IVF/ICSI in Turkey : Activities and Recent Data Timur Gürgan MD Professor and Head

1. IVF/ICSI in Turkey : ActivitiesandRecent Data TimurGürgan MD ProfessorandHead Division of ReproductiveMedicineandInfertility, Dept.of Ob&Gyn,Faculty of Medicine, Hacettepe University,Ankara,Turkey

2. 93 IVF Centers in 22 different cities • 19 are in the goverment and university hospitals • 74 are private centers • 36 centers in Istanbul ,16 centers in Ankara and 7 centers in Izmir • 10 training centers which may give certificate for clinicans and embryologist • Each center must report its data every 3 months

3. ART Centers openedin Turkey • 1987 : 1 • 1988 : - • 1989 : 1 • 1990 : 1 • 1991 : 1 • 1992 : 1 • 1993 : 3 • 1994 : - • 1995 : - • 1996 : 3 • 1997 : 5 • 1998 : 7 • 1999 : 4 • 2000 : 7 • 2001 : 8 • 2002 : 6 • 2003 : 6 • 2004 : 6 • 2005 : 17 • 2006 : 15 • 2007 : 11 Total : 103 * 10 centers closed *93 centers are functional

4. *Ministry of Health *Data Collection Unit

5. ART Data Collection Programme in Turkey • Reporting refuirement : Compulsory • Reponsibility for register : National Health Authority (Ministry of Health) • Reporting Methods: Summaries of cycles reported by the clinics; No data reported on the deliveries • Link to the other registers : No link to the birth,congenital anomalies,cytogenetic,PGD,disease registers • In IVF register,there is info avaible on : PGD,malformations

6. Data Avaible in Turkey • Number of ART clinics in the country (A) • Number of clinics with number of cycles per year, among total (A) • Total number of cycles (A) • Organization Reporting methods (A) • Number of treatments and pregnancy (For IVF, ICSI, GIFT, Frozen Embryos Transfers) • Initiated (A) • Aspirations (A) • Transfers (A) • Pregnancies (A) • Deliveries (not babies) (A) • Total (A) • With live birth (A)

7. Avaible data on the complications of treatment • Women’s complications • OHSS (A) • Oocyte retrieval • Total (A) • Bleeding (A) • Infection (A) • Maternal death (documented) (A) • Congenital anomalies • Total (A)

8. Important Drawbacks I • No avaible data on results by women’s age and ART Technology in fresh and frozen transfers • No avaible data on the results by number of transferred fresh and frozen embryos • No avaible data on the gestational age by treatment and multiple deliveries • No avaible data on the neonates outcome in relation to treatment • No proper data on delivery rate after IVF and ICSI • No proper data on pregnancy loss rate

9. Important Drawbacks II • No data on the number of embryos transferred • No data if there is a trend towards transfers with fewer embryos and decrease in the occurrance of multiple pregnancies and deliveries • No data on the number of embryo reduction and outcome

10. ART Cycles No IVF ICSI Total • 2003 : 48 832 15 323 16 161 • 2004 : 54 561 20 464 21 025 • 2005 : 61 707 24 870 25 577 • 2006 : 77 914 31 989 32 903

11. * Increasing the number of the IVF/ICSI centers and number of cycles in years

12. *The percentage of the deliveries and live births are very low due to the problems on the data collection system and statistcal analysis methods! *Most of the centers may have this data in their files !!

13. Most of the centers may have this data in their files !! Data collection insufficency !

14. Not Available !? Most of the centers may (must) have this data in their files !!

15. Not Available !? This data is important for the decission of single or double ET Quality control of thethe center Most of the centers must have these data in their files !!

16. Most of the centers must (may) have this data in their files !! • Three embryo transfer is permitted • More then three ET should be informed and explained Not Available !?

17. Not Available !? * Very important information * Should be in the files of centers * Ministry of Health should stress its importance and urge the parties to collect this data properly !

18. Not Available According to Women Age PGD Every center and/or genetic lab performing the technique should report !

19. Problems in data collection ! Low and/or incomplete data !

21. ART Data Collection Programme in Turkey * Data represents all IVF clinics * The reporting is incomplete * More detailed data which covers the not avaible information needed * Data sould be recorded for IUI cycles

22. Gamete Donation and Surrogacy • Not permited in Turkey !!??

23. ART Data Collection Programme in Turkey There is a real need to improve the collection of data in order to be able to deliver proper information on the results of ART to really compare the results with other countries !

24. SORRY !!!!

25. Suggestions: • All of the unavailable data should be precisely recollected ?? • Reporting system should be reorganized • Complete coverage of the data need in the reporting system is needed • National software for data collection (Web based) may be helpful • Professional Societies should be included into the system • Working with EIM Consortium will be very helpful to have proper ART data

26. Human Reproduction Advance access Published (Andersen et al) vs Turkish data submitted on 15th Jan, 2009

35. Yanıtlanması gereken sorular: 1- ÜYT'de veri toplamanın önemi ve kalite kontrolüne etkisi 2- ÜYT merkezlerinin standart takip etmesi gereken veri bilgileri ne olmalıdır 3- Embiryoloji laboratuarlarının veri takipleri klinik uygulamalardan bağımsız olmalı mı? 4- Veri toplama sırasında 'home made' programlar mı daha uygun yoksa profesyonel programları kullanma ihtiyacı var mı 5- Ulusal IVF veri bankası Sağlık bakanlığı kontrolünde mi yoksa dernekler bazlı olmalı mı? 6- Ulusal IVF veri bankasına ÜYT merkezlerinin katılım kriterleri ne olmalıdır ? 7- Ulusal IVF veri bankasına aktarılan bilgilerin doğruluğu nasıl sağlanır ? 8- Ulusal IVF veri bankasının sonuçlarının 3. kişilerle (yayın organları veya internet ortamında) paylaşma sorunları 9- ÜYT merkezlerinin gebe kalan hastaların sonuçlarını takip etme problemleri ?