Skip directly to search Skip directly to A to Z list Skip directly to navigation Skip directly to site content Skip directly to page options
CDC Home

Section 2: ART Cycles Using Fresh, Nondonor Eggs or Embryos (Part C)

Section 2 it is broken up into three parts. Part C contains Figures 27–42.

What is the percentage of ART cycles that result in live births for women who have had both previous ART and previous births?

Figure 27 shows the relationship between the success of ART cycles performed in 2009 using fresh nondonor eggs or embryos and a history of both previous ART cycles and previous births. We do not have information on whether the previous births were the result of ART or were conceived naturally. However, among women with previous births, percentages of ART cycles that resulted in live births among women who did not undergo a previous ART procedure were comparable to percentages among women who had undergone previous ART cycles.

Although Figure 26 shows that having undergone previous ART cycles may be related to the success of the current ART cycle, it is also important to consider the outcomes of previous cycles and whether the woman has given birth in the past, as demonstrated in this figure.

Figure 27: Percentages of ART Cycles Using Fresh Nondonor Eggs or Embryos That Resulted in Live Births, by Age of Woman and History of Previous ART Cycles, Among Women with One or More Previous Births, 2009.

What are the specific types of ART performed among women who use fresh nondonor eggs or embryos?

Figure 28 presents the types of ART procedures performed in 2009 among women using fresh nondonor eggs or embryos. For about 27% of ART procedures, standard IVF (in vitro fertilization) techniques were used: eggs and sperm were combined in the laboratory, the resulting embryos were cultured for 2 or more days, and one or more embryos were then transferred into the woman’s uterus through the cervix.

For most of the remaining ART procedures (about 73%), fertilization was accomplished using intracytoplasmic sperm injection (ICSI). This technique involves injecting a single sperm directly into an egg; the embryos are then cultured and transferred as in standard IVF.

For a small proportion of ART procedures, unfertilized eggs and sperm (gametes) or early embryos (zygotes) were transferred into the woman’s fallopian tubes. These procedures are known as gamete and zygote intrafallopian transfer (GIFT and ZIFT). Some women with tubal infertility are not suitable candidates for GIFT and ZIFT. GIFT and ZIFT are more invasive procedures than IVF because they involve inserting a laparoscope into a woman’s abdomen to transfer the embryos or gametes into the fallopian tubes. In contrast, IVF involves transferring embryos or gametes into a woman’s uterus through the cervix without surgery.

Figure 28: Types of ART Procedures Using Fresh Nondonor Eggs or Embryos 2009.

What is the percentage of egg retrievals that result in live births for different types of ART procedures?

Figure 29 shows the percentage of egg retrievals that resulted in live births by type of ART procedure. Percentages for the two predominant types of ART, IVF without ICSI and IVF with ICSI, were similar. Percentages of egg retrievals that resulted in live births for cycles that used GIFT, ZIFT, or a combination* of ART procedures were lower than for cycles that used other ART procedures. See Figures Figures 3032 and Figures 5254 for further details on IVF procedures that used ICSI.

Figure 29: Percentages of Egg Retrievals That Resulted in Live Births, by Type of ART Procedure, 2009.

Is ICSI used only for couples diagnosed with male factor infertility?

ICSI was developed to overcome problems with fertilization that sometimes occur in couples diagnosed with male factor infertility. Figure 30 shows the percentage of fresh nondonor cycles using ICSI in 2009 among couples with and without diagnoses of male factor infertility. In 2009, 66,439 ICSI cycles were performed. Slightly less than half of the ICSI cycles were performed for couples with a diagnosis of male factor infertility. However, diagnostic procedures may vary from one clinic to another, so the categorization of causes of infertility may also vary.

Figure 30: Use of ICSI in Fresh Nondonor Cycles Among Couples With and Without Diagnoses of Male Factor Infertility, 2009.

What is the percentage of retrievals that result in live births for couples with male factor infertility when ICSI is used?

ICSI was developed to overcome problems with fertilization that sometimes occur among couples diagnosed with male factor infertility. In 2009, 83% of couples diagnosed with male factor infertility used IVF with ICSI. Because ICSI can only be performed when at least one egg has been retrieved, Figure 31 presents percentages of retrievals that resulted in live births for these ICSI procedures among couples diagnosed with male factor infertility. For comparison, these percentages are resented alongside percentages for ART cycles that used standard IVF without ICSI among couples with all diagnoses except male factor infertility.

For most age groups, when ICSI was used for couples diagnosed with male factor infertility, percentages of retrievals that resulted in live births were similar to those achieved by couples who used standard IVF without ICSI and were not diagnosed with male factor infertility. Please note, however, the definitions of infertility diagnoses may vary from clinic to clinic and that a review of select clinical records revealed that reporting of infertility causes may be incomplete. (See Findings from Validation Visits for 2009 ART Data in Appendix A for additional information.) Therefore, differences in success rates by causes of infertility should be interpreted with caution.

Figure 31: Percentages of Retrievals That Resulted in Live Births Among Couples Diagnosed with Male Factor Infertility Who Used IVF with ICSI, Compared with Couples Not Diagnosed with Male Factor Infertility Who Used IVF Without ICSI, by Age of Woman, 2009.
Figure 31: Percentages of Retrievals That Resulted in Live Births Among Couples Diagnosed with Male Factor Infertility Who Used IVF with ICSI, Compared with Couples Not Diagnosed with Male Factor Infertility Who Used IVF Without ICSI, by Age of Woman, 2009.

What is the percentage of retrievals that result in live births for couples without a diagnosis of male factor infertility when ICSI is used?

As shown in Figure 30, a large number of ICSI procedures are now performed even when couples are not diagnosed with male factor infertility. Figure 32 presents percentages of egg retrievals that resulted in live births for those cycles compared with ART cycles among couples who used IVF without ICSI. For women younger than age 43, the ICSI procedures were less successful. Please note, however, the definitions of infertility diagnoses may vary from clinic to clinic and that a review of select clinical records revealed that reporting of infertility causes may be incomplete. (See Findings from Validation Visits for 2009 ART Data in Appendix A for additional information.) Additionally, information was not available to determine whether this finding was a direct effect of the ICSI procedure or whether the patients who used ICSI were somehow different from those who use IVF alone. Therefore, differences in success rates by causes of infertility should be interpreted with caution.

Figure 32: Percentages of Retrievals That Resulted in Live Births Among Couples Not Diagnosed with Male Factor Infertility, by Use of ICSI and Age of Woman, 2009.

How many embryos are transferred in an ART procedure?

Figure 33 shows that approximately 35% of ART cycles that used fresh nondonor eggs or embryos and progressed to the embryo transfer stage in 2009 involved the transfer of three or more embryos, about 12% of cycles involved the transfer of four or more, and approximately 4% of cycles involved the transfer of five or more embryos.

Figure 33: Numbers of Embryos Transferred During ART Cycles Using Fresh Nondonor Eggs or Embryos, 2009.

How does the implantation percentage for fresh nondonor embryos differ among women of different ages?

Figure 34 presents the relationship between the implantation percentage (see Implantation rate in Glossary of Terms) for fresh nondonor embryos transferred and a woman’s age. The percentage of embryos transferred that resulted in implantation was highest (35%) among women younger than 35. However, the implantation percentage decreased steadily as the age of the woman increased. Specifically, the implantation percentage was lowest (2%) among women older than 44 compared with the implantation percentage among women in each of the other age groups.

Figure 34: Percentages of Embryos Transferred That Resulted in Implantation Among Women Using Fresh Nondonor Eggs or Embryos, by Age Group, 2009.

In general, is an ART cycle more likely to be successful if more embryos are transferred?

Figure 35 shows the relationship between the number of fresh nondonor eggs or embryos transferred during an ART procedure and the number of live births as a result of that procedure. In 2009, the percentage of transfers that resulted in live births increased when two or more embryos were transferred; however, transferring multiple embryos also poses a risk of having a multiple-infant birth. Multiple-infant births cause concern because of the additional health risks they create for both mothers and infants. Also, pregnancies with multiple fetuses are potentially subject to multifetal reduction. This can happen naturally (e.g., fetal death), or a woman and her doctor may decide to reduce the number of fetuses using a procedure called multifetal pregnancy reduction. CDC does not collect information on multifetal pregnancy reductions.

The relationship between number of embryos transferred, percentages of transfers resulting in live births, and multiple-infant births is complicated by several factors, such as the woman’s age and embryo quality. See Figure 36 and 40 for more details on women using fresh nondonor eggs or embryos who are most at risk of multiple births.

Figure 35: Percentages of Transfers That Resulted in Live Births and Percentages of Multiple-Infant Live Births for ART Cycles Using Fresh Nondonor Eggs or Embryos, by Number of Embryos Transferred, 2009.

Are percentages of transfers that result in live births affected by the number of embryos transferred for women who have more embryos available than they choose to transfer?

Although, in general, transferring more than one embryo tends to improve the chance for a successful ART procedure (see Figure 35), other factors are also important. Previous research suggests that the number of embryos fertilized and thus available for ART is just as, if not more, important in predicting success as the number of embryos transferred. Additionally, younger women tend to have both higher percentages of live births and higher likelihood of multiple-infant births. Figure 36 shows the relationship between the number of fresh nondonor eggs or embryos transferred, percentages of transfers resulting in live births, and multiple-infant births for ART procedures in which the woman was younger than 35 and the couple chose to set aside some embryos for future cycles rather than transfer all available embryos at one time.

In 2009, for this group, the chance for a live birth using ART was about 50% when only one embryo was transferred. If one measures success as the percentage of transfers resulting in singleton live births, the highest likelihood of live birth was observed with only one embryo transferred.

The proportion of live births that were multiple-infant births was about 42% with two embryos and 56% with five or more embryos transferred. In summary, as the number of embryos transferred increased, the proportion of live births that were multiple-infant births also increased.

Figure 36: Percentages of Transfers That Resulted in Live Births and Percentages of Multiple-Infant Live Births for ART Cycles Among Women Who Were Younger Than 35, Used Fresh Nondonor Eggs or Embryos, and Set Aside Extra Embryos for Future Use, by Number of Embryos Transferred, 2009.

How long after egg retrieval does embryo transfer occur?

Once an ART cycle has progressed from egg retrieval to fertilization, the embryo(s) can be transferred into the woman’s uterus in the subsequent 1 to 6 days. Figure 37 shows that in 2009 approximately 55% of embryo transfers occurred on day 3. Day 5 embryo transfers were the next most common, accounting for about 36% of ART procedures that progressed to the embryo transfer stage.

Figure 37: Day of Embryo Transfer Among ART Cycles Using Fresh Nondonor Eggs or Embryos, 2009.

In general, is an ART cycle more likely to be successful if embryos are transferred on day 5?

As shown in Figure 37, in the vast majority of ART procedures, embryos were transferred on day 3 (55%) or day 5 (36%). Figure 38 compares percentages of day 3 embryo transfers that resulted in live births with those for day 5 embryo transfers. In all age groups, percentages were higher for day 5 embryo transfers than for day 3 transfers. However, some cycles do not progress to the embryo transfer stage because of embryo arrest (interruption in embryo development) between day 3 and day 5. These cycles are not accounted for in percentages of day 5 transfers that resulted in live births. Therefore, differences in percentages of day 3 and day 5 transfers that result in live births should be interpreted with caution.

Figure 38: Percentages of Day 3 and Day 5 Embryo Transfers Using Fresh Nondonor Eggs or Embryos That Resulted in Live Births, by Age of Woman, 2009.

Does the number of embryos transferred differ for day 3 and day 5 embryo transfers?

Figure 39 shows the number of embryos transferred on day 3 and day 5. Overall, fewer embryos were transferred on day 5 than on day 3. Approximately 46% of day 3 embryo transfers and 18% of day 5 embryo transfers involved the transfer of three or more embryos. The decrease in the number of embryos transferred on day 5, however, did not translate into a lower risk of multiple-infant births. See Figure 40 for more details on the relationship between multiple-infant birth risk and day of embryo transfer.

Figure 39: Numbers of Embryos Transferred During ART Cycles Using Fresh Nondonor Eggs or Embryos for Day 3 and Day 5 Embryo Transfers, 2009.

In general, how does the multiple-infant birth risk vary by the day of embryo transfer?

Multiple-infant births are associated with greater problems for both mothers and infants, including higher rates of caesarean section, prematurity, low birth weight, and infant disability or death.

Part A of Figure 40 shows that among the 14,201 live births that occurred following day 3 embryo transfer, about 73% were singletons, 25% were twins, and 2% were triplets or more. Thus, approximately 27% of these live births produced more than one infant.

In 2009, 14,396 live births occurred following day 5 embryo transfer. Part B of Figure 40 shows that approximately 35% of these live births produced more than one infant.

As shown in Figure 39, fewer embryos were transferred on day 5 than on day 3. However, the proportion of live births resulting in twins is higher among transfer procedures performed on day 5 than on day 3. Thus, the risk of having a multiple-infant birth was higher for day 5 embryo transfers. The likelihood of multiple-infant births for both day 3 and day 5 embryo transfers is much higher overall than for multiple-infant births in the general U.S. population (about 3%).

Figure 40: Risks of Having Multiple-Infant Live Births for ART Cycles Using Fresh Nondonor Eggs or Embryos for Day 3 and Day 5 Embryo Transfers, 2009.

For day 5 embryo transfers, are percentages of transfers that result in live births affected by the number of embryos transferred for women who have more embryos available than they choose to transfer?

As shown in Figures 39 and 40, embryos transferred on day 5 result in more multiple-infant births compared with embryos transferred on day 3, despite the smaller number of embryos transferred on day 5. Figure 41 shows the relationship between the number of embryos transferred, the percentage of transfers resulting in live births, and the percentage of multiple-infant births for day 5 embryo transfer procedures in which the woman was younger than 35 and the couple decided to set aside some embryos for future cycles rather than transfer all available embryos at one time.

The percentage of transfers resulting in live births was the highest (about 61%) when two embryos were transferred; however, the proportion of live births that were multiples (twins or more) — which present a higher risk of poor health outcomes — was 48%. The percentage of live births that were higher-order multiples (triplets or more) was much higher when three or more embryos were transferred on day 5 (approximately 13%) than for those involving the transfer of just two embryos on day 5 (approximately 1%).

If one measures success as the percentage of transfers resulting in singleton live births, the highest percentage (53%) was observed with the transfer of a single embryo on day 5.

Figure 41: Percentages of Transfers That Resulted in Live Births and Percentages of Multiple-Infant Live Births for Day 5 Embryo Transfers Among Women Who Were Younger Than 35, Used Fresh Nondonor Eggs or Embryos, and Set Aside Extra Embryos for Future Use, by Number of Embryos Transferred, 2009.
Figure 41: Percentages of Transfers That Resulted in Live Births and Percentages of Multiple-Infant Live Births for Day 5 Embryo Transfers Among Women Who Were Younger Than 35, Used Fresh Nondonor Eggs or Embryos, and Set Aside Extra Embryos for Future Use, by Number of Embryos Transferred, 2009.

How do percentages of transfers that result in live births for women who use gestational carriers compare with women who do not use gestational carriers?

In some cases a woman has trouble carrying a pregnancy. In such cases the couple may use ART with a gestational carrier, sometimes called a surrogate. A gestational carrier is a woman who agrees to carry the developing embryo for a couple with infertility problems. Gestational carriers were used in about 1% of ART cycles using fresh nondonor embryos in 2009 (883 cycles). Figure 42 compares percentages of transfers that resulted in live births for ART cycles that used a gestational carrier in 2009 with cycles that did not. In most age groups, percentages of transfers that resulted in live births for ART cycles that used gestational carriers were higher than for those cycles that did not.

Figure 42: Comparison of Percentages of Transfers Using Fresh Nondonor Eggs or Embryos That Resulted in Live Births Between ART Cycles That Used Gestational Carriers and Those That Did Not, by Age of ART Patient, 2009.
Figure 42: Comparison of Percentages of Transfers Using Fresh Nondonor Eggs or Embryos That Resulted in Live Births Between ART Cycles That Used Gestational Carriers and Those That Did Not, by Age of ART Patient, 2009.
 
Contact Us:
  • Centers for Disease Control and Prevention
    1600 Clifton Rd
    Atlanta, GA 30333
  • 800-CDC-INFO
    (800-232-4636)
    TTY: (888) 232-6348
  • Contact CDC-INFO
USA.gov: The U.S. Government's Official Web PortalDepartment of Health and Human Services
Centers for Disease Control and Prevention   1600 Clifton Road Atlanta, GA 30329-4027, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 - Contact CDC–INFO
A-Z Index
  1. A
  2. B
  3. C
  4. D
  5. E
  6. F
  7. G
  8. H
  9. I
  10. J
  11. K
  12. L
  13. M
  14. N
  15. O
  16. P
  17. Q
  18. R
  19. S
  20. T
  21. U
  22. V
  23. W
  24. X
  25. Y
  26. Z
  27. #