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Section 5: ART Trends 2001-2010

This report marks the sixteenth consecutive year that CDC has published an annual report detailing the success rates for ART clinics in the United States. Having several years of data provides us with the opportunity to examine trends in ART use and success rates over time. This report features an examination of trends for the most recent 10 years, 2001–2010. Statistics for earlier years are available in previous annual publications of the Assisted Reproductive Technology Success Rates: National Summary and Fertility Clinic Reports.

Is the use of ART increasing?

Figure 48 shows the number of ART cycles performed, live-birth deliveries, and infants born using ART from 2001 through 2010. The number of ART cycles performed in the United States has increased, from 107,587 cycles in 2001 to 147,260 in 2010. The number of live-birth deliveries in 2010 (47,090) was more than one and a half times higher than in 2001 (29,344). The number of infants born who were conceived using ART also increased between 2001 and 2010. In 2010, 61,564 infants were born, which was more than one and a half times higher than the 40,687 born in 2001. Because in some cases more than one infant is born during a live-birth delivery (e.g., twins), the total number of infants born is greater than the number of live-birth deliveries.

Figure 48: Numbers of ART Cycles Performed, Live-Birth Deliveries, and Infants Born Using ART, 2001–2010.

Is the use of ICSI increasing?

Intracytoplasmic sperm injection (ICSI) was originally developed to use in ART cycles to improve fertilization rates when severe male factor infertility was the indication for using ART. Today, this procedure is widely used even without a diagnosis of male factor infertility.

Figure 49 shows the number of ART cycles performed using ICSI from 2001 through 2010. Overall, the number of ART cycles with ICSI procedures continued to increase for all fresh cycles. During the past 10 years, the number of fresh nondonor cycles performed with ICSI increased more than 65%, from 40,432 in 2001 to 66,859 in 2010. The number of fresh donor cycles with ICSI nearly doubled, from 4,259 to 7,882 over the same period.

The number of frozen cycles (with or without ICSI) nearly doubled, from 14,705 in 2001 to 28,425 in 2010 for frozen nondonor cycles and more than doubled from 3,426 to 7,162 for frozen donor cycles over the same period.

Note that the information on use of ICSI is not consistently collected across clinics for ART cycles using frozen embryos; therefore, these cycles are presented together as one group.

Figure 49: Numbers of ICSI Procedures Performed, by Type of ART Cycle, 2001–2010.

Has the percentage of transfers that resulted in live births for ART cycles with or without ICSI changed?

Figure 50 presents percentages of transfers that resulted in live births for ART cycles with or without ICSI. Percentages of transfers that resulted in live births are presented rather than percentages of cycles that resulted in live births because this is the only way to directly compare cycles using fresh embryos with those using frozen embryos.

In general, with or without ICSI, fresh donor cycles had the highest success rates when compared with fresh nondonor cycles or frozen cycles. However, when comparing success rates within each type of ART cycle, the percentage of transfers that resulted in live births among cycles without ICSI remained slightly higher than cycles with ICSI during 2001–2010.

The percentage of transfers that resulted in live births for cycles using fresh donor embryos without ICSI increased from 49% in 2001 to 57% in 2010, while cycles using fresh donor embryos with ICSI increased from 45% to 55% over the same period. Similar to trends with cycles using fresh donor embryos, the percentage of transfers that resulted in live births for fresh nondonor cycles with ICSI increased from 32% in 2001 to 36% in 2010, which was generally lower than for the fresh nondonor cycles without ICSI (35% in 2001 to 38% in 2010).

Note that the information on use of ICSI is not consistently collected across clinics for ART cycles using frozen embryos; therefore, these cycles are presented together as one group.

Figure 50: Percentages of Transfers That Resulted in Live Births, by Type of ART Cycle and ICSI, 2001–2010.

Has the percentage of transfers that resulted in singleton live births for ART cycles with or without ICSI changed?

Singleton live births are an important measure of success because they have a much lower risk than multiple-infant births for adverse infant health outcomes, including prematurity, low birth weight, disability, and death. Figure 51 shows that the percentage of transfers that resulted in singleton live births increased over time for all ART cycles with or without ICSI.

Although the total number of nondonor cycles using ICSI increased over the past 10 years (see Figure 49), percentages of transfers that resulted in singleton live births from these cycles were not any higher than those without ICSI.

Overall, percentages of transfers that resulted in singleton live births were consistently higher for fresh donor cycles than for fresh nondonor cycles and frozen cycles. Fresh donor cycles without ICSI increased from 28% in 2001 to 35% in 2010; a similar increase was observed for fresh donor cycles with ICSI. Over the same period, the percentage of transfers that resulted in singleton live births increased from 22% to 26% for fresh nondonor cycles without ICSI and from 21% to 25% with ICSI.

Note that the information on use of ICSI is not consistently collected across clinics for ART cycles using frozen embryos; therefore, these cycles are presented together as one group.

Figure 51: Percentages of Transfers That Resulted in Singleton Live Births, by Type of ART Cycle and ICSI, 2001–2010.

Has the percentage of transfers that resulted in live births for all ART patients changed or only for those in particular age groups?

Figure 52 presents percentages of transfers that resulted in live births, by the age of the woman, for ART cycles using fresh nondonor eggs or embryos.

From 2001 through 2010, the percentage of transfers that resulted in live births for women younger than age 35 increased 16%, from 41% in 2001 to 48% in 2010. Over the same period, the percentage of transfers that resulted in live births increased 9% (from 35% to 38%) for women aged 35–37 years, 10% (from 25% to 28%) for women aged 38–40, and 15% (from 15% to 17%) for women aged 41–42. Please note that percentages of transfers that resulted in live births were rounded to the nearest whole number, while percent changes were calculated with raw data.

Figure 52: Percentages of Transfers That Resulted in Live Births for ART Cycles Using Fresh Nondonor Eggs or Embryos, by Age Group, 2001–2010.

Have there been changes in percentages of transfers that resulted in singleton live births for all ART patients or only for those in particular age groups?

Singleton live births are an important measure of success because they have a much lower risk than multiple-infant births for adverse infant health outcomes, including prematurity, low birth weight, disability, and death. Figure 53 presents percentages of transfers that resulted in singleton live births, by the age of the woman, for ART cycles using fresh nondonor eggs or embryos.

From 2001 through 2010, the percentage of transfers that resulted in singleton live births for women younger than 35 increased 27%, from 25% in 2001 to 31% in 2010. Over the same period, the percentage of transfers that resulted in singleton live births increased 19% (from 23% to 27%) for women aged 35–37, 16% (from 19% to 22%) for women aged 38–40, and 15% (from 12% to 14%) for women aged 41–42. Please note that percentages of transfers that resulted in singleton live births were rounded to the nearest whole number, while percent changes were calculated with raw data.

Figure 53: Percentages of Transfers That Resulted in Singleton Live Births for ART Cycles Using Fresh Nondonor Eggs or Embryos, by Age Group, 2001–2010.

Has the number of embryos transferred changed in fresh nondonor cycles?

Figure 54 presents the trends for the number of embryos transferred in fresh nondonor cycles that progressed to the embryo transfer stage. From 2001 through 2010, cycles that involved the transfer of one embryo more than doubled, from 6% to 15%; cycles that involved the transfer of two embryos nearly doubled, from 27% in 2001 to 53% in 2010. Cycles that involved the transfer of three embryos decreased from 35% in 2001 to 21% in 2010, and cycles that involved the transfer of four or more embryos decreased dramatically from 32% in 2001 to 10% in 2010.

Figure 54: Percentages of Fresh Nondonor Cycles That Involved the Transfer of One, Two, Three, or Four or More Embryos, 2001–2010.
Figure 54: Percentages of Fresh Nondonor Cycles That Involved the Transfer of One, Two, Three, or Four or More Embryos, 2001–2010.

Has the number of embryos transferred changed in fresh nondonor cycles for women younger than 35 who have more embryos available than they choose to transfer?

As shown in Figure 54 the number of embryos transferred in fresh nondonor cycles has decreased during the past 10 years. Figure 55 shows the change over time in the number of embryos transferred for ART cycles in which the woman was younger than 35 and chose to set aside some embryos for future cycles rather than transfer all available embryos at one time. Previous research suggests that the number of embryos available for an ART cycle is important in predicting success. Younger women also tend to have higher percentages of ART cycles that result in pregnancies and live births (see Figure 14).

Overall, the number of embryos transferred decreased among patients who chose to transfer fewer embryos than were available. In 2001, approximately 12% of ART cycles involved the transfer of four or more embryos; 39%, three embryos; and 48%, two embryos. By 2010, four or more embryos were transferred in about 1% of cycles, three in 6% of cycles, two in 75% of cycles, and one in 19% of cycles.

Figure 55: Percentages of Fresh Nondonor Cycles That Involved the Transfer of One, Two, Three, or Four or More Embryos Among Women Who Were Younger Than 35 and Set Aside Extra Embryos for Future Use, 2001–2010.

Have there been changes in percentages of transfers that resulted in live births, by number of embryos transferred?

Figure 56 presents percentages of transfers that resulted in live births, by the number of embryos transferred for ART cycles using fresh nondonor eggs or embryos from 2001 through 2010. The percentage of transfers that resulted in live births increased for ART cycles that involved the transfer of one or two embryos (11% to 28% and 37% to 44%, respectively). However, over the same period, there was a decrease for ART cycles that involved the transfer of three or four or more embryos (37% to 32% and 31% to 25%, respectively).

Interpretation of the relationship between the number of embryos transferred and success rates is complicated by several factors, such as the woman’s age and embryo quality. Trends over time may reflect changes in these factors.

Figure 56: Percentages of Transfers That Resulted in Live Births Using Fresh Nondonor Eggs or Embryos, by Number of Embryos Transferred, 2001–2010.

Have there been changes in percentages of transfers that resulted in live births for women younger than 35 who have more embryos available than they choose to transfer?

Figure 57 shows changes over time in the number of embryos transferred and the percentage of transfers that resulted in live births for ART cycles using fresh nondonor eggs or embryos in which the woman was younger than 35 and chose to set aside some embryos for future cycles rather than transfer all available embryos at one time. Previous research suggests that the number of embryos available for an ART cycle is an important predictor of success. Younger women also tend to have higher percentages of ART cycles that result in pregnancies and live births (see Figure 14).

For this group of women, the percentage of transfers that resulted in live births generally increased over time, regardless of the number of embryos transferred. The biggest increase was for cycles in which one embryo was transferred, from 30% in 2001 to 51% in 2010.

Percentages of transfers that resulted in live births for cycles involving the transfer of one embryo were comparable to those that involved three or four or more embryos. Elective single-embryo transfer minimizes the risk of multiple-fetus pregnancy and related adverse outcomes. In 2009, the Society for Assisted Reproductive Technology (SART) revised its embryo transfer guidelines to encourage single-embryo transfer among patients with good prognoses. (For more information, contact SART by telephone at 205-978-5000 or online at www.sart.org.)

Figure 57: Percentages of Transfers That Resulted in Live Births Using Fresh Nondonor Eggs or Embryos Among Women Who Were Younger Than 35 and Set Aside Extra Embryos for Future Use, by Number of Embryos Transferred, 2001–2010.

Have percentages of multiple-infant live births changed?

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. Figure 58 shows percentages of multiple-infant live births for each type of ART cycle performed.

For fresh nondonor cycles, the percentage of multiple-infant live births decreased 15% since 2001, from 36% of all live births in 2001 to 30% in 2010. Over the same period, the percentage of multiple-infant live births decreased 11% for frozen nondonor cycles, 12% for frozen donor cycles, and 10% for fresh donor cycles. Please note that percentages of cycles that resulted in multiple-infant live births were rounded to the nearest whole number, while percent changes were calculated with raw data.

Figure 58: Percentages of ART Cycles That Resulted in Multiple-Infant Live Births, by Type of ART Cycle, 2001–2010.

Have percentages of multiple-infant live births for ART cycles using fresh nondonor eggs or embryos changed in particular age groups?

Figure 59 presents percentages of multiple-infant live births by the age of the woman, for ART cycles using fresh nondonor eggs or embryos. From 2001 through 2010, the percentage of multiple-infant live births decreased 14% (from 40% to 34%) for women younger than 35, 17% (from 35% to 29%) for women aged 35–37, and 14% (from 27% to 23%) for women aged 38–40. The percentage of multiple-infant live births remained nearly the same from 2001 through 2010 for women aged 41–42. However, the percentage of multiple-infant live births among women older than 44 increased from 13% to 24% between 2007 and 2008 and decreased to 14% by 2010. Please note that percentages of multiple-infant live births were rounded to the nearest whole number, while percent changes were calculated with raw data.

Figure 59: Percentages of ART Cycles That Resulted in Multiple-Infant Live Births Using Fresh Nondonor Eggs or Embryos, by Age Group, 2001–2010.

Have percentages of singletons, twins, and triplets or more changed for ART cycles using fresh nondonor eggs or embryos?

Figure 60 presents the trends in percentages of transfers that resulted in live births and percentages of multiple-infant live births for ART cycles using fresh nondonor eggs or embryos. Overall, the percentage of transfers that resulted in live births increased from 33% in 2001 to approximately 37% in 2010. From 2001 through 2010, the percentage of singleton live births increased from 64% to 70%; the percentage of twin births declined from 32% to 29%; and the percentage of triplet or higher order births decreased considerably from 4% in 2001 to 1% in 2010.

It is important to note that twins, albeit to a lesser extent than triplets or more, are still at substantially greater risk of illness and death than singletons. These risks include low birth weight, preterm birth, and neurological impairments such as cerebral palsy.

Figure 60: Percentages of Transfers That Resulted in Live Births and Percentages of Multiple-Infant Live Births for ART Cycles Using Fresh Nondonor Eggs or Embryos, 2001–2010.

 

 

ART 2010 National Summary Presentation.
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