Oral Presentation ESA-SRB-ANZOS 2025 in conjunction with ENSA

A global analysis of critical shifts in infertility treatment from 30 years of ART reporting  (128672)

Alexandra Peters 1 2 , Elizabeth Bromfield 3 4 5 , Shaun Roman 6 , Brett Nixon 4 5 , Kirsty Pringle 1 2 , Eileen McLaughlin 4 7 , Jessie Sutherland 1 2
  1. School of Biomedical Science and Pharmacy, College of Health, Medicine, and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
  2. Women's Health Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
  3. School of BioSciences, Faculty of Science, Bio21 Institute, The University of Melbourne, Parkville, VIC, Australia
  4. School of Environmental and Life Sciences, College of Engineering, Science, and Environment, University of Newcastle, Newcastle, NSW, Australia
  5. Infertility and Reproduction Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
  6. Hunter Medical Research Institute, Newcastle, NSW, Australia
  7. Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong, NSW, Australia

Infertility affects 1 in 6 people globally, with tremendous health, economic, and social consequences. To treat infertility, assisted reproductive technologies (ART) are increasingly employed, resulting in ~10-13 million births worldwide. However, gamete quality remains the largest barrier to ART success, driving advancements to bypass this limitation. This study aimed to analyse 30 years of ART data to examine key trends and industry shifts in infertility treatment. 

Clinical data were extracted from publicly available annual reports and databases spanning 1991-2022, across 66 countries including Australia and New Zealand, Canada, Japan, Latin America, United Kingdom, United States, and Europe (subdivided into Central + Eastern, Northern, Southern, and Western regions). Patient demographics, treatment cycles, and outcomes were evaluated regionally and collectively to identify global trends.  

Over three decades, global ART uptake rose from 3.0 to 23.0 cycles/10,000 inhabitants, totalling >29 million reported cycles. Among these cycles, striking shifts were observed in fertilisation procedures and oocyte/embryo preservation. IVF use declined 2.8-fold, while adoption of ICSI (intracytoplasmic sperm injection) escalated to comprise 69.9% of all fertilisations in 2022. This represents over double the number of ICSI fertilisations (2.4-fold higher) than those performed for male-factor infertility, the primary clinical indication for ICSI. From 2010, oocyte and embryo cryopreservation “freeze-all” cycles increased 6.1-fold, constituting 33.2% of cycles in 2022. Subsequently, thaw cycles (using cryopreserved eggs/embryos) overtook fresh cycles, comprising 41.2% of cycles in 2022. 

This analysis highlights growing reliance on ART and shifting treatment paradigms, prioritising ICSI and cryopreservation to maximise patient success. These technologies may enable use of lower-quality gametes or exert additional cellular stressors, raising concerns about how short-term success impacts future offspring health trajectories. This study underscores the need to minimise excessive ICSI use, evaluate long-term cryopreservation safety, and strengthen ART reporting to encourage ethically responsible practices for improved global ART outcomes.