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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 27–39.

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

Figure 27 presents the types of ART procedures performed among women using fresh nondonor eggs or embryos. For about 26% of ART procedures that progressed to the egg retrieval step, 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 74%), 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 very 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, respectively). 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 27: Types of ART Procedures Using Fresh Nondonor Eggs or Embryos, 2010.

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

ICSI was developed to overcome problems with fertilization that sometimes occur with a diagnosis of male factor infertility. In 2010, 84% of couples who received a diagnosis of male factor infertility used IVF with ICSI. Because ICSI can only be performed when at least one egg has been retrieved, Figure 28 presents percentages of retrievals that resulted in live births for these ICSI procedures among couples with diagnosed male factor infertility.

For comparison, these percentages are presented alongside percentages for ART cycles that used standard IVF without ICSI among patients and partners who received all diagnoses except male factor infertility. For most age groups, when ICSI was used for patients with male factor infertility, percentages of retrievals that resulted in live births were similar to those using standard IVF without ICSI and no diagnosis of male factor infertility. 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 informational information.) Therefore, differences in success rates by causes of infertility should be interpreted with caution.

Figure 28: Percentages of Retrievals That Resulted in Live Births Among Couples with Diagnosed Male Factor Infertility Who Used IVF with ICSI, Compared with Couples Without Diagnosed Male Factor Infertility Who Used IVF Without ICSI, by Age Group, 2010.

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

Among 66,830 ICSI cycles performed in 2010, slightly more than half (53%) were performed without a diagnosis of male factor infertility. Figure 29 presents percentages of egg retrievals that resulted in live births for those cycles compared with ART cycles using IVF without ICSI. For women aged 44 and younger, the ICSI procedures were less successful. 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.) 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 used IVF alone. Therefore, differences in success rates by causes of infertility should be interpreted with caution.

Figure 29: Percentages of Retrievals That Resulted in Live Births Among Patients Without Diagnosed Male Factor Infertility, by Use of ICSI and Age Group, 2010.

How many embryos are transferred in an ART procedure?

Figure 30 shows that in 2010, the majority (68%) of ART cycles that used fresh nondonor eggs or embryos and progressed to the embryo transfer stage involved the transfer of one or two embryos. Approximately 32% of cycles involved the transfer of three or more, about 10% of cycles involved the transfer of four or more, and approximately 3% of cycles involved the transfer of five or more embryos.

Figure 30: Numbers of Embryos Transferred During ART Cycles Using Fresh Nondonor Eggs or Embryos, 2010.

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

Figure 31 presents the relationship between the implantation percentage (see Implantation rate in Appendix B: the Glossary of Terms) for fresh nondonor embryos transferred and a woman’s age. The percentage of embryos transferred that resulted in implantation was highest (approximately 37%) among women younger than 35. However, the implantation percentage decreased steadily as the age of the woman increased. Specifically, the implantation percentage was lowest (about 2%) among women older than 44 compared with the implantation percentage among women in each of the other age groups.

Figure 31: Percentages of Embryos Transferred That Resulted in Implantation Among
Women Using Fresh Nondonor Eggs or Embryos, by Age Group, 2010.
Figure 31: Percentages of Embryos Transferred That Resulted in Implantation Among Women Using Fresh Nondonor Eggs or Embryos, by Age Group, 2010.

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

Figure 32 shows the relationship between the number of fresh nondonor eggs or embryos transferred and percentages of live births and multiple-infant live births that resulted for these cycles. In 2010, the percentage of transfers that resulted in live births increased when two or three 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.

Interpretation of 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 Figures 33 and 37 for more details on women using fresh nondonor eggs or embryos who are most at risk of multiple births.

Figure 32: 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, 2010.

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?

Figure 33 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 chose to set aside extra embryos for future cycles rather than transfer all available embryos at one time.

In 2010, the percentage of transfers that resulted in live births was the highest (57%) when two embryos were transferred; however, the highest percentage of singleton live births was observed with the transfer of one embryo.

The proportion of live births that were multiple-infant births (about 40% twins, 11% triplets or more) was highest (51%) when three embryos were transferred.

Figure 33: 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, 2010.

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 34 shows that in 2010 approximately 52% of embryo transfers occurred on day 3. Day 5 embryo transfers were the next most common, accounting for about 38% of ART procedures that progressed to the embryo transfer stage.

Figure 34: Day of Embryo Transfer Among ART Cycles Using Fresh Nondonor Eggs or Embryos, 2010.

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

As shown in Figure 34, in the vast majority of ART procedures using fresh nondonor embryos, embryos were transferred on day 3 (52%) or day 5 (38%). Figure 35 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 35: Percentages of Day 3 and Day 5 Embryo Transfers Using Fresh Nondonor Eggs or Embryos That Resulted in Live Births, by Age Group, 2010.

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

Figure 36 shows the number of fresh nondonor embryos transferred on day 3 and day 5. Overall, fewer embryos were transferred on day 5 than on day 3. Approximately 44% of day 3 embryo transfers and 15% 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 37 for more details on the relationship between multiple-infant birth risk and day of embryo transfer.

Figure 36: Numbers of Embryos Transferred Among ART Cycles Using Fresh Nondonor Eggs or Embryos for Day 3 and Day 5 Embryo Transfers, 2010.

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

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 37 shows that among the 13,247 live births that occurred following the transfer of day 3 embryos, 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 2010, 14,827 live births occurred following the transfer of day 5 embryos. Part B of Figure 37 shows that approximately 34% of these live births produced more than one infant.

As shown in Figure 36, 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 37: Distribution of Multiple-Infant Live Births Among ART Cycles Using Fresh Nondonor Eggs or Embryos for Day 3 and Day 5 Embryo Transfers, 2010.

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 Figure 37, the transfer of fresh nondonor embryos on day 5 resulted in a higher percentage of multiple-infant births compared with embryos transferred on day 3. Figure 38 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 transfers among women who were younger than 35 and set aside extra 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 15%) than when two embryos were transferred on day 5 (approximately 1%).

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

Figure 38: 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, 2010.

How do percentages of transfers that result in live births for ART cycles using gestational carriers compare with those that do not use gestational carriers?

A gestational carrier is a woman who agrees to carry the developing embryo for others. Gestational carriers were used in about 1% of ART cycles using fresh nondonor embryos in 2010 (926 cycles). Figure 39 compares percentages of transfers that resulted in live births for ART cycles that used a gestational carrier in 2010 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 39: 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 Group, 2010.
 

ART 2010 National Summary Presentation.
[PDF - 1.75MB]

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