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The IFFS Surveillance is a triennial survey, initiated in 1998 by Drs. Howard Jones, Jr. and Jean Cohen, assessing practices of assisted reproductive technology (ART) at the global level. IFFS invites representatives from the global ART community to forward the details of reproductive policy and practice in their home country via a proprietary electronic platform. Responses are analyzed by an appointed Surveillance Committee and published in Global Reproductive Health. This unique report attests to the evolution of the practice of ART, local and regional differences, and the continued international collaboration that has characterized the field since its inception.

To learn more about the Surveillance Committee and to inquire about survey participation, click here.


The 2019 Surveillance was supported in part by an unrestricted educational grant from Cryos International ApS. IFFS thanks Cryos for this support. 

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. 

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 facilitated cooperation and participation. Consequently, Surveillance 2019 depicts a further maturation of the field, with wide adoption of technologic advances, and an emerging consensus regarding some of the more controversial aspects of ART.

Significant limitations remain, however. Although the report refers to practices and policies of countries, responses for most of the participating countries were provided by a single well-informed, responsible individual. The responses have not been validated for the majority, and may include inherent inaccuracies. Some respondents were not able to provide complete data sets. Some ART practices have undoubtedly changed since the survey was completed and answers may not reflect current practices. For these reasons, caution should be exercised in interpreting the data. When feasible, responses from previous triennial surveys and multiple respondents have been compared. When discrepancies were identified among multiple respondents, or from other published reports, the editors adjudicated the inconsistencies. However, this occurred infrequently.

IFFS Surveillance 2019: Global Trends in Reproductive Policy and Practice, 8th Edition is unique in its depiction of world-wide ART policy and practice. This report attests to the dynamic, ongoing growth of the practice of ART, the local and regional differences, and the continued international collaboration that has characterized the field since its inception (Table 1).

Steven J Ory
Editor-in -Chief
Surveillance 2019


International Federation of Fertility Societies (IFFS) Surveillance 2016 represents several milestones. Surveillance 2016 serves as the first edition of the new online IFFS journal, Global Reproductive Health. Surveillance 2016 represents a broader joint effort of the IFFS and World Health Organization (WHO) in association with the IFFS status as a non-governmental organization (NGO) in official relations with WHO. WHO representatives participated in the reorganization and reformatting of the 2012 questionnaire and expansion of the database of contacts among global public health officials and experts in order to supplement the pre-existing Surveillance contact list. We anticipate, that as we fulfill our responsibilities in our relations with WHO, that our joint activities in subsequent editions will likely continue to expand. 

Surveillance 2016 represents the culmination of the efforts of many. I am profoundly grateful to the respondents who committed a great deal of time and effort to accurately compile and convey the information that was sought. A very talented editorial board was assembled and all contributed substantially to the revision of the questionnaire, the selection of new content, the analysis of the data, and the individual organization and production of each section.

Surveillance 2016 serves as a record and an overview of the practice, policies and activities associated with assisted reproductive technology (ART) as it existed globally, at the end of 2015. It also, provides an evaluation of specific national and global trends over time that concern specific, and sometimes controversial, topics and issues. However, there are significant limitations to this report. All aspects of ART are dynamic and continuing to change. The respondents for the 2016 edition represent the majority of countries with the most active ART services worldwide; however, the experiences of over 100 countries are not depicted in this report despite intensive efforts to find representative respondents to include them. The responses to the questionnaire were provided by one or two well-informed individuals in each country but these responses were not validated and may contain inherent accuracies. Caution should be taken when interpreting or re-presenting these data. There are limitations in the completeness and quality of the surveillance data reported, including the variability in respondents from countries who provided feedback to surveys in 2013 versus in 2016. 

Nevertheless, this report remains the only source of information that provides a global overview of ART practices. Potential partnerships with other global organizations and an increase in awareness of this IFFS data collection should improve the quality in years to come.  Despite this, Surveillance 2016 attests to a robust and expanding scope of ART practices, policies, and activities among nations around the world while highlighting significant and important differences with a review of trends that have occurred the triennium.

Steven J Ory
Editor-in -Chief
Surveillance 2016

Surveillance Archives

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