Dr Ernestine Gwet-Bell Place of GIERAF in ART in Africa and the world: first data in 2013 from francophone Africa Dr Moïse fiadjoe Dr Ernestine Gwet-Bell Dr Bell Béa Gwet M, Ata Camille aduayi Dr Jacques de mouzoN Dr Silke Dyer

Introduction ART since 1978 First national registers in early 80’s (France, Germany, Great Britain, United States, Australia) International registers, Annual reports IWGROAR-ICMART since 1989 Latin America since 1990 Europe: EIM-ESHRE: 1997 Few data from Africa, but…. Gieraf

GIERAF: Since Febuary 2009 DEFINITION: Groupe Interafricain d’Etude, de Recherche et d’Application sur la Fertilité (Interafrican Group of Study, Research and Application on Fertility) OBJECTIVES: Promote prevention of the avoidable causes of infertility, Promote the training of practitioners in the field of reproduction, Promote exchanges and partnerships with scientific societies concerned with the problems of medicine and the biology of human reproduction.

GIERAF COUNTRIES Benin, Burkina Faso, Cameroun , Congo, Ivory Coast, Gabon, Mali, Niger, Democratic Republic of Congo, Senegal, Togo. CENTRES Polyclinique St Michel (Benin), Burkina Faso, Clinique de l’aéroport, Clinique ODYSSÉE (Cameroun), Clinique PROCREA (Ivory Coast), Clinique KABALA (Mali), Democratic Republic of Congo, Laboratoire BIO 24 (Senegal), Clinique BIASA (Togo).

DATA 2013 Modality of collection: Data sent to ICMART and ANARA, treated by Sylke DYER. Data sent by SENEGAL lately, but included. Voluntary centers Retrospective cohort survey ICMART / ANARA Centers: Clinique POSAM (Benin), Clinique ODYSSÉE (Cameroon) , Clinique PROCREA (Ivory Coast), Clinique KABALA (Mali), Laboratoire BIO24 (Senegal), Clinique BIASA (Togo).

DATA 2013 Number of clinics with number of cycles per year, among total <100 1 100-199 3 200-499 2 500 or more

DATA 2013 Link to other registers Birth Congenital anomalies Cytogenetic PGD Disease Other yes (Ivory Coast, Mali) no Yes (Ivory Coast)

DATA 2013 Information available in the country register on Prematurity on Perinatal mortality on Malformations   In general By technique By multiple pregnancies In general Yes (Benin, Ivory Coast) Yes (Benin, Ivory Coast) yes (Ivory Coast)

DATA 2013 GIERAF Regional Report Form 2: Number of treatments and pregnancies  Fresh IVF ICSI Initiated cycles1 177 446 Aspirations 229 355 Embryo freezing, no transfer 9 31 Transfers 208 356 Pregnancies 68 126 Deliveries (not babies) 56 110 Deliveries with live births 108 PR/asp 29.7% 35.5% PR/ET 32.7% 35.4%

DATA 2013 GIERAF Regional Report Form 2: Number of treatments and pregnancies  FROZEN FET Thawings 41 Transfers Pregnancies 2 Deliveries (not babies) Deliveries with live births PR/asp 4.9% PR/ET

DATA 2013 GIERAF Regional Report Form 3: Results by age and technique   IVF&ICSI1 Age <=34 Age 35-39 Age>=40 Aspirations 204 141 92 Pregnancies 70 36 12 Deliveries (not babies)3 59 26 10 PR/asp 34.3% 25.5% 13.0% DR/asp 28.9% 18.4% 10.9%

GIERAF Regional Report Form 8: Oocyte donation1 DATA 2013 GIERAF Regional Report Form 8: Oocyte donation1   Age <=34 Age 35-39 Age 40-44 Age>=44 All women Aspirations: Total 241 Specific donors 185 Egg sharing 56 Transfers: Total 47 42 121 43 253 1 embryo 9 6 24 7 46 2 embryos 4 21 63 22 110 3 embryos 11 23 54 4 embryos 1 8 3 16 ≥ 5 embryos 2 10 not specified 17 Clinical pregnancies 18 15 14 89 CPR/asp 36.9% CPR/ET 38.3% 35.7% 34.7% 32.6% 35.2% Deliveries: Total 12 27 61 Singleton 44 Twin Triplet Quadruplet/higher Unknown number Multiple rate 50.0% 27.3% 22.2% 18.2% 27.9%% Births: Total 5 Stillbirths Live births Neonatal deaths Unknown health Data from Benin, Cameroon, Ivory Coast and Togo.

DATA 2013 GIERAF Regional Report Form 4: Results by number of embryos transferred    After fresh IVF & ICSI 1 1 Embryo 2 Embryos 3 Embryos 4 Embryos 5 Embryos TOTAL Transfers 59 71 42 18 261 Percentage of total TFs 22,6% 27,2% 16,1% 6,9% 100% Pregnancies 5 13 21 15 6 60 Pregnancy losses 1 3 2 7 Total deliveries (not babies)3 4 53 Singleton deliveries 12 37 Twin deliveries Triplet + deliveries Lost to follow up PR/ET 23.0% DR/ET 20.3% Singleton DR 69.8% MPR 30.2%%

DATA 2013 FET after IVF & ICSI2 1 Embryo 2 Embryos 3 Embryos 4 Embryos   FET after IVF & ICSI2 1 Embryo 2 Embryos 3 Embryos 4 Embryos 5 Embryos TOTAL Transfers 1 7 2 10 Pregnancies Pregnancy losses Total deliveries (not babies)3 Data from Cameroon and Togo

DATA 2013 GIERAF Regional Report Form 5: Gestational age and multiple deliveries (after fresh IVF & ICSI1)   All 20-27 28-32 33-36 37-41 42 + Unknown Singleton deliveries 45 1 4 6 7 21 Twin deliveries 13 2 5 Triplet deliveries Data from Benin and Cameroon

DATA 2013 GIERAF Regional Report Form 11: Intrauterine insemination   IUI-H 1 Age <=34 Age 35-39 Age>=40 TOTAL Cycles 58 31 17 106 Pregnancies 15 7 1 23 Total deliveries (not babies)3 12 5 18 Singleton deliveries 8 14 Twin deliveries Triplet + deliveries Unknown 3 PR/cycle 21/7% DR/cycle 17.0% Data from Benin, Cameroon, Ivory Coast, Mali

DATA 2013 Age <=34 Age 35-39 Age>=40 TOTAL Cycles 18 12 30   Age <=34 Age 35-39 Age>=40 TOTAL Cycles 18 12 30 Pregnancies 6 3 9 Total deliveries (not babies)3 4 2 Singleton deliveries Twin deliveries Triplet + deliveries Unknown PR/cycle 30.0% DR/cycle 20.0% Data from Cameroon and Ivory Coast

AFRICA IN ART’S REGISTERS TIL 2009: Absence of data Except centers in MOROCCO, TUNISIA, irregular 2009: 4 countries: South Africa, Cameroon, Togo, Tunisia, 2010: 4 countries + Mali 2011: 8 countries: 5 + Benin, Ivory Coast, Morocco 2012: 8 countries, idem 2013: 6 countries GIERAF’s members (Benin, Cameroon, Ivory Coast, Mali, Togo, Senegal) + Ghana, Mauritius, Nigeria, South Africa, Morocco and Tunisia

Fresh and Cumulative DR/ASP by Region 2013, IVF & ICSI Gieraf

ACTIVITIES NOT REPORTED PGD PGS SURROGACY

CONCLUSION INTEREST OF REPORTING: SELF EVALUATION, BEST WAY OF IMPROVEMENT PROPER PLACE AMONG PEERS NATIONAL REGISTER ? REGIONAL REGISTER ? RETROSPECTIVE ? : LOT OF WORK FOR MONTHS MANY YEARS AFTER. INCONSISTANCIES IN THE DATA? CASE BY CASE REPORTING ? DIFFICULT AT THE BEGINNING BUT EASIER IN THE ROUTINE COLLABORATION WITH INTERNATIONAL REGISTERS: ICMART ANARA

GUTS, DETERMINATION AND STAMINA CONCLUSION CHALLENGES FEAR OF COMPARISON MORE WORK FOR STAFF BUT WAY FOR QUALITY WAY FOR IMPROVEMENT WITH GUTS, DETERMINATION AND STAMINA SENEQUE: « It is not because things are difficult that we don’t dare but we do not dare that’s why they are difficult. »

THANKS G I E R A F