Annual Report 2013
The data included in this reports were collected from Ngoc Lan Fertility Clinic’s system of 3 IVF centers:
IVF Van Hanh
Van Hanh Hospital - Floor 3 & 4 700 (72 - 74) Su Van Hanh Street, Ward 12, District 10, HCM City, Vietnam Tel: (84.8) 6299 5021 - 3863 1272 - Email: lienhe@ivfvanhanh.com.vn
IVFAS
An Sinh Hospital - Floor 3 No.10 Tran Huy Lieu Street, Ward 12, PhĂş Nhuan District, HCM City, Vietnam Tel: (84.8) 38457777 - Email: info@ansinh.com.vn
IVF Mekong
International Obstetrics Gynecology Hospital 300 Nguyen Van Cu (extended), An Khanh Ward, Ninh Kieu District, Can Tho City, Vietnam Tel: (84.71) 2222 555 - Email: info@phuongchau.com
Table of Content Intrauterine Insemination (IUI)
5
Assisted Reproductive Technologies (ART)
9
In-vitro Fertilization / Intracytoplasmic Sperm Injection (IVF / ICSI) 17 ICSI-With Surgically Retrieved Sperm (ICSI-SRS)
21
In-vitro Maturation (IVM)
27
Oocyte Donation
31
Frozen Embryo Transfer (FET)
35
DEFINITIONS AND ACRONYMS USED IN THIS REPORT Clinical pregnancy: a pregnancy diagnosed by ultrasonographic visualization of one or more gestational sacs or definitive clinical signs of pregnancy. It includes ectopic pregnancy. (The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary on ART terminology, 2009). Note: Multiple gestational sacs are counted as one clinical pregnancy. Clinical pregnancy rate is calculated per embryo transfer.
ABBREVIATION CPR
Clinical pregnancy rate
FET
Frozen embryo transfer
FSRS
Frozen surgically retrieved sperm
ICSI
Intracytoplasmic sperm injection
IUI
Intra-uterine insemination
IVF
In-vitro fertilization
IVM
In-vitro maturation of oocyte
MESA
Microsurgical epididymal sperm aspiration
OR
Oocyte retrieval
PCOS
Polycystic ovary syndrome
PESA
Percutaneous epidydimal sperm aspiration
SRS
Surgically retrieved sperm
TESE
Testicular sperm extraction
Page 4 | NGOC LAN CLINIC ANNUAL REPORT 2013
INTRAUTERINE INSEMINATION
NUMBER OF IUI CYCLES PER YEAR (2008-2013) 3000
2833
2800
2500
1885
2000
1500
1000
887
836
2009
2010
626 500
0
2008
2011
2012
2013
2008
2009
2010
2011
2012
2013
Total no. of IUI cycles
626
887
836
1885
2800
2883
Cycles with full data
626
887
609
1130
2196
2262
Page 6 | NGOC LAN CLINIC ANNUAL REPORT 2013
PATIENT CHARACTERISTICS & TREATMENT OUTCOMES 30.72 Âą 4.52
19-49
Male
1029
35.7%
PCOS
377
13.1%
Ovulation disorder
375
13.0%
Unexplained
537
18.6%
Others
565
19.6%
Total
2883
Female age Causes
Treatment outcomes* Clinical prenancies
409
18.1%
Biochemical pregnancies
115
5.1%
* Among 2262 IUI patients with full data
INTRAUTERINE INSEMINATION | PAGE 7
ASSISTED REPRODUCTIVE TECHNOLOGIES
NUMBER OF TREATMENT CYCLES 8000
6979
7000
7456
5957
6000 5000 4000
3382
3000 2000
828
1000 0
1883
1364
2006
TU DU HOSPITAL
2007
2008
2153
2009
2010
2011
2012
2013
2006 2007 2008 2009
2010
2011
2012
2013
828
374
-
-
-
-
-
-
SI HOSPITAL
-
546
167
41
24
-
-
-
IVF VAN HANH
-
444
1716
1447
1282
1853
2054
1924
IVFAS
-
-
-
665
2076 3869
4579
5126
IVF MEKONG
-
-
-
-
-
235
346
403
828
1364
1883
2153
3382
5957
6979
7453
TOTAL
Page 10 | NGOC LAN CLINIC ANNUAL REPORT 2013
OVERALL CLINICAL PREGNANCY RATE PER EMBRYO TRANSFER (FRESH AND FROZEN EMBRYO TRANSFER 2006-2013)
36.9
40 % 35 %
34.4
36.2
33.9
37.2
35.6
38.0 38.3
30 % 25 % 20 % 15 % 10 % 5% 0%
2006
2007
2008
2009
2010
2011
2012
2013
Year
2006
2007 2008 2009
2010
2011
2012
2013
Overall CPR (%)
36.9
34.4
37.2
35.6
38.0
38.3
36.2
33.9
ASSISTED REPRODUCTIVE TECHNOLOGIES | PAGE 11
PATIENTS’ AGE Mean
Standard Deviation
Range
Mean female age
33.44
5.07
19-45
Donor cycles
37.86
5.12
23-45
IVF / ICSI
33.24
4.73
19-45
ICSI-SRS
31.67
4.59
21-44
IVM
29.29
3.45
20-44
Non-donor cycles
DISTRIBUTION BY AGE GROUP Age ≤24, 2.3% Age ≥40, 13.5%
Age 35-39, 26.0%
Page 12 | NGOC LAN CLINIC ANNUAL REPORT 2013
Age 25-29, 22.5%
Age 30-34, 35.8%
PATIENTS’ LOCATION – 2013 Hanoi, 10.7% Oversea, 10.0% Southern (HCM city excluded), 21.9% HCM city, 32.0%
Central, 21.4% Nothern (Hanoi excluded), 13.0%
ASSISTED REPRODUCTIVE TECHNOLOGIES | PAGE 13
Page 14 | NGOC LAN CLINIC ANNUAL REPORT 2013
0
1000
2000
3000
4000
5000
6000
698
1057
1487
Oocyte retrievals
1355
2300
4005
4779
5109
612
Fresh Embryo Transfers
933
1355 1357
1956
3193
4033
4254
NUMBER OF OOCYTE RETRIEVALS AND EMBRYO TRANSFERS (2006 – 2013)
130
666
2200
Frozen Embryo Transfers
307
528
1058
1952
2344
2013
2012
2011
2010
2009
2008
2007
2006
ASSISTED REPRODUCTIVE TECHNOLOGIES | PAGE 15
0%
10 %
20 %
30 %
40 %
50 %
60 %
FET 36.2% 36.2% 34.5% 26.3% 27.5% 30.6% 34.6% 38.1%
OOCYTE DONATION 48.1% 39.6% 37.6% 40.3% 43.7% 42.5% 54.2% 47.8%
IVM (NON-DONOR) 48.1% 39.4% 33.1% 33.6% 31.7% 38.4% 47.2% 43.8%
ICSI-SRS (NON-DONOR) 32.4% 33.8% 44.6% 41.1% 43.2% 42.5% 47.2% 45.7%
ICSI (NON-DONOR)
37.3%
34.3%
38.9%
37.8%
34.1%
37.8%
39.8%
36.2%
2006
2007
2008
2009
2010
2011
2012
2013
CLINICAL PREGNANCY RATE BY DIFFERENT TREATMENT TECHNIQUES
IN-VITRO FERTILIZATIONINTRACYTOPLASMIC SPERM INJECTION
NUMBER OF IVF/ICSI CYCLES PER YEAR (2006 – 2013) 4000
3692 3787 3379
3500 3000 2500
1850
2000 1500
1090
908
1000
1247
583 500 0
2006
2007
2008
2009
2010
2011
2012
2013
Year
2006
2007
2008
2009
2010
2011
2012
2013
IVF/ICSI
583
908
1090
1247
1850
3379
3692
3787
Page 18 | NGOC LAN CLINIC ANNUAL REPORT 2013
CLINICAL PREGNANCY RATE (2006-2013)
40 %
38.9 37.8
37.3 34.3
35 %
37.8 38.1 34.1
36.2
30 % 25 % 20 % 15 % 10 % 5% 0%
2006
2007
2008
2009
2010
2011
2012
2013
Year
2006
2007
2008
2009
2010
2011
2012
2013
CPR - IVF/ICSI (%)
37.3
34.3
38.9
37.8
34.1
37.8
38.1
36.2
IN-VITRO FERTILIZATION-INTRACYTOPLASMIC SPERM INJECTION | PAGE 19
CLINICAL PREGNANCY RATE OF IVF/ICSI BY FEMALE AGE 50 %
40 %
39.6
42.2
40.5
29.4
30 %
24.6
20 %
10 %
0% ≤24
Page 20 | NGOC LAN CLINIC ANNUAL REPORT 2013
25-29
30-34
35-39
40-45
ICSI – WITH SURGICALLY RETRIEVED SPERM
NUMBER OF IVF/ICSI CYCLES PER YEAR (2006 – 2013)
300
265 250
244
236
200
162 150
87
100
106
99
45
50 0
2006
Year ICSI-SRS
Page 22 | NGOC LAN CLINIC ANNUAL REPORT 2013
2007
2008
2009
2010
2011
2012
2013
2006
2007
2008
2009
2010
2011
2012
2013
45
87
99
106
162
265
244
236
CLINICAL PREGNANCY RATE OF ICSI WITH SURGICALLY RETRIEVED SPERM (2006 – 2013) 50 %
44.6
41.1
43.2 42.5
44.7 45.7
40 %
32.4 33.8 30 %
20 %
10 %
0%
2006
2007
2008
2009
2010
2011
2012
2013
Year
2006 2007 2008 2009
2010
2011
2012
2013
CPR / ICSI-SRS (%)
32.4
43.2
42.5
44.7
45.7
33.8
44.6
41.1
ICSI – WITH SURGICALLY RETRIEVED SPERM | PAGE 23
CLINICAL PREGNANCY RATE OF ICSI WITH SURGICALLY RETRIEVED SPERM BY FEMALE AGE
50 %
50.0
47.5
48.9 44.9
40 %
30 %
20 %
15.4
10 %
0%
Page 24 | NGOC LAN CLINIC ANNUAL REPORT 2013
≤24
25-29
30-34
35-39
40-45
NUMBER OF TESTISCULAR BIOPSIES FOR DIAGNOSIS (2009 - 2013) 2009
2010
2011
2012
2013
Diagnostic PESA/TESE
16
94
396
123
339
Freezing of surgically retrieved sperm
14
48
63
123
92
ICSI - FSRS
14
87
42
37
90
Year
CPR of FSRS 60 %
53.9
52.9 46.8
50 % 40 %
46.3 35
30 % 20 % 10 % 0%
2009
2010
2011
2012
2013
ICSI – WITH SURGICALLY RETRIEVED SPERM | PAGE 25
IN-VITRO MATURATIOn
NUMBER OF IVM CYCLES PER YEAR (2006 – 2013) 600
503
500
417 400
361 288
300
166
200 100
73
42
0
134
2006
2007
2008
2009
2010
2011
2012
2013
Year
2006
2007
2008
2009
2010
2011
2012
2013
IVM
42
73
166
134
288
361
417
503
Page 28 | NGOC LAN CLINIC ANNUAL REPORT 2013
CLINICAL PREGNANCY RATE OF IVM (2006 – 2013) 48.1
50 %
46.5 39.4
40 %
43.8
38.4 33.1
34.1
2007
2008
2009
Year
2006
2007
2008
2009
2010
2011
2012
2013
CPR - IVM (%)
48.1
39.4
33.1
34.1
31.7
38.4
46.5
43.8
31.7
30 %
20 %
10 %
0%
2006
2010
2011
2012
2013
IN-VITRO MATURATION | PAGE 29
CLINICAL PREGNANCY RATE OF IVM BY FEMALE AGE 48.2
50 %
41.7
40.7
40 %
38.3
30 %
20 %
10 %
0%
Page 30 | NGOC LAN CLINIC ANNUAL REPORT 2013
1/5 ≤24
25-29
30-34
35-39
40-45
OOCYTE DONATION
NUMBER OF OOCYTE DONATION CYCLES PER YEAR (2006 – 2013)
600
570
583
2012
2013
463
500 400
285
300
198
200
180
182
2007
2008
194
100 0
2006
Year Oocyte Donation
Page 32 | NGOC LAN CLINIC ANNUAL REPORT 2013
2009
2010
2011
2006
2007
2008
2009
2010
2011
2012
2013
198
180
182
194
285
463
570
583
CLINICAL PREGNANCY RATE OF OOCYTE DONATION PROGRAM (2006 – 2013) 60 %
53.9 48.1
50 %
39.6
40 %
37.6
40.3
47.8
43.7 42.5
30 % 20 % 10 % 0%
2006
2007
Year CPR of oocyte donation (%)
2008
2009
2010
2011
2012
2013
2006 2007 2008 2009
2010
2011
2012
2013
48.1
43.7
42.5
53.9
47.8
39.6
37.6
40.3
OOCYTE DONATION | PAGE 33
CLINICAL PREGNANCY RATE OF OOCYTE DONATION PROGRAM BY RECIPIENT’S AGE 50.0
50 %
44.8
47.4
48.9
40 %
30 %
20 %
10 %
0%
N/A ≤24
Page 34 | NGOC LAN CLINIC ANNUAL REPORT 2013
25-29
30-34
35-39
40-45
FROZEN EMBRYO TRANSFER
NUMBER OF FROZEN EMBRYO TRANSFER CYCLES PER YEAR (2006 – 2013)
2500
2200
2344
1952
2000
1500
1067 1000
528
500
307
130 0
666
2006
2007
2008
2009
2010
2011
2012
2013
Year
2006
2007
2008
2009
2010
2011
2012
2013
FET
130
307
528
666
1067
1952
2200
2344
Page 36 | NGOC LAN CLINIC ANNUAL REPORT 2013
CLINICAL PREGNANCY RATE OF FROZEN EMBRYO TRANSFER (2006 - 2013)
40 %
36.2 36.2
35 %
38.1 34.5
30 %
33.8 26.3
27.5
30.6
25 % 20 % 15 % 10 % 5% 0%
2006
2007
2008
2009
2010
2011
2012
2013
Year
2006
2007
2008
2009
2010
2011
2012
2013
FET (%)
36.2
36.2
34.5
26.3
27.5
30.6
33.8
38.1
FROZEN EMBRYO TRANSFER | PAGE 37
CLINICAL PREGNANCY RATE OF IVF/ICSI BY FEMALE AGE
50 %
44.9 40.9
40 %
34.7
33.3
31.3
30 %
20 %
10 %
0%
Page 38 | NGOC LAN CLINIC ANNUAL REPORT 2013
≤24
25-29
30-34
35-39
40-45
CLINICAL PREGNANCY RATE OF FROZEN EMBRYO TRANSFER BY DIFFERENT INDICATIONS FOR EMBRYO FREEZING 60 %
55.4
50 % 40 %
39.5
37.8
37.9
Unfavourable endometrium
Others
30 % 20 % 10 % 0%
Extra embryos
High risk of OHSS
FROZEN EMBRYO TRANSFER | PAGE 39
CONTRIBUTORS Vöông Thò Ngoïc Lan MD Voõ Thò Haø BSc, Embryologist Laâm Anh Tuaán BSc, Embryologist Nguyeãn Ngoïc Yeán Nhi BSc, Embryologist Höùa Traàn Phong BSc, Embryologist
55/27 Le Thi Hong Gam Street, District 1, Hochiminh City, Vietnam Tel: (+84-83) 2219 4473, 2219 2273