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Section 5: ART Trends 2002-2011

This report marks the seventeenth consecutive year that CDC has published an annual report detailing the success rates for ART clinics in the United States. Having many 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 year period, 2002–2011. Statistics for earlier years are available in previous annual publications of the Assisted Reproductive Technology Success Rates: National Summary and Fertility Clinic Reports and the Assisted Reproductive Technology National Summary Report for more recent years.

Is the use of ART increasing?

Figure 43 shows the number of ART cycles performed, live-birth deliveries, and infants born using ART from 2002 through 2011. The number of ART cycles performed in the United States has increased 32%, from 115,392 cycles in 2002 to 151,923 in 2011. The number of live-birth deliveries in 2011 (47,818) was almost one and a half times higher than in 2002 (33,141). The number of infants born who were conceived using ART also increased from 2002 through 2011. In 2011, a total of 61,610 infants were born, as compared with the 45,751 infants born in 2002. Because more than one infant is born during a live-birth delivery in some cases (e.g., twins), the total number of infants born is greater than the number of live-birth deliveries.

Figure 43: Numbers of ART Cycles Performed, Live-Birth Deliveries, and Infants Born Using ART, 2002–2011.

Download Slide 43 [PDF - 240KB]

What are oocyte/embryo banking cycles and are they increasing?

An oocyte/embryo banking cycle is an ART cycle started with the intention of cryopreserving (freezing) all resulting oocytes/embryos for potential future use, when they may be thawed, fertilized (oocytes), and transferred. This may be performed to avoid potentially negative effects of stimulation, or when it is necessary to wait for results of genetic testing. Oocyte/Embryo banking may also be used when only a small number of oocytes/embryos develop during one cycle. In this case, women may undergo several banking cycles to improve availability of good-quality oocytes/embryos for transfer. In other situations, patients may choose to freeze oocytes or embryos because the patient or partner needs to undergo medical treatment that may be harmful for their future reproduction capabilities or to delay childbearing for other reasons. These cycles are referred to as fertility preservation cycles.

Figure 44 shows that the number of cycles performed for banking all fresh nondonor eggs or embryos increased dramatically during recent years.

Figure 44: Numbers of ART Cycles Performed for Banking All Fresh Nondonor Eggs or Embryos, 2002–2011.

Download Slide 44 [PDF - 238KB]

Is the use of ICSI increasing?

Intracytoplasmic sperm injection (ICSI) was originally developed for 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 reported diagnosis of male factor infertility.

Figure 45 shows the number of ART cycles performed using ICSI from 2002 through 2011. 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 almost 50%, from 45,611 in 2002 to 67,603 in 2011. The number of fresh donor cycles with ICSI increased more than 60%, from 4,919 to 8,013 during the same period.

Information on use of ICSI is not consistently collected across clinics for ART cycles using frozen embryos. The number of frozen cycles (with or without ICSI) doubled, from 16,383 in 2002 to 32,180 in 2011 for nondonor cycles and from 3,922 to 7,733 for donor cycles during the same period.

Figure 45: Numbers of ICSI Procedures Performed, by Type of ART Cycle, 2002–2011.

Download Slide 45 [PDF - 241KB]

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

Figure 46 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 to permit direct comparison of 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 2002–2011.

The percentage of transfers that resulted in live births for cycles using fresh donor embryos without ICSI increased from 53% in 2002 to 56% in 2011, while cycles using fresh donor embryos with ICSI increased from 48% to 55% during 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 34% in 2002 to 36% in 2011.

Note that 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, regardless of whether ICSI is used.

Figure 46: Percentages of Transfers That Resulted in Live Births, by Type of ART Cycle and ICSI, 2002–2011.

Download Slide 46 [PDF - 241KB]

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

Figure 47 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 2002 through 2011, the percentage of transfers that resulted in live births for women younger than age 35 increased from 43% in 2002 to 46% in 2011. During the same period, the percentage of transfers that resulted in live births increased from 37% to 38% for women aged 35–37 years, from 26% to 27% for women aged 38–40, and from 15% to 16% for women aged 41–42.

Figure 47: Percentages of Transfers That Resulted in Live Births for ART Cycles Using Fresh Nondonor Eggs or Embryos, by Age Group, 2002–2011.

Download Slide 47 [PDF - 242KB]

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

Singleton live births have a much lower risk than multiple-infant births for adverse infant health outcomes, including prematurity, low birth weight, disability, and death. Figure 48 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 2002 through 2011, the percentage of transfers that resulted in singleton live births for women younger than age 35 increased from 26% in 2002 to 31% in 2011. During the same period, the percentage of transfers that resulted in singleton live births increased from 24% to 28% for women aged 35–37, from 19% to 21% for women aged 38–40, and from 12% to 14% for women aged 41–42.

Figure 48: Percentages of Transfers That Resulted in Singleton Live Births for ART Cycles Using Fresh Nondonor Eggs or Embryos, by Age Group, 2002–2011.

Download Slide 48 [PDF - 242KB]

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

Figure 49 presents trends in percentages for the number of embryos transferred in fresh nondonor cycles that progressed to the embryo transfer stage. From 2002 through 2011, cycles that involved the transfer of one embryo more than doubled, from 7% to 17%; cycles that involved the transfer of two embryos increased, from 32% in 2002 to 54% in 2011. However, cycles that involved the transfer of three embryos decreased from 34% in 2002 to 20% in 2011, and cycles that involved the transfer of four or more embryos decreased dramatically from 28% in 2002 to 9% in 2011.

Figure 49: Percentages of Fresh Nondonor Cycles That Involved the Transfer of One,
Two, Three, or Four or More Embryos, 2002–2011.

Figure 49: Percentages of Fresh Nondonor Cycles That Involved the Transfer of One, Two, Three, or Four or More Embryos, 2002–2011.

Download Slide 49 [PDF - 239KB]

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

As shown in Figure 49, the number of embryos transferred in fresh nondonor cycles has decreased during the past 10 years. Figure 50 shows the change over time in the number of embryos transferred for ART cycles in which the woman was younger than age 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 younger than age 35 who chose to transfer fewer embryos than were available. In 2002, approximately 9% of ART cycles involved the transfer of four or more embryos; 35%, three embryos; 55%, two embryos; and 1%, one embryo. By 2011, four or more embryos were transferred in less than 1% of cycles, three in 5% of cycles, two in 73% of cycles, and one in 22% of cycles.

Figure 50: Percentages of Fresh Nondonor Cycles That Involved the Transfer of One, Two, Three, or Four or More Embryos Among Women Who Were Younger Than Age 35 and Set Aside Extra Embryos for Future Use, 2002–2011.

Download Slide 50 [PDF - 257KB]

Has the percentage of elective single embryo transfers changed?

Elective single embryo transfer (eSET) refers to cycles in which only one embryo is transferred, even when additional, high-quality embryos are available for transfer. It does not include cycles in which only one embryo was available. When more than one embryo is available, the use of eSET is the most effective way to avoid a multiple gestation pregnancy and to reduce the risks for adverse infant health outcomes such as prematurity and low birth weight. Figure 51 presents percentages of transfers using eSET by the age of the woman, for ART cycles using fresh nondonor eggs or embryos.

From 2002 through 2011, the percentage of transfers using eSET for women younger than age 35 increased from 1% in 2002 to 12% in 2011. During the same period, the percentage of transfers using eSET for women aged 35–37 increased from <1% in 2002 to 7% in 2011. For women aged 38–40, the percentage of transfers using eSET increased from <1% in 2002 to 2% in 2011, and, for women older than age 40, the percentage of transfers increased from <1% to 1%.

Figure 51: Percentages of Elective Single Embryo Transfer (eSET) Among all Transfers Using Fresh Nondonor Eggs or Embryos, by Age Group, 2002–2011.

Download Slide 51 [PDF - 251KB]

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

Figure 52 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 2002 through 2011. The percentage of transfers that resulted in live births increased for ART cycles that involved the transfer of one or two embryos (13% to 29% and 40% to 42%, respectively). However, during the same period, there was a decrease for ART cycles that involved the transfer of three or four or more embryos (38% to 31% and 31% to 23%, 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 52: Percentages of Transfers That Resulted in Live Births Using Fresh Nondonor Eggs or Embryos, by Number of Embryos Transferred, 2002–2011.

Download Slide 52 [PDF - 241KB]

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

Figure 53 presents percentages of transfers that resulted in multiple live births, by the number of embryos transferred for ART cycles using fresh nondonor eggs or embryos from 2002 through 2011. As shown in Figures 49 and 55, as the number of embryos transferred decreased from 2002 through 2011, the percentage of transfers that resulted in triplets or more also decreased.

The percentage of transfers that resulted in multiple live births decreased from 2002 to 2011 for ART cycles that involved the transfer of three or four or more embryos (from 14% to 9% and from 12% to 5%, respectively). During the same period, there was a minimal increase in multiple live births for ART cycles that involved the transfer of one or two embryos (the overall percentage change from 2002 to 2011 was <1% and 2%, respectively). This minimal increase may be attributable to several factors, such as the day of embryo transfer and embryo quality.

Figure 53: Percentages of Transfers That Resulted in Multiple-Infant Live Births Using Fresh Nondonor Eggs or Embryos, by Number of Embryos Transferred, 2002–2011.

Download Slide 53 [PDF - 241KB]

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

Figure 54 presents percentages of multiple-infant live births by the age of the woman, for ART cycles using fresh nondonor eggs or embryos. From 2002 through 2011, the percentage of multiple-infant live births decreased 18% (from 39% to 32%) for women younger than age 35, 20% (from 35% to 28%) for women aged 35–37, 17% (from 27% to 22%) for women aged 38–40, and 15% (from 19% to 16%) for women aged 41–42. Overall, the percentage of multiple-infant live births among women older than age 44 decreased 57% (from 13% to 6%) from 2007 through 2011. Please note that percentages of multiple-infant live births were rounded to the nearest whole number, while percentage changes were calculated with raw data. Additionally, when interpreting data for women older than age 44, percentages may not be meaningful due to small numbers.

Figure 54: Percentages of ART Cycles That Resulted in Multiple-Infant Live Births Using Fresh Nondonor Eggs or Embryos, by Age Group, 2002–2011.

Download Slide 54 [PDF - 243KB]

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

Figure 55 presents 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 slightly during the past 10 years. From 2002 through 2011, the percentage of singleton live births increased from 65% to 71%; the percentage of twin births declined from 32% to 27%; and the percentage of triplet or higher order births decreased considerably from 4% in 2002 to 1% in 2011.

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 55: Percentages of Transfers That Resulted in Live Births and Percentages of Multiple-Infant Live Births for ART Cycles Using Fresh Nondonor Eggs or Embryos, 2002–2011.

Download Slide 55 [PDF - 274KB]

 

 

ART 2011 National Summary Presentation.
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