Extended Analyses of the German IVF Registry (DIR): Andrological Aspects, Medical-Economical Assumptions Related to the Shift from IVF to ICSI and Stimulation with Gonadotropins

Journal für Reproduktionsmedizin und Endokrinologie - Journal of Reproductive Medicine and Endocrinology 2010; 7 (1): 40-44

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Keywords: DIR,  ICSI,  azoospermia,  GnRH analogues,  Gonadotropin,  lifestyle,  reimbursement

In addition to the annual report of the German IVF Registry (D·I·R) the database of 498,784 ART cycles between 1998 and 2008 was analysed for aspects regarding andrology, medical and economical aspects of ICSI and stimulation with gonadotropins. The indication for an ICSI procedure is related to the retrieval of sperm. Seven percent of all ART cycles in the DIR are already performed with epididymal or testicular sperm due to azoospermia. The analysis of cycles with testicular sperm revealed that fertilisation and pregnancy rates are reduced in comparison to ejaculated or frozen sperm, but miscarriage and birth rates do not increase. The data recording of lifestyle parameters can be valuable in the future. The analysis of the D·I·R data demonstrates that restrictions on the reimbursement for ART cycles have significant impact on the use of IVF and ICSI treatments. Medical indications rather than economic reasons seem to be responsible for the increase in ICSI treatment. Since the commercial launch of GnRH antagonists in 1999 and 2000 more than 90 % of IVF and ICSI protocols in Germany are now performed with GnRH agonists (54.8 %) and GnRH antagonists (31.5 %). Approximately 90% of the IVF and ICSI cycles in Germany are performed with recombinant FSH (rFSH), highly purified menotropin (HP-hMG) or a combination of both. Non-medical factors can influence the choice of gonadotropins for stimulation. Women beyond the age of 34 probably have better IVF or ICSI outcome when the stimulation is performed with rFSH. J