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© The Author(s) 2021. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited., Study question: What are the data on ART and IUI cycles, and fertility preservation (FP) interventions reported in 2017 as compared to previous years, as well as the main trends over the years? Summary answer: The 21st ESHRE report on ART and IUI shows the continual increase in reported treatment cycle numbers in Europe, with a decrease in the proportion of transfers with more than one embryo causing an additional slight reduction of multiple delivery rates (DR) as well as higher pregnancy rates (PR) and DR after frozen embryo replacement (FER) compared to fresh IVF and ICSI cycles, while the number of IUI cycles increased and their outcomes remained stable. What is known already: Since 1997, ART aggregated data generated by national registries, clinics or professional societies have been gathered and analyzed by the European IVF-monitoring Consortium (EIM) and communicated in a total of 20 manuscripts published in Human Reproduction and Human Reproduction Open. Study design size duration: Data on European medically assisted reproduction (MAR) are collected by EIM for ESHRE on a yearly basis. The data on treatments performed between 1 January and 31 December 2017 in 39 European countries were provided by either National Registries or registries based on personal initiatives of medical associations and scientific organizations. Participants/materials setting methods: Overall, 1382 clinics offering ART services in 39 countries reported a total of 940 503 treatment cycles, including 165 379 with IVF, 391 379 with ICSI, 271 476 with FER, 37 303 with preimplantation genetic testing (PGT), 69 378 with egg donation (ED), 378 with IVM of oocytes, and 5210 cycles with frozen oocyte replacement (FOR). A total of 1273 institutions reported data on 207 196 IUI cycles using either husband/partner's semen (IUI-H; n = 155 794) or donor semen (IUI-D; n = 51 402) in 30 countries and 25 countries, respectively. Thirteen countries reported 18 888 interventions for FP, including oocyte, ovarian tissue, semen and testicular tissue banking in pre- and postpubertal patients. Main results and the role of chance: In 21 countries (20 in 2016) in which all ART clinics reported to the registry, 473 733 treatment cycles were registered for a total population of approximately 330 million inhabitants, allowing a best-estimate of a mean of 1435 cycles performed per million inhabitants (range: 723-3286).Amongst the 39 reporting countries, the clinical PR per aspiration and per transfer in 2017 were similar to those observed in 2016 (26.8% and 34.6% vs 28.0% and 34.8%, respectively). After ICSI the corresponding rates were also similar to those achieved in 2016 (24% and 33.5% vs 25% and 33.2% in 2016). When freeze all cycles were removed, the clinical PRs per aspiration were 30.8% and 27.5% for IVF and ICSI, respectively.After FER with embryos originating from own eggs the PR per thawing was 30.2%, which is comparable to 30.9% in 2016, and with embryos originating from donated eggs it was 41.1% (41% in 2016). After ED the PR per fresh embryo transfer was 49.2% (49.4% in 2016) and per FOR 43.3% (43.6% in 2016).In IVF and ICSI together, the trend towards the transfer of fewer embryos continues with the transfer of 1, 2, 3 and ≥4 embryos in 46.0%, 49.2%, 4.5% and in 0.3% of all treatments, respectively (corresponding to 41.5%, 51.9%. 6.2% and 0.4% in 2016). This resulted in a reduced proportion of twin DRs of 14.2% (14.9% in 2016) and stable triplet DR of 0.3%. Treatments with FER in 2017 resulted in a twin and triplet DR of 11.2% and 0.2%, respectively (vs 11.9% and 0.2% in 2016).After IUI, the DRs remained similar at 8.7% after IUI-H (8.9% in 2016) and at 12.4% after IUI-D (12.4.0% in 2016). Twin and triplet DRs after IUI-H were 8.1% and 0.3%, respectively (in 2016: 8.8% and 0.3%) and 6.9% and 0.2% after IUI-D (in 2016: 7.7% and 0.4%). Amongst 18 888 FP interventions in 13 countries, cryopreservation of ejaculated sperm (n = 11 112 vs 7877 from 11 countries in 2016) and of oocytes (n = 6588 vs 4907 from eight countries in 2016) were the most frequently reported. Limitations reasons for caution: As the methods of data collection and levels of reporting vary amongst European countries, interpretation of results should remain cautious. Some countries were unable to deliver data about the number of initiated cycles and deliveries. Wider implications of the findings: The 21st ESHRE report on ART, IUI and FP interventions shows a continuous increase of reported treatment numbers and MAR-derived livebirths in Europe. Being already the largest data collection on MAR in Europe, efforts should continue to optimize data collection and reporting with the perspective of improved quality control, transparency and vigilance in the field of reproductive medicine. Study funding/competing interests: The study has received no external funding and all costs are covered by ESHRE. There are no competing interests.

Due to the high virulence of the SARS-CoV-2 virus, the infection rate in the community has led to a state of pandemic, leading to the introduction of new emergency measures all over the world. With the aim of controlling and preventing the SARS-CoV-2 viral epidemic, the health institutions performing medically assisted reproduction (MAR) suspended any new MAR treatments in order to reduce the burden on the health care system and implement current social distancing recommendations. Considering the favorableepidemiological situation in Croatia, our perspective is that it is time to conceive, plan and bring forth guidelines for restarting work in MAR centres, taking into account the selection of patients and organization of good laboratory and clinical practices with emphasis on the safety of patients and health workers. In regard to epidemiological knowledge, it is important to establish the reorganization of work in MAR centres includingepidemiological measures of reducing unnecessary stays in closed spaces, the usage of protective gear by patients and health workers and disinfection of the working spaces and equipment.

STUDY QUESTION: What is known in Europe about the practice of oocyte cryopreservation (OoC), in terms of current statutory background, funding conditions, indications (medical and ‘non-medical’) and specific number of cycles? SUMMARY ANSWER: Laws and conditions for OoC vary in Europe, with just over half the responding countries providing this for medical reasons with state funding, and none providing funding for ‘non-medical’ OoC. WHAT IS ALREADY KNOWN: The practice of OoC is a well-established and increasing practice in some European countries, but data gathering on storage is not homogeneous, and still sparse for use. Ovarian tissue cryopreservation (OtC) is only practiced and registered in a few countries. STUDY DESIGN, SIZE, AND DURATION: A transversal collaborative survey on OoC and OtC, was designed, based on a country questionnaire containing information on statutory or professional background and practice, as well as available data on ovarian cell and tissue collection, storage and use. It was performed between January and September 2015. PARTICIPANTS/MATERIALS, SETTING AND METHODS: All ESHRE European IVF Monitoring (EIM) consortium national coordinators were contacted, as well as members of the ESHRE committee of national representatives, and sent a questionnaire. The form included national policy and practice details, whether through current existing law or code of practice, criteria for freezing (age, health status), availability of funding and the presence of a specific register. The questionnaire also included data on both the number of OoC cycles and cryopreserved oocytes per year between 2010 and 2014, specifically for egg donation, fertility preservation for medical disease, ‘other medical’ reasons as part of an ART cycle, as well as for ‘non-medical reasons’ or age-related fertility decline. Another question concerning data on freezing and use of ovarian tissue over 5 years was added and sent after receiving the initial questionnaire. MAIN RESULTS AND THE ROLE OF CHANCE: Out of 34 EIM members, we received answers regarding OoC regulations and funding conditions from 27, whilst 17 countries had recorded data for OoC, and 12 for OtC. The specific statutory framework for OoC and OtC varies from absent to a strict frame. A total of 34 705 OoC cycles were reported during the 5-year-period, with a continuous increase. However, the accurate description of numbers was concentrated on the year 2013 because it was the most complete. In 2013, a total of 9126 aspirations involving OoC were reported from 16 countries. Among the 8885 oocyte aspirations with fully available data, the majority or 5323 cycles (59.9%) was performed for egg donation, resulting in the highest yield per cycle, with an average of 10.4 oocytes frozen per cycle. OoC indication was ‘serious disease’ such as cancer in 10.9% of cycles, other medical indications as ‘part of an ART cycle’ in 16.1%, and a non-medical reason in 13.1%. With regard to the use of OoC, the number of specifically recorded frozen oocyte replacement (FOR) cycles performed in 2013 for all medical reasons was 14 times higher than the FOR for non-medical reasons, using, respectively, 8.0 and 8.4 oocytes per cycle. Finally, 12 countries recorded storage following OtC and only 7 recorded the number of grafted frozen/thawed tissues. LIMITATIONS, REASONS FOR CAUTION: Not all countries have data regarding OoC collection, and some data came from voluntary collaborating centres, rather than a national authority or register. Furthermore, the data related to use of OoC were not included for two major players in the field, Italy and Spain, where numbers were conflated for medical and non-medical reasons. Finally, the number of cycles started with no retrieval is not available. Data are even sparser for OtC. WIDER IMPLICATIONS OF THE FINDINGS: There is a need for ART authorities and professional bodies to record precise data for practice and use of OoC (and OtC), according to indications and usage, in order to reliably inform all stakeholders including women about the efficiency of both methods. Furthermore, professional societies should establish professional standards for access to and use of OoC and OtC, and give appropriate guidance to all involved. STUDY FUNDING/COMPETING INTEREST(S): The study was supported by ESHRE. There are no conflicts of interest., peer-reviewed

We have observed that sperm quality parameters indicative of spermatozoa hyperactivation such are lower “linearity” and “straightness”, and as showed by this research “elongation”, were more pronounced in patients with normal spermiogram compared to the group of men with reduced sperm motility who were undergoing routine in vitro fertilisation. The research encompassed 97 men diagnosed with normozoospermia (n=20), asthenozoospermia (n=54) and oligoasthenozoospermia (n=23). The findings indicate that sperm quality of patients with normal spermiogram diagnosed according to WHO criteria, may be compromised by showing premature spontaneous hyperactivation which can decrease the chances of natural conception. We assessed synergistic effects of multiple chemical elements in ejaculated semen to find if premature spontaneous hyperactivation of spermatozoa can be a sign of imbalanced semen composition especially of elements K, Ca, Cu and Zn. Human semen samples showing low or high baseline status of chemical elements concentrations were found in samples from all three diagnostic groups. However, correlation of K/Ca and Cu/Zn ratios, taking into account samples from all three groups of men, were negative at statistical significance level p=0.01. We tested if the negative correlation between K/Ca and Cu/Zn ratio works for greater number of semen samples. We found the negative correlation to be valid for 175 semen samples at statistical significance of p=0.00002. The ratio of K/Ca and Cu/Zn, i.e. increased concentrations of K and Zn in comparison to concentrations of Ca and Cu, were associated with a decrease of “straightness” in the group of men with normal spermiogram and pronounced spontaneous hyperactivation of spermatozoa, implying that these elements act in synergy and that the balance of elements and not their absolute concentrations plays the major role in premature spermatozoa hyperactivation in ejaculated semen.

The in vitro fertilization (IVF) legislation can directly affect the success of IVF treatment. The illustration and support for these statements can be found in the Italian restrictive law (Law 40/2004) and the effect of its implementation. The aim of this study was to compare data on assisted reproduction treatment and outcome before and after the introduction of this new legislation and give answer to a question on the possible negative effects of restrictive IVF regulation using data from Croatia. Data were analysed retrospectively: the first group consisted of data from patients which underwent IVF/ICSI procedure during period of restrictions (group I) and the second one of data from patients which underwent IVF/ICSI procedure after the new law was enforced (group II).In both groups there were more antagonist cycles (71.9%) than agonist cycles (28.1%) ; but after the new law was enforced there were more antagonist cycles (81.4% for group II compared to 59.5% for group I). Regarding ICSI and IVF procedure ; for ICSI 68.7% in group I vs. 67.4% in group II, and for IVF cycles 31.3% in group I vs. 32.6% in group II. Ratio of ICSI and IVF was similar (χ²=0.598, df=1, p >.01) although we expected more ICSI cycles in group I. During restrictions (in group I, 49.2%) usually three embryos were implemented but after the enforcement of the new law (group II, 63.4%) mostly two embryos were implemented (χ²=77.70, df=2, p < .01). In both groups embryo transfer was usually done on the third day but after the enforcement of the new law much more transfers were done on the fifth day (group II, 23.1%) compared to previous period (group I, 7.1%). During restrictive IVF law there were 28% of twin pregnancies (group I) compared to 12.5% under the new IVF regulation (group II) ; in addition multiple pregnancies (triplets) were 2.81% in group I and 0.96% in group II. In group I there were 9.58% biochemical pregnancies compared to 6.73% in group II ; and there were 4.22% of miscarriages (spontaneous abortions) in group I compared to 12.5% of miscarriages in group II. The percentage of pregnancies did not differ between groups (χ²=0.70, df=1, p>.01) leaving us with a conclusion that the pregnancy rate around 30% was achieved during enforcement of both laws. These results show that IVF regulation affects the treatment and outcomes in ART, and that for some issues in ART restrictive regulations has negative effects. Our findings represent clinical contribution for countries still debating the enforcement of restrictions in ART legislation.

Sperm preparation techniques are an essential component of assisted reproductive technologies, and they are related to the success of infertility treatment. The aim of this study was to compare apoptosis and sperm DNA fragmentation between native and processed (after density gradient) sperm samples, and to explore the relation between apoptosis and DNA fragmentation in both sperm samples. The participants were 30 men undergoing fertility treatments in a public hospital. The results showed significantly higher percentage of apoptosis in native sperm sample than in processed sperm sample. The percentage of DNA fragmentation did not differ between native and processed sperm samples. The relation between apoptosis and DNA fragmentation in processed sperm sample and native sperm sample was very low and did not reach statistical significance. Apoptosis was not significantly associated with the number of normal and fragmented forms of sperm cells and this pattern of relations was the same in both samples. The results showed that the age of patients was positively and significantly correlate to the value of apoptosis in processed sperm sample but not in native sample. In conclusion, the findings suggest that even in processed sperm samples the incidence of DNA fragmentation remains unchanged, although sperm processing results in a lower incidence of apoptosis especially in younger men. These findings point to importance of evaluation of apoptosis in processing sperm in IVF.

Metallothioneins (MTs) are small, cysteine-rich, phylogenetically highly conserved proteins with metal binding properties. Acting as a metal acceptor and metal donors, these metalloproteins are involved in numerous fundamental physiological processes, such as regulation of gene expression, cell proliferation and apoptosis. Furthermore, due to rapid oxidation of their structural thiolate clusters, they act as a highly-potent endogenous antioxidants and anti-inflammatory agents. Additional protective features of MTs arise from their ability to bind exogenous heavy metal ions, thereby preventing / reducing toxic effects. Objective of this study was to investigate MT I and II isoform expression in spermatozoa of fertile males and males diagnosed with oligoasthenoteratozoospermia (subnormal spermatozoa count, reduced spermatozoa motility and increased abnormal spermatozoa forms). Since the MTs are closely related to the zinc bioavailability, content of free Zn2+ ions ("labile zinc") was also examined. Semen analysis was performed using standard spermiogram techniques. MTs expression was assesed by immunocytochemistry on cytospin preparations of normal sperm samples and samples with oligoasthenoteratozoospermia. Free zinc content was examined labeling spermatozoa with fluorescent specific Zn2+ chelator Zinquin. Semen samples with oligoasthenoteratozoospermia showed significantly higher proportion of MTs positive spermatozoa compared to the normal samples (20, 2% vs 7, 8%). On the other hand, Zinqiun labeling resulted in significantly lower mean fluorescence intensity of spermatozoa from samples with oligoasthenoteratozoospermia, indicating a lower free zinc content in relation to the normal sperm samples. Results point to the disregulation of MTs expression and consequential disturbance of Zn2+ bioavailability in the pathogenesis of male subfertility.

Sperm Cell in ART

Anti-Müllerov hormon (AMH) sintetizira se u u granuloza stanicama jajnika u žena. Dosadašnje studije dokazale su važnost određivanja anti-Müllerovog hormona kao novog biljega u procjeni ovarijske rezerve. Također, ranije objavljeni rezultati pokazali su neznačajnu promjenjivost koncentracija AMH u serumu, tijekom menstruacijskog ciklusa. Rezultati naših istraživanja, iako na ograničenom broju ispitanica, podupiru dijagnostičku važnost AMH kao osjetljivog biljega u procjeni ovarijske rezerve.

Previous large studies suggest that, among breast cancer survivors, the risk of developing second primary nonmammary neoplasms is higher than in the general population. Our patient, a 47-year-old female patient with a positive familial history of breast cancer, was diagnosed with breast cancer nine years ago. After a mastectomy she was treated with irradiation and chemotherapy. Subsequently, a tamoxifen citrat therapy was introduced because of the positive immunohistochemical test results of estrogens and progestogenes tumour receptors. Almost a decade after she was admitted to the gynecology ward because of vaginal bleeding. A hysterectomy with a bilateral oophorectomy was performed. Pathohistological analyses revealed an endometrioid adenocarcinoma of the endometrium synchronous with clarcellular carcinoma of the one ovary (FIGO III). No gene mutations of BRCA1 and BRCA2 were detected. Although BRCA1 and BRCA2 founder mutations predispose a specific subset of patients to carcinoma of the breast and ovary, the majority of these cancers are sporadic. Furthermore, it can be argued that radiotherapy, adjuvant chemotherapy and tamoxifen are associated with the development of second primary nonmammary neoplasms, especially in the breast cancer population in which these modalities are a part of the treatment. Even though the risk of individual second primary cancers cannot be reliably assessed due to today’s limited knowledge, preventive strategies, continued monitoring and early detection of second neoplasms may be wise precautions for this patient population.

Sve četiri važnije značajke kinetike (VAP, VSL, VCL i ALH) pokazale su povezanost s glavnim morfološkim parametrima i kao takve čine glavne odrednice računalne analize pokretljivosti spermija. Rapidna pokretljivost također ulazi u navedenu grupu jer pokazuje povezanost s svim ispitivanim morfološkim značajkama. Opća, kao i progresivna pokretljivost dopunske su, ali ne i manje važne značajke koje upotpunjuju mozaik funkcije i ponašanja spermija. Frekvencija otklona glave (BCF) kao manje specifična značajka pokazuje zadovoljavajuću povezanost s morfološkim indeksom koji se inače pokazao kao vrlo reprezentativan i siguran morfološki čimbenik u interpretaciji analiza pokretljivosti i morfologije. Uz BCF, elongacija spermija predstavlja siguran pokazatelj, poglavito u odnosu na morfološki indeks. Linearnost putanje spermija svakako spada u pozitivne pokazatelje nativnog nalaza prije hiperaktivacije. Znakovita korist od metode računalne analize spermija je visoka preciznost i kvantificiranje svih značajki pokretljivosti. Stoga, ova vrsta analize određuje način i osobine kretanja spermija, a ne koncentraciju i broj. Kao okosnicu povezanosti karakteristika analize spermija svakako čine značajke pokretljivosti i morfologije spermija.

Computer assisted sperm analysis (CASA) of kinetics and morphology represents an objective method of sperm function analysis. The purpose of this poster presentation is to find the connection between sperm movement and morphology parameters. We analyzed 201 specimen of semen with emphasis on kinetics and morphology. The parameters that were analysed are: average path velocity (VAP), straight-line velocity (VSL), curvilinear velocity (VCL), amplitude of lateral head displacement (ALH), beat-cross frequency (BCF), normal and abnormal forms, morphological index, shape of head and midpiece.

This report describes the case of a patient with CIN III on cytology and a colposcopic pattern resembling invasive cervical cancer. We know that the cervical cancer screening is an essential component of antenatal care. A 32-year-old pregnant woman underwent diagnostic procedure at 20 weeks of pregnancy with CIN III in Pap smear. Cytologic finding was confirmed with punch biopsy (CIN III). Although the diagnosis and management of cervical intraepithelial neoplasia during pregnancy are challenging, CIN lesions are usually stable. Due to the complexity of colopscopic examination during pregnancy with all the features and toils we didn` t decide to solve the disease by surgery during pregnancy. Woman was delivered at the regular time. After 6 months the amputation of the cervix by Sturmdorf mode was done, and the changes in conus of the neat edges were gained. Hystology revealed CIN III. The treatment was finished with further checkups of the patient. The postponement of the surgery of the cervical lesion had enabled the regular pregnancy termination without jeopardizing the medical treatment and prognosis of the fundamental disease.

SAŽETAK Cilj: Cilj ovog rada bio je ispitati povezanost kompjutorske analize spermija (engl. computer-aided sperm analysis, CASA), posebno parametara koncentracije i pokretljivosti progresivnih spermija, s postizanjem oplodnje in vitro. Metode: Analiza kvalitete sjemena napravljena je pomoću CASA sistema. Analizirano je 36 bolesnika kod kojih je napravljena in vitro oplodnja (engl. in vitro fertilization, IVF) i embrio transfer (ET). Karakteristike spermija prije i nakon ‘swim up’ metode pročišćavanja uspoređene su između 23 ciklusa s oplodnjom ≤ 50% i 13 ciklusa bez oplodnje. Rezultati i zaključak: Ispitivanje pokazuje da parametri brzine i pokretljivosti spermija iz nativnog sjemena i spermija pročišćenih ‘swim up’ metodom koreliraju s oplodnjom in vitro, što ukazuje da ovi parametri mogu biti dobar pokazatelj ishoda oplodnje., Aim: The aim of this study was to investigate the relationships between computer-aided sperm analysis (CASA), especially the concentration and movement characteristics of progressively motile spermatozoa and fertilization rates in vitro. Methods: Analysis of semen quality was performed using CASA in 36 in vitro fertilization – embryo transfer (IVF-ET) cycles with at least 2 oocytes collected. Sperm quality before and after swim-up procedure was compared between 23 cycles with fertilization rate ≤50% and 13 cycles without fertilization. Results and conclusion: Our study demonstrated that velocity parameters and motility characteristics of sperms from freshly obtained semen and those after swim up procedure correlated with fertilization rates, indicating that these parameters could be good predictors of the fertilization outcome.

Problem: Compelling evidence suggests that an abnormally functioning maternal immune system often leads to poor reproductive performance. Failure of proper function of immunologic interaction during implantation has been implicated as a cause of recurrent miscarriage, late pregnancy fetal loss, IVF failure and infertility. Women with risk factors such as a positive personal or family history of autoimmune disorders such as rheumatoid arthritis, lupus erythematosis and hypothyroidism (Hashimoto’ s disease) need properly evaluation because immunologic problems may lead to implantation failure. The selective use of immunotherapy (heparin/aspirin, intravenous immunoglobulin G, corticosteroid therapy) has enabled to achieve successful pregnancies in-patients who had previously suffered repeated IVF failures. Disease therapy and drugs continue to be a concern in the first trimester and throughout pregnancy. Some drugs can cause birth defects, others can cause miscarriages. The greatest risk of these drugs comes later in pregnancy, when they may interfere with labor, affect amniotic fluid production or cause excessive bleeding during delivery. Method of study: We presented case report of 27 year old woman with iuvenile rheumatoid arthritis and infertility problems who gave healthy term birth after second IVF procedure in our institution. Conclusion: There are many risk for pregnancy in rheumatoid arthritis patient. Successful pregnancy is possible after assisted reproductive technology, also. Pregnancy surveillance needs multidisciplinary approach.

Chromosomal aberrations disturb gamete formation and impair male fertility. The frequency of chromosomal abnormalities in infertile males ranges between 12, 6% and 17, 6%. Since male infertility is largely due to impairment of gametogenesis, in which a number of genes participate, mutations in spermatogenic genes would also result in impaired spermatogenesis, leading to infertility. Recombinant DNA techniques provide the potential for explaining as much as 10% of idiopathic forms of infertility. Deletions in AZF region can cause severe spermatogenic defects ranging from non-obstructive azoospermia to oligozoospermia. The use of intracytoplasmatic sperm injection technique (ICSI) allows AZF deletions to be passed to male offspring. Out of 78 cases examined, 21 had some chromosomal abnormality (26, 9%), while Y-chromosomal microdeletions were found in two of them (2, 56%).

This study was carried out to investigate the relationships between computer-aided sperm analysis (CASA), especially the concentration and movement characteristics of progressively motile spermatozoa and fertilization rates in vitro. Semen quality analisys was performed using CASA in 69 IVF-ET cycles with at least 2 oocytes collected. Sperm quality before and after swim-up procedure was compared between 33 cycles with fertilization rate >50%, 23 cycles ≤ 50% and 13 cycles without fertilization. Our study demonstrated that velocity parameters and motility characteristics of sperm from freshly obtained semen and those after swim up procedure correlated with fertilization rates, indicating that these parameters could be good predictors of fertilization outcome.

U ovom radu analizirani su podaci o pticama gnjezdaricama na području Kopačkog rita. Zabilježeno je 130 vrsta. Od toga je 40 vrsta ptca mogućih gnjezdarica Kopačkog rita, a ostale su sigurne. Danas Kopački rit predstavlja jednu od posljednjih močvara Europe. Mnoge vrste koje su već iščezle ili su ugrožene na europskoj razini, mogu se naći u Kopačkom ritu. Zato je od životne važnosti trajno voditi brigu o ovom području i trajno ga zaštititi.

Study Question The 16th European IVF-monitoring (EIM) report presents the data of the treatments involving assisted reproductive technology (ART) and intrauterine insemination (IUI) initiated in Europe during 2012: are there any changes compared with previous years? Summary Answer Despite some fluctuations in the number of countries reporting data, the overall number of ART cycles has continued to increase year by year, the pregnancy rates (PRs) in 2012 remained stable compared with those reported in 2011, and the number of transfers with multiple embryos (3+) and the multiple delivery rates were lower than ever before. What is Known Already Since 1997, ART data in Europe have been collected and re-ported in 15 manuscripts, published in Human Reproduction. Study Design, Size, Duration Retrospective data collection of European ART data by the EIM Consortium for the European Society of Human Reproduction and Embryology (ESHRE). Data for cycles between 1 January and 31 December 2012 were collected from National Registers, when existing, or on a voluntary basis by personal information. Participants/Materials, Setting, Methods From 34 countries (+1 compared with 2011), 1111 clinics reported 640 144 treatment cycles including 139 978 of IVF, 312 600 of ICSI, 139 558 of frozen embryo replacement (FER), 33 605 of egg donation (ED), 421 of in vitro maturation, 8433 of preimplantation genetic diagnosis/preimplantation genetic screening and 5549 of frozen oocyte replacements (FOR). European data on intrauterine insemination using husband/partner's semen (IUI-H) and donor semen (IUI-D) were reported from 1126 IUI labs in 24 countries. A total of 175 028 IUI-H and 43 497 IUI-D cycles were included. Main Results and the Role of Chance In 18 countries where all clinics reported to their ART register, a total of 369 081 ART cycles were performed in a population of around 295 million inhabitants, corresponding to 1252 cycles per million inhabitants (range 325-2732 cycles per million inhabitants). For all IVF cycles, the clinical PRs per aspiration and per transfer were stable with 29.4 (29.1% in 2011) and 33.8% (33.2% in 2011), respectively. For ICSI, the corresponding rates also were stable with 27.8 (27.9% in 2011) and 32.3% (31.8% in 2011). In FER cycles, the PR per thawing/warming increased to 23.1% (21.3% in 2011). In ED cycles, the PR per fresh transfer increased to 48.4% (45.8% in 2011) and to 35.9% (33.6% in 2011) per thawed transfer, while it was 45.1% for transfers after FOR. The delivery rate after IUI remained stable, at 8.5% (8.3% in 2011) after IUI-H and 12.0% (12.2% in 2011) after IUI-D. In IVF and ICSI cycles, 1, 2, 3 and 4+ embryos were transferred in 30.2, 55.4, 13.3 and 1.1% of the cycles, respectively. The proportions of singleton, twin and triplet deliveries after IVF and ICSI (added together) were 82.1, 17.3 and 0.6%, respectively, resulting in a total multiple delivery rate of 17.9% compared with 19.2% in 2011 and 20.6% in 2010. In FER cycles, the multiple delivery rate was 12.5% (12.2% twins and 0.3% triplets). Twin and triplet delivery rates associated with IUI cycles were 9.0%/0.4% and 7.2%/0.5%, following treatment with husband and donor semen, respectively. LIMITATIONS, REASONS FOR CAUTION The method of reporting varies among countries, and registers from a number of countries have been unable to provide some of the relevant data such as initiated cycles and deliveries. As long as data are incomplete and generated through different methods of collection, results should be interpreted with caution. Wider Implications of the Findings The 16th ESHRE report on ART shows a continuing expansion of the number of treatment cycles in Europe, with more than 640 000 cycles reported in 2012 with an increasing contribution to birthrate in many countries. However, the need to improve and standardize the national registries, and to establish validation methodologies remains manifest. STUDY FUNDING/COMPETING INTERESTS The study has no external funding; all costs are covered by ESHRE. There are no competing interests.