1. 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

2. 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

3. 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.

4. 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).

5. 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).

6. DATA 2013
Number of clinics with number of cycles per year, among total
<100 1 3 2
500 or more

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

8. 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)

9. 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%

10. 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

11. 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%

12. 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.

13. 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%%

14. 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

15. 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

16. 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

17. 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

18. 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

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

20. ACTIVITIES NOT REPORTED
PGD PGS SURROGACY

21. 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

22. 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. »

23. THANKS
G I E R A F