Section 2: ART Cycles Using Fresh, Nondonor Eggs or Embryos (Part B)
Section 2 it is broken up into three parts. Part B contains Figures 16–26.
A woman’s age not only affects the chance for pregnancy when her own eggs are used, but also affects her risk of miscarriage. Figure 16 shows percentages of ART cycles using fresh nondonor eggs or embryos in 2010 that resulted in miscarriage for women of different ages. Percentages of ART cycles that resulted in miscarriage were below 15% among women aged 35 or younger. The percentage of ART cycles that resulted in miscarriages began to increase among women in their mid to late 30s and continued to increase with age, reaching approximately 29% at age 40 and over 65% among women older than age 44.
The risk of miscarriage among women undergoing ART procedures using fresh nondonor eggs or embryos appears to be similar to those reported in various studies of other pregnant women in the United States.
The risk of pregnancy loss (loss of an entire pregnancy or all fetuses in a multiple-fetus pregnancy, including stillbirths and miscarriages) is affected by the duration of a woman’s pregnancy and her age. Figure 17 shows that 11% to 63% of pregnancies were lost through 24 weeks gestation, depending on the woman’s age. Among women younger than age 35, 11% of pregnancies were lost and 87% continued through week 24. In contrast, among women older than age 44, about 63% of pregnancies were lost and only 34% continued through week 24. In all age groups, most pregnancy losses occurred before week 14 (i.e., during the first trimester). The risk of pregnancy loss after 24 weeks was 1% or less for all age groups because most pregnancies that progress beyond week 24 lead to live births. Note that percentages of pregnancy loss and percentages of pregnancy continuation for each age group may not add up to 100% because some pregnancies resulted in outcomes other than pregnancy loss before week 24 (e.g., live births, induced abortions, or maternal death).
In 2010, a total of 100,824 cycles using fresh nondonor eggs or embryos were started:
- 41,744 among women younger than age 35
- 21,369 among women aged 35–37 years
- 21,741 among women aged 38–40 years
- 10,122 among women aged 41–42 years
- 4,501 among women aged 43–44 years
- 1,347 among women older than age 44
Figure 18 shows that a woman’s chance of progressing from the beginning of ART to pregnancy and live birth (using her own eggs) decreases at every stage of ART as her age increases.
- As women get older, the likelihood of a successful response to ovarian stimulation and progression to egg retrieval decreases.
- As women get older, cycles that have progressed to egg retrieval are less likely to reach transfer.
- The percentage of cycles that progress from transfer to pregnancy also decreases as women get older.
- As women get older, cycles that have progressed to pregnancy are less likely to result in a live birth because the risk of miscarriage is greater (see Figure 16).
Overall, 41% of cycles started in 2010 among women younger than age 35 resulted in live births. This percentage decreased to 32% among women aged 35–37, 22% among women aged 38–40, 12% among women aged 41–42, 5% among women aged 43–44, and 1% among women older than age 44.
by Stage and Age Group, 2010.
Figure 19 shows the infertility diagnoses reported among patients who had an ART procedure using fresh nondonor eggs or embryos in 2010. Diagnoses range from one infertility factor in one partner to one or more multiple infertility factors in the patient or in either one or both partners. However, diagnostic procedures may vary from one clinic to another, so the categorization also may vary.
- Tubal factor means that the woman’s fallopian tubes are blocked or damaged, making it difficult for the egg to be fertilized or for an embryo to travel to the uterus.
- Ovulatory dysfunction means that the ovaries are not producing eggs normally. Such dysfunctions include polycystic ovary syndrome and multiple ovarian cysts.
- Diminished ovarian reserve means that the ability of the ovary to produce eggs is reduced. Reasons include congenital, medical, or surgical causes or advanced age.
- Endometriosis involves the presence of tissue similar to the uterine lining in abnormal locations. This condition can affect both fertilization of the egg and embryo implantation.
- Uterine factor means a structural or functional disorder of the uterus that results in reduced fertility.
- Male factor refers to a low sperm count or problems with sperm function that make it difficult for a sperm to fertilize an egg under normal conditions.
- Other causes of infertility include immunological problems, chromosomal abnormalities, cancer chemotherapy, and serious illnesses.
- Unexplained cause means that no cause of infertility was found in either the woman or the man.
- Multiple factors, female only, means that more than one female cause was diagnosed.
- Multiple factors, female and male, means that one or more female causes and male factor infertility were diagnosed.
Figure 20 shows the percentage of ART cycles using fresh nondonor eggs or embryos that resulted in live births according to the causes of infertility. (See Figure 19, or the Glossary of Terms in Appendix B for an explanation of the diagnoses.) Although the national average was 30% in 2010 (see Figure 8), the percentage of ART cycles that resulted in live births varied somewhat depending on the patient’s diagnosis. In 2010, the percentage of ART cycles resulting in live births was higher than the national average for couples with diagnosed tubal factor, ovulatory dysfunction, endometriosis, male factor, or unexplained infertility; it was lower for patients with diagnosed diminished ovarian reserve, uterine factor, “other” causes, or multiple infertility factors. Please note, however, that 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 2010 ART Data in Appendix A for additional information.) Therefore, differences in success rates by causes of infertility should be interpreted with caution.
Figure 21 shows the number of previous births among women who had ART procedures using fresh nondonor eggs or embryos in 2010. Most ART procedures (70%) were among women who had no previous births, although they may have had a pregnancy that resulted in a miscarriage or an induced abortion. About 22% of ART procedures were among women who reported one previous birth, and about 8% were among women who reported two or more previous births. However, we do not have information about how many of these were births resulting from ART and how many were not. These data nonetheless point out that women who have previously given birth can still face infertility problems.
Do women who have previously given birth have higher percentages of ART cycles that result in live births?
Figure 22 shows the relationship between the success of ART cycles performed in 2010 using fresh nondonor eggs or embryos and a history of previous births. Previous live-born infants were conceived naturally in some cases and through ART in others. In all age groups, percentages of ART cycles that resulted in live births were slightly higher or equal among women who had one or more previous live births compared to those who had no previous live births.
Is there a difference in percentages of ART cycles that result in live births between women with previous miscarriages and women who have never been pregnant?
In 2010, 70,817 ART cycles using fresh nondonor eggs or embryos were performed among women who had not previously given birth. However, about 27% of those cycles were reported by women with one or more previous pregnancies that had ended in miscarriage—we do not have information on whether the pregnancies ending in miscarriage were the result of ART or were conceived naturally. Figure 23 shows the relationship between the success of an ART cycle in 2010 and the history of previous miscarriage. In all age groups, percentages of cycles that resulted in live births were similar among women who had one or more previous miscarriages and women who never were pregnant. Thus, a history of unsuccessful pregnancy does not appear to be associated with lower chances for success using ART.
That Resulted in Live Births, by Age Group and History of Miscarriage,
Among Women with No Previous Births, 2010.
Figure 24 presents ART cycles that used fresh nondonor eggs or embryos in 2010 according to whether previous ART cycles had been performed. For about 45% of ART procedures performed in 2010, one or more previous cycles were reported. (This percentage includes previous cycles using either fresh or frozen embryos.) This finding illustrates that it is not uncommon for women to undergo multiple ART cycles. We do not have information on when previous cycles were performed, nor do we have information on the outcomes of those previous cycles.
ART with Fresh Nondonor Eggs or Embryos, 2010.
Are percentages of ART cycles that result in live births different for women using ART for the first time and women who previously used ART but did not give birth?
Figure 25 shows the relationship between the success of ART cycles performed in 2010 using fresh nondonor eggs or embryos and a history of previous ART cycles among women with no previous births. In the majority of age groups, percentages of ART cycles that resulted in live births among women who previously had an unsuccessful ART cycle were lower or similar to those among women who had no previous ART cycles and no previous births.
What is the percentage of ART cycles that result in live births for women who have both previously used ART and previously given birth?
Figure 26 shows the relationship between the success of ART cycles performed in 2010 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 in all age groups.
Figure 25 shows that the percentage of ART cycles resulting in live births decreases with a woman’s age and for those women with one or more previous ART cycles among women with no previous births. In Figure 26, for women with one or more previous births, the percentage of live births also decreases with a woman’s age, but does not appear to be related to a woman’s history of use of ART.