Assisted Reproductive Technologies in Latin America and Europe: a Comparative Analysis of Reported Databases for 2013

Abstract

Objective To compare the Latin American and European assisted reproductive technology (ART) registries regarding data accessibility and quality, treatment utilization, effectiveness, safety, and quality of services.

Methods We performed an ecological study using data from scientific publications of Latin American and European registries that report cycles initiated during 2013 (the most recent registries available until December of 2017). The summarized data are presented as frequencies, percentages, minimum-maximum values, and absolute numbers.

Results Reporting clinics and cycle treatments were unevenly distributed between the participating countries for both registries, although access to ART is 15 times greater in Europe. In Latin America, individual services participate voluntarily reporting started cycles until cancellation, birth or miscarriage, while in Europe it varied among countries. It makes the data available from Latin America more uniform, although lesser representative when compared with European ones, given that reporting is compulsory for most countries. The cumulative live birth rate was better in Latin America. Female age, use of intracytoplasmic sperm injection (ICSI), cycles with transfer of ≥ 3 embryos, as well as multiple pregnancy rates were greater in the Latin American Register of Assisted Reproduction (RLA, in the Portuguese acronym). Assisted reproductive technology complications, such as ovarian hyperstimulation syndrome, hemorrhage, and infections were also higher in Latin America, although they are extremely uncommon in both regions.

Conclusion Both regions have points to improve in the quality of their reports. Latin America has produced a more uniform reporting, their clinical results are generally comparable and sometimes higher than the European ones. In contrast, the safety of the treatment was higher in Europe, with lower rates of complications, especially multiple pregnancies.

Resumo

Objetivo Comparar os registros das técnicas de reprodução assistida da América Latina e da Europa em relação à qualidade dos dados e acesso, utilização do tratamento, efetividade, segurança e qualidade dos serviços.

Métodos Estudo ecológico usando os dados das publicações científicas dos registros da América Latina e da Europa com os ciclos iniciados durante o ano de 2013 (que são os dados mais recentes disponíveis até dezembro de 2017). Os dados são apresentados como porcentagens, valores mínimos e máximos e números absolutos.

Resultados Em comum, vemos que o número de clínicas e de ciclos de tratamento varia bastante entre os países dentro de cada região em ambos os registros, embora o acesso às técnicas de reprodução assistida seja 15 vezes maior na Europa. Na América Latina, os serviços reportam voluntariamente os ciclos iniciados até o cancelamento, o nascimento ou aborto, enquanto que na Europa o que é reportado varia entre os países. Isso faz o registro da América Latina mais uniforme, apesar de ser menos representativo quando comparado ao Europeu, dado o caráter compulsório na maioria dos países deste último. A taxa de gravidez cumulativa, idade feminina, uso de injeção intracitoplasmática de espermatozoides (ICSI), ciclos com transferência ≥ 3 embriões e taxa de gestação múltipla foram mais elevados na América Latina. Complicações da reprodução assistida, como síndrome de hiperestimulação ovariana, hemorragia, e infecções também foram mais comuns na América Latina, embora sejam incomuns em ambas as regiões.

Conclusão Ambas as regiões têm pontos a melhorar na qualidade dos registros. A América Latina tem produzido um registro mais uniforme, e seus resultados clínicos são comparáveis e, algumas vezes, superiores aos Europeus. Por outro lado, a segurança do tratamento foi maior na Europa, com menores taxas de complicações, especialmente gestações múltiplas.

Keywords

registries - assisted reproductive technique - in vitro fertilization - intracytoplasmic sperm injection - artificial insemination

Palavras-chave

registros - técnicas de reprodução assistida - fertilização in vitro - injeção intracitoplasmática de esperma - inseminação artificial

Contributions

Duarte-Filho O. B., Bianchi P. H. M., Lobel A., Peregrino P., Piccinato C. A., and Podgaec S. contributed with the project and the interpretation of data, the writing of the article, the critical review of the intellectual content, and with final approval of the version to be published.

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