Australia finally has high-quality data illuminating the success rates of assisted reproductive technology – and some of the reasons for using it.
Male infertility accounts for one in three IVF cycles, yet three quarters of that is unexplained, according to a new Australian report.
This 2020 data offers the first detailed breakdown of the prevalence of male infertility recorded by IVF clinics in the country.
This analysis by the Fertility Society of Australia and New Zealand and the University of NSW revealed that one in five IVF cycles were undertaken solely due to male infertility, and 11% were due to a combination of male and female infertility.
Female-only infertility was behind 36% of IVF cycles, the authors wrote in the Assisted Reproductive Technology in Australia and New Zealand 2020 (ANZARD) report.
This was the “first blush” of Australian data and the numbers would get tighter as more data was gathered in coming years, Melbourne endocrinologist Professor Robert McLachlan said.
“We can start to give tailored patient information, which is a world first,” said the medical director of the national organisation for men’s health, previously known as Andrology Australia.
“It will be a major contribution to patient care and information and to clinical staff.”
This is the first time this male infertility data has been broken into 12 categories rather than just a single category of “male factor only” infertility that covered all causes.
The report breakdown shows that 77% of male infertility cases were unexplained, while more than 7% were caused by a previous vasectomy which could not be reversed.
Testis damage from cancer was the reason for 2.4% of infertility cases, while testis damage due to vascular issues, infection or trauma was responsible for another 2.9% cases of infertility.
Other primary causes of infertility included genetic conditions such as Klinefelter Syndrome and Y chromosome microdeletions, gonadotrophin deficiency, congenital absence of the vas deferens, erectile dysfunction and ejaculation disorders due to spinal injury.
“These men, who have irreparable problems, are now being helped through IVF,” said Professor McLachlan, who was not involved in the report.
He said the report backed anecdotal suggestions men contributed to around a third of the need for IVF, and underscored how important it was to consider and properly assess men when couples present with infertility.
“If you don’t think about the male, you’re missing a third of the story,” said Professor McLachlan.
“It encourages good practice to have clinics mandated to provide the male factor diagnosis.”
As male infertility was more routinely investigated, the proportion of IVF cycles due to unexplained male infertility may drop, he said.
“As the thorough evaluation of the male becomes more routine, you’ll find more cases have a diagnosis being made.”
Professor McLachlan said GPs could “start the ball rolling” with a clinical history, scrotal examination and tests, and then refer patients to fertility specialists who focus on testing male fertility in detail.
“Assessing a male is not a sperm count on its own. You’ve got to do more than that.”
While infertility was devastating for patients, a diagnosis allowed them to move on, he said.
When it comes to making a baby, the health of a man’s sperm is very important, Dr Karin Hammarberg, fertility expert from Monash University said in a statement. “It plays a big role in determining the chance of a pregnancy, the chance of miscarriage and the health of a baby before and after birth.
“We know that a man’s age, weight and habits such as drug use can cause fertility problems. We also know sexually transmitted infections can cause infertility. However, a lot of Australian men may not be aware of these things until it’s too late.”
The report also found one in four women had a live birth after their first IVF cycle.
One in 18 babies born in Australia were now conceived through IVF, said the report’s lead author, Professor Georgina Chambers from the University of NSW.
Overall, 18,462 babies were born in 2020 in Australia and New Zealand, and almost 96,000 ART treatment cycles were performed that year.
“This represents a 7.6% increase in cycles on 2019,” Professor Chambers said in a statement.
“The number of cycles may have been affected by the covid-19 pandemic, with IVF services limited in some states.
She also noted that one in seven women doing IVF were in same-sex relationships or were single, “indicating how important access to IVF is for many less traditional families”.
The report also showed that thaw cycles have higher live birth rates than fresh cycles. The live birth rate per initiated autologous fresh cycle was 16% after freeze-all cycles were excluded, and the live birth rate per initiated autologous thaw cycle was 30%.
There was a higher live birth rate in younger women, the report said. For women under 30, the live birth rate per embryo transfer was 40% for autologous fresh cycles and 35% for autologous thaw cycles. For women older than 44 years, the live birth rate per embryo transfer was 1% for autologous fresh cycles and 7% for thaw cycles.
The release of the report comes as the Victorian government announced Australia’s first public IVF clinics. Royal Women’s Hospital and Monash Health will run the clinics, which will have capacity to treat 4000 women a year.
The clinics will offer IVF, fertility preservation, genetic testing, donor and surrogacy services and a sperm and egg bank.
