Assisted reproductive technology in Africa: the African Network and Registry for ART, 2021 and 2022

What were the utilization, effectiveness and safety of assisted reproductive technology (ART) in Africa in 2021 and 2022?

Cross-sectional cycle-based data collected from voluntarily participating centres.

Data were reported by 63 centres in 14 countries in 2021, and 69 centres in 16 countries in 2022. In 2021, there were 26,481 autologous aspirations and 29,523 autologous transfers (58.8% fresh transfers), 2681 transfers after oocyte donation, and 2074 cycles utilizing preimplantation genetic testing (PGT). In 2022, there were 31,596 autologous aspirations and 35,109 autologous transfers (55.8% fresh transfers), 3393 transfers after oocyte donation, and 2297 cycles utilizing PGT. In both years, the mean age of women undergoing autologous fresh transfers was 34 years, with a mean number of 2.3 embryos per transfer. In 2021, the pregnancy rate was 38.1% per fresh transfer and 41.9% per frozen embryo transfer, with a cumulative pregnancy rate per aspiration of 44.2%. In 2022, these rates were 36.5%, 42.6% and 43.6%, respectively. In total, 16,549 pregnancies were lost to follow-up. Based on reported outcomes, the multiple delivery rate was ≥20% following most procedures. Most multiples were born preterm and had substantially increased perinatal mortality compared with singletons. Elective single embryo transfer provided the best balance of ART effectiveness and safety. Ten-year trends documented stable effectiveness in fresh cycles, increasing effectiveness in frozen cycles, and no decline in multiple delivery rates.

This report marks the 10^th anniversary of the African Network and Registry for Assisted Reproductive Technology (ANARA). ANARA's annual reports represent and critically inform regional ART development based on real-world evidence and national, regional and global cooperation.