries where all clinics reported to the register, a total of 108 910 cycles were performed in a population of 131.4 million, corresponding to 829 cycles per million inhabitants. For IVF, the clinical pregnancy rate per aspiration and per transfer was 25.1 and 29.0%, respectively. For ICSI, the corresponding rates were 26.2 and 28.3%. These figures are similar to the results from 2000. After IUI-H, the clinical pregnancy rate was 12.8% in women <40 and 9.7% in women > or =40 years of age. After IVF and ICSI, the distribution of transfer of one, two, three and > or =4 embryos was 12.0, 51.7, 30.8 and 5.5%, respectively. Compared with the year 2000, fewer embryos were transferred, but huge differences existed between countries. The distribution of singleton, twin and triplet deliveries for IVF and ICSI combined was 74.5, 24.0 and 1.5%, respectively. This gives a total multiple delivery rate of 25.5%, compared with 26.9% in the year 2000. The range of triplet deliveries after IVF and ICSI differed from 0.0 to 8.2% between countries. After IUI-H in women <40 years of age, 10.2% were twin and 1.1% were triplet gestations.     

Assisted reproductive technology in Europe, 2002. Results generated from European registers by ESHRE

European results of assisted reproductive techniques (ART) from treatments initiated during 2002 are presented in this sixth report. Data was mainly collected from already existing national registers. From 25 countries, 631 clinics reported 324,238 treatment cycles with: IVF 122,634, ICSI 135,048, frozen embryo replacement (FER) 57 162, egg donation (ED) 7677, preimplantation genetic diagnosis/screening (PGD/PGS) 1563 and in vitro maturation (IVM) 154. Overall this represents a 12% increase since year 2001. For the second time, results on European data on intrauterine inseminations were reported from 17 countries. A total of 93,284 cycles [IUI-husband/partner (H), 78 505 and IUI-donor (D), 14,779] were included. In 13 countries where all clinics reported to the register, a total of 177,429 cycles were performed in a population of 193.7 million, corresponding to 916 cycles per million inhabitants. For IVF the clinical pregnancy rate per aspiration and per transfer was 26.0 and 29.5%, respectively. For ICSI the corresponding rates were 27.2 and 29.4%. These figures are marginally better than in 2001. After IUI-H the clinical pregnancy rate was 11.6% in women below 40 and 7.8% in women>or=40 years of age. After IVF and ICSI the distribution of transfer of 1, 2, 3 and 4 or more embryos was 13.7, 54.8, 26.9 and 4.7%, respectively. Compared with year 2001, less embryos were transferred, but huge differences existed between countries. The distribution of singleton, twin and triplet deliveries for IVF and ICSI combined was 75.5, 23.2 and 1.3%, respectively. This gives a total multiple delivery rate of 24.5%, compared with 25.5% in year 2001. The range of triplet deliveries after IVF and ICSI varied from 0.0 to 5.2% between countries. After IUI-H in women below 40 years of age, 10.2% were twin and 1.3% triplet gestations.     

Assisted reproductive technology in Europe, 2003. Results generated from European registers by ESHRE

BACKGROUND: European results of assisted reproductive techniques (ARTs) from treatments initiated during 2003 are presented in this seventh report. METHODS: Data were mainly collected from already existing national registers. From 28 countries, 725 clinics reported 365 103 treatment cycles with: IVF 132 932, ICSI 162 149, frozen embryo replacement (FER) 60 412, oocyte donation (OD) 7548, PGD/PGS 1956 and IVM 109. Overall, this represents a 13% increase since 2002. For the third time, results on European data on intrauterine inseminations (IUIs) were reported from 19 countries. A total of 99 577 cycles (IUI-H, 82 834; IUI-D, 16 743) were included. RESULTS: In those 15 countries where all clinics reported to the register, a total of 284 765 cycles were performed in a population of 278.7 million, corresponding to 1022 cycles per million inhabitants. For IVF, the clinical pregnancy rates per aspiration and per transfer were 26.1 and 29.6%, respectively. For ICSI, the corresponding rates were 26.5 and 28.7%. After IUI-H, the clinical pregnancy rate was 12.2% in women below 40 years and 8.8% in women > or =40 years. After IVF and ICSI, the distribution of transfer of one, two, three and four or more embryos was 15.7, 55.9, 24.9 and 3.5%, respectively. Compared to the year 2002, fewer embryos were transferred, but huge differences still exist between countries. The distribution of singleton, twin and triplet deliveries for IVF and ICSI combined was 76.7, 22.0 and 1.1%, respectively. This gives a total multiple delivery rate of 23.1% compared with 24.5% in 2002. The range of triplet deliveries after IVF and ICSI varied from 0.0 to 4.4% between countries. After IUI-H in women below 40 years of age, 11.4% were twin and 2.2% triplet gestations.     

Congenital malformations in 4224 children conceived after IVF

BACKGROUND: The percentage of children born after IVF will continue to increase due to demographic changes such as increasing maternal age and new developments in assisted reproduction techniques. IVF conceptions may carry an increased risk of congenital malformations. METHODS: We compared overall and specific congenital malformation rates calculated for IVF children (n = 4224) and naturally conceived children (n = 314 605), using records from the same Dutch national database for the years 1995 and 1996 and controlling for confounding maternal factors. RESULTS: The overall crude odds ratio (OR) for the risk of any malformation for IVF children compared with naturally conceived children was 1.20 [95% confidence interval (CI): 1.01-1.43]. After correction for differences in maternal age, parity and ethnicity between the IVF and control population the OR was 1.03 (95% CI: 0.86-1.23). The crude OR for IVF children appeared higher for the cardiovascular organ system and for several specific minor congenital malformations. However, these could be chance findings due to comparison of many malformation categories or may result from remaining differences in ascertaining malformations between IVF and naturally conceived children. CONCLUSIONS: The small increase in overall congenital malformations observed in the IVF children appears to be attributable to differences in maternal characteristics and not to any aspect of the IVF procedure.     

Triplet pregnancy achieved through intracytoplasmic sperm injection with spermatozoa obtained by prostatic massage of a paraplegic patient: case report.

Spinal cord-injured men with ejaculation disorders can have children thanks to assisted reproduction techniques. Spermatozoa from these patients are usually obtained through vibratory stimulation, electroejaculation or by puncturing the seminal duct or the testicle. We present the first published case, as far as we are aware, of spermatozoa obtained through prostatic massage of a paraplegic patient. Penile vibratory stimulation was unsuccessful in this patient. In-vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) with spermatozoa obtained through electroejaculation was performed at another centre but pregnancy was not achieved. Through prostatic massage, we obtained a total semen volume of 6 ml containing a total count of 12.32x10(6) spermatozoa (6.24x10(6) with tails), 8% of which had motility (graded + and ++); and 16% of which had normal morphology. The spermatozoa obtained were then used to perform IVF with ICSI and a triplet pregnancy was achieved. Prostatic massage appears to be an easy, non-traumatic and risk-free method to obtain spermatozoa from paraplegic patients.     

Multiple gestation pregnancy. The ESHRE Capri Workshop Group

Multiple gestation pregnancy rates are high in assisted reproductivetreatment cycles because of the perceived need to stimulateexcess follicles and transfer excess embryos in order to achievereasonable pregnancy rates. Perinatal mortality rates are, however,4-fold higher for twins and 6-fold higher for triplets thanfor singletons. Since the goal of infertility therapy is a healthychild, and multiple gestation puts that goal at risk, multiplepregnancy must be regarded as a serious complication of assistedreproductive treatment cycles. The 1999 ESHRE Capri Workshopaddressed the psychological, medical, social and financial implicationsof multiple pregnancy and discussed how it might be prevented.Multiple gestations are high risk pregnancies which may be complicatedby prematurity, low birthweight, pre-eclampsia, anaemia, postpartumhaemorrhage, intrauterine growth restriction, neonatal morbidityand high neonatal and infant mortality. Multiple gestation childrenmay suffer long-term consequences of perinatal complications,including cerebral palsy and learning disabilities. Even whenthe babies are healthy they must share their parents' attentionand may experience slow language development and behaviouralproblems. Current data indicate that the average hospital costper multiple gestation delivery is greater than the averagecost of in-vitro fertilization (IVF) and intracytoplasmic sperminjection (ICSI) cycles. Prevention is the most important meansof decreasing multiple gestation rates. Multiple gestation ratesin ovulation induction and superovulation cycles can be reducedby using lower dosage gonadotrophin regimens. If there are morethan three mature follicles, the cycle should be converted toan IVF cycle, or it should be cancelled and intercourse shouldbe avoided. In IVF cycles two embryos can be transferred withoutreducing birth rates in most circumstances. Embryo reductioninvolves extremely difficult decisions for infertile couplesand should be used only as a last resort. Assisted reproductivetreatment centres and registries should express cycle resultsas the proportion of singleton live births; twin and tripletrates should be reported separately as complications of theprocedures. Reducing the multiple gestation pregnancy rate shouldbe a high priority for assisted reproductive treatment programmes,despite the pressure from some patients to transfer more embryosin order to improve success. If nothing is done, public concernmay lead to legislation in many countries, a step that wouldbe unnecessary if assisted reproductive treatment programmesand registries took suitable steps to reduce multiple pregnancyrates.     

Infertility: Psychological follow-up of children born after in-vitro fertilization

We have studied from birth up to the 3rd year the psychologicalattitude of 33 in-vitro fertilization (IVF) children comparedto two other groups: children born after ovarian stimulationwithout IVF (n = 33) and children conceived naturally (n = 33)during the same period. Fourteen children, born by oocyte donation,were also studied by the same methodology. In the IVF group,we found some feeding difficulties and sleep disorders in theinfants at 9 months and some signs of depression in mothers.All these symptoms disappeared afterwards. The development ofall the children is satisfactory and the relationship with theirmother is excellent. In this preliminary study, we concludethat the method of assisted reproduction has no bad influenceon the psychomotor development of these children.     

Possibilities and limitations of techniques of assisted reproduction for the treatment of male infertility

Since relatively few spermatozoa are needed for oocyte fertilization during gamete intra-Fallopian transfer (GIFT) or in-vitro fertilization (IVF), these methods have been applied in couples with infertility due to male causes. Forty-six couples with male factor infertility were enrolled in this study and results were compared with those attained in 48 couples treated with the same techniques for other than male causes. Overall, GIFT resulted in 26% ongoing pregnancies. GIFT seems to be particularly successful when the sperm concentration is 20 x 10(6)/ml or more, but sperm motility and/or morphology are poor. Nine pregnancies occurred out of 26 GIFT cycles in 18 cases selected on this basis. The ongoing pregnancy rate after IVF was 16% per patient. The latter treatment should be attempted in male immune infertility and in cases with a low sperm concentration, with or without abnormal sperm motility and/or morphology. In these circumstances, five pregnancies were attained out of 28 cycles in 14 cases. For similar sperm concentrations, the conception rate per cycle attained with techniques of assisted reproduction was more than twice that attained with conventional treatment of male infertility.     

The IVF league tables: time for a reality check

In many countries the reported results of the different IVF clinics are published nationally by the relevant regulatory bodies, such as the Human Fertilisation and Embryology Authority in the UK. The published format suggests that clinics are being compared on a valid basis, and the involvement of the regulatory bodies apparently gives this comparison the official seal of authenticity. However, clinics can control many factors in patient selection, management and reporting, and these can inflate the reported results. Consequently, patients, instead of being appropriately guided, can be misled by these so-called "IVF league tables". The IVF community, including users, providers and regulatory bodies, need to recognize these factors and to develop a way forward for comparing clinics results on an equal and a valid basis. In this paper we discuss the factors that could affect the reported IVF results, and suggest possible options for valid comparison.     

A review of ten years experience of ICSI

This review summarizes the introduction of ICSI in the early 1990s as an assisted fertilization procedure in couples with severe male factor infertility, who could not be helped by conventional IVF. As for current practice, the indications for ICSI using fresh or frozen-thawed ejaculated, epididymal or testicular sperm are reviewed as well as some reports on the use of ICSI in non-male infertility. The main steps in an ICSI cycle are well standardized by now; it is rare that ICSI cannot be carried out and the results in terms of fertilization, embryo transfer and clinical pregnancy rate have been consistent for many years, indicating that a substantial number of couples can now have their own genetic child instead of having to use artificial insemination with donor sperm. This review also emphasizes the importance of assessing the risk of ICSI for the children: there is a slight increase in de novo chromosomal abnormalities, the major congenital malformation rate is similar for IVF and ICSI (between 3 and 4%), and at approximately 2 years of age the developmental outcome as assessed by the Bayley scale is similar for IVF and ICSI. Recent publications mention that a few children are affected by diseases caused by imprinting disorders. Future studies are needed to assess the association between assisted reproductive technologies and imprinting disorders. ICSI is frequently used in couples undergoing preimplantation genetic diagnosis. PGD stricto sensu as well as PGD for aneuploidy screening and for Klinefelter patients are reviewed using the ESHRE PGD Consortium data.     

Assisted reproductive technology in Europe, 1998. Results generated from European registers by ESHRE. European Society of Human Reproduction and Embryology.

European results of assisted reproductive techniques from treatments initiated during 1998 are presented in this second ESHRE report. Data was collected from 18 European countries usually from pre-existing national registers. A total of 521 clinics from these 18 countries reported 232 443 cycles: IVF 103 919 intracytoplasmic sperm injection (ICSI) 89 192 unclassified fertilization method 667 frozen embryo replacement (FER) 34 03 oocyte donations (OD) 4629. In nine countries where all clinics reported to the register a total of 128 801 cycles were performed in a population of 165 million corresponding to 781 cycles per million inhabitants 3.2 cycles per 1000 women aged 15-49 years. After IVF ICSI the distribution of transfer of 1, 2, 3 > or =4 embryos was 11.5, 37.2, 42.0 and 9.4% respectively. Huge differences existed between countries. For IVF the clinical pregnancy rate per aspiration per transfer was 23.2% 27.0% respectively. For ICSI the corresponding rates were 24.8% 26.8%. The distribution of singleton, twin, triplet, quadruplet deliveries for IVF and ICSI combined was 73.7, 23.9, 2.3 and 0.1%. This gives a total multiple delivery rate of 26.3%. The range of triplet deliveries after IVF and ICSI differed from 0.2-5.3% between countries. Compared with 1997, the number of reported cycles has increased by 14% and the number of reporting clinics by 8%. The clinical pregnancy rate per transfer increased from 26.1 to 27.0% after IVF and from 26.4 to 26.8% after ICSI. Multiple deliveries after IVF and ICSI decreased from 29.6 to 26.3%.     

Are 'natural' twinning rates continuing to decline?

During the 1960s and 1970s, the maternal age-specific twinningrates were declining in England and Wales and many other countries.However, around 1980 this change reversed and since then twinningrates have been increasing. The question arises whether thisincrease is simply a consequence of hormonal induction of ovulationand various other techniques of assisted reproduction. The questionassumes some importance because the level of ‘natural’twinning may be an index of reproductive (and other) health.Nationwide data on the prevalence of medically assisted conceptionsare not available, so indirect methods have to be used to answerthe question. It is tentatively concluded here that the ‘natural’twinning rate has recently been increasing in England and Walesand Belgium. These conclusions are based on two assumptions:(i) that in England and Wales, conceptions by young women areinfrequently preceded by medical assistance; and (ii) in Belgium,the rate of medically assisted conceptions is not lower in EastFlanders than in the rest of Belgium. Direct data on these pointswould test these conclusions.     

The European study of assisted reproduction families: the transition to adolescence

BACKGROUND: Findings are presented of the second phase of a European longitudinal study of families created by assisted reproduction. The present investigation reports on data obtained during the child's transition to adolescence. METHODS: A total of 102 IVF families, 94 donor insemination (DI) families, 102 adoptive families, and 102 families with a naturally conceived child were compared on standardized interview and questionnaire measures of parenting and children's psychological well-being. RESULTS: The assisted reproduction families were similar to the adoptive and natural conception families for many of the measures of the quality of parent-child relationships. To the extent that differences were found between the assisted reproduction families and the other family types, these reflected mainly more positive functioning among the assisted reproduction families, with the possible exception of the overinvolvement with their children of a small proportion of assisted reproduction mothers and fathers. The assisted reproduction children were functioning well and did not differ from the adoptive or naturally conceived children on any of the measures of psychological adjustment. However, only 8.6% had been told about their genetic origins. CONCLUSIONS: IVF and DI families with an early adolescent child appear to be functioning well.     

Assisted reproductive technology in Europe, 2004: results generated from European registers by ESHRE

BACKGROUND: European results of assisted reproductive techniques from treatmentsinitiated during 2004 are presented in this eighth report. METHODS: Data were mainly collected from existing national registers.From 29 countries, 785 clinics reported 367 066 treatment cyclesincluding: IVF (114 672), ICSI (167 192), frozen embryo replacement(FER, 71 997), egg donation (ED, 10 334), preimplantation geneticdiagnosis/screening (PGD/PGS, 2701) and in vitro maturation(IVM, 170). Overall, this represents only a marginal increasesince 2003, due to a huge reduction in treatments in Germany.European data on intrauterine insemination using husband/partner’ssemen (IUI-H) and donor semen (IUI-D) were reported from 20countries. A total of 115 980 cycles (IUI-H, 98 388; IUI-D,17 592) were included. RESULTS: In 14 countries where all clinics reported to the IVF register,a total of 248 937 ART cycles were performed in a populationof 261.6 million, corresponding to 1095 cycles per million inhabitants.For IVF, the clinical pregnancy rates per aspiration and pertransfer were 26.6% and 30.1%, respectively. For ICSI, the correspondingrates were 27.1% and 29.8%. After IUI-H, the clinical pregnancyrate was 12.6% in women below 40. After IVF and ICSI, the distributionof transfer of 1, 2, 3 and 4 or more embryos was 19.2%, 55.3%,22.1% and 3.3%, respectively. Compared with 2003, fewer embryoswere transferred, but huge differences still existed betweencountries. The distribution of singleton, twin and triplet deliveriesafter IVF and ICSI combined was 77.2%, 21.7% and 1.0%, respectively.This gives a total multiple delivery rate of 22.7% comparedwith 23.1% in 2003 and 24.5% in 2002. After IUI-H in women below40 years of age, 11.9% were twin and 1.3% triplet gestations. CONCLUSIONS: Compared with earlier years, the reported number of ART cyclesin Europe increased and the pregnancy rates increased marginally,even though fewer embryos were transferred and the multipledelivery rates were reduced.