International Federation of Fertility Societies’ Surveillance (IFFS) 2019: Global Trends in Reproductive Policy and Practice, 8th Edition

Abstract

The International Federation of Fertility Societies (IFFS) is a federation of national membership societies that have an interest in the clinical and research aspects of reproduction and fertility. IFFS is a non-governmental organization (NGO) in official relations with the World Health Organization (WHO). Copyright 2019 by International Federation of Fertility Societies (IFFS). All rights reserved. No part of this publication may be reproduced by any means without the prior written consent of the IFFS. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the IFFS concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The editorial board members and survey respondents are responsible for the views and comments, respectively, expressed in this publication and they do not necessarily represent the decisions, policy, or views of the IFFS. PREFACE Table of contents Number of centres Legislation and policy guidelines Insurance coverage Marital status and same sex and single parenting policy Number of embryos for transfer in assisted reproductive technology (ART) Cryopreservation Posthumous reproduction Donation and anonymity of donors Oocyte maturation Micromanipulation Welfare of the child and identity rights Fetal reduction and sex selection Preimplantation genetic testing Surrogacy Cross border reproductive care Human pre-implantation embryo research Status of the embryo Conclusions PREFACE The triennial Surveillance project, initiated in 1998 by Drs. Howard Jones, Jr and Jean Cohen, continues to evolve, now with a new name, the International Federation of Fertility Societies’ Surveillance (IFFS) 2019: Global Trends in Reproductive Policy and Practice, 8th Edition. The new name more accurately reflects the scope and focus of the project, and makes the report more accessible to a global audience, particularly those seeking this information online. IFFS is a non-state actor (NSA) in official relations with the World Health Organization (WHO), and the publication of Surveillance serves as part of the IFFS’ WHO mandate. The 2019 version has several major changes. Some chapters have been expanded, and some topics have been combined to eliminate redundancies. The number of chapters has been reduced from 24 to 18, but all previous topics and questions have been retained. The 2018 online questionnaire was the sole source of data for IFFS Surveillance 2019: Global Trends in Reproductive Policy and Practice, 8th Edition. The online questionnaire was further refined, and was again administered by Medtech for Solutions®. The refined questionnaire consisted of 94 questions, in English, with translated versions available. On average, it took 90 minutes (cumulative on-site time) to complete. The survey was accessible online from February 1 through March 31, 2018. Although a few responses were accepted shortly after the deadline, they reflect the practices of assisted reproductive technology (ART) (also called assisted reproductive treatment) through that time. Respondents representing 97 countries (22 more than in 2015) registered online at the website, and all provided at least some responses to the 2018 questionnaire, enough to be included in the analysis. There were 27 more usable responses than in the 2015 survey, in which 26 responses were new to Surveillance. Responses were not received for all questions, and this is reflected in the variations in amount of data submitted for the individual queries. The percent positive response is given for all answers, for that particular query. For specific questions, participants could answer “yes’, “no” or “unknown” if the respondent did not know the answer to a particular query. Many individuals contributed to the success of this project. I am profoundly grateful for the efforts of the 191 respondents, representing 97 countries, who completed the survey. The questionnaire is lengthy, and the answers to some questions are not readily accessible. The diligence and commitment of a wide array of colleagues around the world was essential to the successful completion of the publication. Although Surveillance 2019 is a global project, relying on many individuals from many nations, the ultimate success in engaging such a diverse representation hinged on personal relationships. To this end, many IFFS officers and representatives gave generously of their time, contacting and enlisting many international colleagues who were new to Surveillance. I would particularly like to acknowledge the efforts of Drs. Silke Dyer and Fernando Zegers, who issued countless personal appeals; they deserve a large share of the credit for the increased representation this year. Closer to home, our administrative assistant, Leila Grass, resorted to extensive social media searches to identify ART centres in countries that we had previously been unable to engage; her efforts were ultimately successful. The Surveillance Editorial Board worked tirelessly; all had roles in developing the 2018 questionnaire, reformatting the organization of Surveillance, and conducting data analysis, and were also involved in chapter preparation and editing. Special recognition is due Drs. Edgar Mocanu and Marcos Horton. The Assistant Editor, Dr. Horton, worked relentlessly, as he did in previous editions, and was particularly invaluable in this capacity. Our Managing Editor, Dr. Kathleen Miller, deserves the greatest accolades for her passionate pursuit of a comprehensive, high-quality product. Finally, I would like to recognize the continuing support, encouragement, and participation of the IFFS officers and Board of Directors, and the administrative staff of the IFFS Secretariat, for their essential roles in the project’s successful completion. Surveillance 2019 presents a more comprehensive global assessment of the status of reproductive policy and practice than previous editions, drawing input from 97 of the 132 countries believed to offer ART services. Data collection was improved by further refinements in the questionnaire, a more robust process for identifying and engaging prospective participants, and many local and regional developments that and Surveillance 2019 a further maturation of the with wide of and an some of the more aspects of Although the report to practices and of countries, responses for of the countries were provided by a single responsible The responses have not been for the and may Some respondents were not to data Some ART practices have the survey was completed and answers may not reflect For be in the responses from previous triennial and respondents have been were respondents, or from the the this IFFS Surveillance 2019: Global Trends in Reproductive Policy and Practice, 8th is in its of ART policy and report to the of the practice of the local and regional and the international that has the its Table 2018 in previous editions, a of the number of ART centres in any The number of ART in the world is new ART are and some centres are or we in global in and has been the and the data for countries may represent a more and than previous are many countries in which this information is if at and are The represent the of the respondents the questionnaire was countries with national are a of and are accessible. a of centres in countries with more ART but a more of is a and those are more For countries such as and to have many but comprehensive and is more The 2018 questionnaire to Surveillance 2019: Global Trends in Reproductive Policy and Practice, 8th that has been in developing ART in many countries, the number of we 97 countries to on our and some ART data for their countries more countries and more responses than the 2015 questionnaire, and countries new to Table and countries in the report and the did not to the survey. we for the a of countries that we have ART were included in this after a was to the of ART services. contacting in the country, in countries or the and social media many of were as was a of countries that did not to have ART as of March 31, 2018 some of the of previous countries that are to ART but that we were unable to for our survey included all countries by the in of the in the Table without Table countries with all 97 countries that registered on our provided some data the number of ART centres in their countries countries were to but in are with previous The number of ART in the 2018 was to centres in this not countries that in 2015 but not in 2018 number of those centres was but the new The new countries with the number of ART were and with and of the respondents new to Surveillance the of or that ART has in some of Table Number of countries a or in the number of centres the but countries a particular an in from to from to and from to a from to as did from to is not are or if they reflect or for the is it have for the if they are changes. also the of ART or or sole not all respondents provided data the for of the and to be the The of the sole a from it was the least the 2018 questionnaire reflect a more in the number of ART centres than in previous from to with centres for by reduction in the number of in some countries is a new and this reduction be due to or and be a for queries. for the of Surveillance be to as many of the countries as is and to to our of countries that are not ART The 2019 Surveillance a of Data from respondents in countries of and The to be of and some of now in countries ART is available. the of that the of The legal is with guidelines by the or by many countries also have for and The of such are by the local local care local and national and and responsible for The for is on and and is in in chapters of this of extensive the in the genetic assessment of in reproductive the of anonymity for to ART for and for individuals in and on of the survey The respondents as the practice of ART was by or in their to and Respondents in countries the Surveillance respondents from countries that was countries than did in the 2018 survey Table is ART in the respondents that had in had and and had respondents, had some of or and of had all 26 had and and and guidelines and and guidelines and had of the the respondents who in their country, some of all of the and and and guidelines and and guidelines had had a to or There were countries that to the 2018 survey, and had also in the 2015 of countries to and the previous survey. 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