IFFS Surveillance 2016
Global Reproductive Health · 2016
The International Federation of Fertility Societies (IFFS) is a federation of national membership societies that have an interest in the clinical and research aspects of reproduction and fertility. IFFS is a non-governmental organization (NGO) in official relations with the World Health Organization (WHO). Copyright 2016 by International Federation of Fertility Societies (IFFS). All rights reserved. No part of this publication may be reproduced by any means without the prior written consent of the IFFS. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the IFFS concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The editorial board members and survey respondents are responsible for the views and comments, respectively, expressed in this publication and they do not necessarily represent the decisions, policy, or views of the IFFS. The 2016 IFFS Surveillance was made possible, in part, through the funding of an MSD grant. FOREWORD An estimated one in four couples worldwide are affected by infertility and the levels of primary and secondary infertility have changed little over the previous two decades. While infertility is rarely considered a national health priority by governments, its impact on the lives of individuals, couples and their families who experience problems having children are enormous. The development of Assisted Reproductive Technologies (ART) is gradually transforming the range of options available to couples and individuals, bringing hope to millions. As these technologies become more effective and affordable they become more accessible, thereby enabling more and more of those affected with fertility problems to have a genuine choice in achieving their fertility goals. The World Health Organization’s (WHO) Department of Reproductive Health and Research, including the Special Programme of Research on Human Reproduction, wholeheartedly congratulates IFFS for producing Surveillance 2016. The information collected through its innovative rapid survey methodology provides extremely useful insights into the provision of ART globally, as well as nationally through the IFFS national members and respondents. Thoughtful selection of a wide range of topics on which data were collected affords a detailed understanding of the opportunities and challenges facing expansion of ART services. Of particular concern is the limited access to these services by those living in LMICs due to cost and other barriers. While some recent policy restrictions are noted, the overall situation is one of increasing access in most countries, and a better understanding of the complexity of the issues surrounding ART provision. WHO is delighted to have partnered with IFFS in preparing this document. WHO is in the process of broadening its activities that address infertility and fertility care. We look forward to continuing and expanding our engagement with IFFS and other partners that are dedicated to improving the lives of those affected by infertility. The information in Surveillance 2016 provides a strong basis for guiding WHO’s work on ART and we thank IFFS for its leadership and partnership in producing this valuable resource.Ian Askew Director, Reproductive Health and Research World Health Organization DEDICATION: HOWARD W. JONES, JR, MD, 1910 – 2015 Surveillance 2016 is dedicated to Dr. Howard W. Jones, Jr., in vitro fertilization (IVF) pioneer, surgeon, educator, visionary, and past editor of Surveillance. He was among the first to recognize the need to create a forum to record and compare ART practices around the world. He remained interested and engaged in this project until shortly before his death. CONTENTS Foreword Dedication Preface Number of centres Legislation and guidelines Insurance coverage Marital status Number of embryos for transfer in assisted reproductive technology (ART) Cryopreservation Posthumous insemination Donation Anonymity Micromanipulation Oocyte maturation Welfare of the child Fetal reduction Preimplantation genetic diagnosis IVF gestational carriers Experimentation with embryonic cells Cloning Status of the embryo Sex selection Fertility preservation Reporting mechanisms Same sex/ single parenting policy Cross border reproductive care Conclusions PREFACE International Federation of Fertility Societies (IFFS) Surveillance 2016 represents several milestones. Surveillance 2016 serves as the first edition of the new online IFFS journal, Global Reproductive Health. Surveillance 2016 represents a broader joint effort of the IFFS and World Health Organization (WHO) in association with the IFFS status as a non-governmental organization (NGO) in official relations with WHO. WHO representatives participated in the reorganization and reformatting of the 2012 questionnaire and expansion of the database of contacts among global public health officials and experts in order to supplement the pre-existing Surveillance contact list. We anticipate, that as we fulfill our responsibilities in our relations with WHO, that our joint activities in subsequent editions will likely continue to expand. An entirely new survey was developed and used for Surveillance 2016. The contract for conducting the online questionnaire, follow-up, data analysis an ultimate product development was awarded to Medtech For Solutions. The previous Excel spreadsheet was abandoned in favor of a streamlined, more focused web-based questionnaire that eliminated redundancies and sought more focused information in evolving areas of interest. A few sections were added addressing reporting mechanisms, policies regarding access for and single parenting individuals, as well as policies reproductive care. The questionnaire survey or of in and the to The online survey was on 2015 and to were to over in for of the publication of Surveillance 2016. The survey on were as as 2016 and were in the were respondents in with data to be in the overall to and the of as the and of Surveillance 2016 represents the of the of to the respondents who a of and effort to and the information that was A editorial board was and and to the of the questionnaire, the selection of new the analysis of the and the organization and of Dr. for and that not to the to and editorial Medtech For was a editor and was to the the process including of the development of the new questionnaire, of the online and of the of the online development of the and of the and Dr. made WHO, as a WHO and IFFS and made to organization and for the development of the questionnaire and this a in the of the International Assisted Reproductive Technologies on Assisted Reproductive and was in that our was with the new 2016 on for fertility care and infertility. to the IFFS of and for their and Surveillance 2016 serves as a record and an of the policies and activities with assisted reproductive technology (ART) as globally, the of provides an of national and global over that concern and topics and are to this All aspects of ART are and continuing to The respondents for the 2016 edition represent the of with the most ART services the of over are not in this to respondents to The to the questionnaire were by one or two in these were not and may be or these are in the and of the data including the in respondents who to in in 2016. this the of information that provides a global of ART with other global and an in of this IFFS data the in to Surveillance 2016 to a and expanding of ART and activities among around the and with a of that have the Surveillance 2016 2016 an of the of centres assisted reproductive technology (ART) services a The of centres are or is to and may be made in these that global made in ART and over the The 2016 data for these may represent a more and previous with an to the to ART national ART information is collected and are on The 2016 data a more to the of ART centres worldwide over not the 2015 While this a to the of the are to not have ART or are to have a of respondents who data and of centres Of the estimated of centres is an in 2012 to in Surveillance 2016 countries, which not in of the respondents that information for have a in the of or the to the 2016 by their respondents in were new to the 2016 edition and that in not for 2016. Of representatives have for and to have and and the a of or more Of the that in and having The in the of centres this to more of data a of representatives and a overall in the of centres in a few Number of respondents were regarding the of centres in their countries, including designations for and The to be the most and the the The of assisted reproductive technology (ART) is by in of and ART Of the that to the questionnaire in information to be in this analysis on and the previous International Federation of Fertility Societies (IFFS) Surveillance more of the representatives reporting guidelines ART Legislation and guidelines are evolving for the most part, have restrictions on of the of While some of these are to the and of other have limited or practices and that are and in other While the overall to be one of increasing and the practices of ART among and and are by the and national and other responsible for and As the of ART become more and public health care services and a of have subsequent public and interest have in the genetic of in border reproductive regarding the of for and on gestational carriers are of topics that have over the past of these issues and aspects of ART have in and Surveillance 2016 a more detailed look and guidelines to past The 2016 survey topics that more detailed questionnaire to respondents to the most to address the process for and of for ART and were in the 2016 questionnaire and a of of among is ART of the was respondents in in this 2016 IFFS Surveillance this data for analysis was Of the were for in their to Of these countries, ART guidelines in their and to of countries, of respondents national guidelines without any of these countries, were in the of or guidelines regarding in the 2012 of the new and The of respondents were and and the aspects of ART by in the past in the most topics in new to Legislation in Of that of one may have the in which the respondents that access to ART not limited in of of countries, new was as having affected and that a The of to of of ART was of countries, respondents were of of that to ART and in the of was The ART The of and of the to ART centres was The that of for ART centres as a Of on an or and used a employed of ART centres was in of The mechanisms employed in the that in for a national and a of the with their data to an were responsible for ART centres in of and were responsible for in of of with Reproductive of countries, or for reproductive or who have in ART was in over of by of of reproductive ART of countries, were for by or in of was not of these for reproductive and likely the of with and without The ART of countries, were to the ART the The of on a in of An was in of countries, and a was in of of for the ART and the used for this the in of countries, officials in in and in of and of countries, were for the and for the more of this was by and was in of for the and for mechanisms to the of ART The respondents were regarding mechanisms for ART of a national was that they data to an and ART on their ART was by in of was in of by by by and by for of or of were in for of or of were in and was in A of the a be in the IVF its or be or was in of countries, and one that publication of the of an IVF was a more of countries, ART was by or a of the was in of and the were as in the of The of and in reproductive is continuing to are in and and guidelines these The respondents the as a in that they not access or the of ART in of survey countries, which was an with the survey data for was more data the topics in was an analysis of the of an ART are and over The issues that the most in were coverage for on the of embryos for of status in genetic and parenting The on Legislation and in this Surveillance 2016 data countries, which was more previous IFFS The 2015 questionnaire was to more data for and more detailed information ART of used or a of to ART in of and of these were to be by the respondents. 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some is considered an is for who without the for or embryo and is the available for of was to be to and the of the of the the and have not be a the vitro and is a new more clinical of the prior to in order to shortly of and Of the respondents that information on this the that are by or have guidelines and have and guidelines to of these were to have or or are by or is Cryopreservation The of of and of and embryos was through development in the which not embryo to the in embryo and that a of be of embryos was embryo and the this to be most of its The embryo selection and in embryo which was not the of publication of Surveillance of and the is not is the of with to the embryo and to the of the of embryos with the of and the need to the of of that embryos in are not a to the its guidelines to that embryos be used for and not be The for embryo is for the of in most of the is a of in and An of is in and in as The on embryo is in and in for this and for this the the embryos be before the of 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of a of and fertility are we in Cryopreservation of embryos and in assisted for Oocyte for for of and A A of the of of and embryos and to to in their The of on the of and of and of the of a and to of for Reproductive a and of a assisted reproduction technology the status of embryos in a of and for clinical IVF of the for Reproductive of abandoned a The of of reproduction was in the 2015 questionnaire to the Surveillance 2016 The that of not the including the of of and to of and Posthumous reproduction two may the of or of reproductive a who is