The state of ART

Key Points

Since 1978, hundreds of thousands of babies have successfully been born in the United States because of assisted reproductive technologies (ART), most commonly in vitro fertilization (IVF).¹ Although initially modest, pregnancy rates using IVF now exceed the natural fecundity of couples for women younger than 35 years of age.² Despite lingering studies that suggest a possible association with birth defects,³ IVF remains the most effective method of treating infertility.

This article will look at the state of ART as summarized in the latest report provided by the Centers for Disease Control and Prevention (CDC) as part of the Fertility Clinic Success Rate and Certification Act of 1992 that requires the Department of Health and Human Services, through the CDC, to develop a model program for the certification of embryo laboratories, which is carried out voluntarily by interested states.¹ The Society of Assisted Reproductive Technology (SART) assists IVF clinics in data collection to report to the CDC and to comply with the 1992 act; alternately, clinics may report directly to the CDC. Because the CDC performs an extensive and time-consuming verification process and includes in its analysis fertility clinics that had not reported to SART, the CDC results are delayed in being released to the public. More current SART statistics can be found online ( http://www.sart.org/find_frm.html).

Success rates by age

Some cycles do not proceed to a fresh embryo transfer, in contrast to frozen, because of rare problems such as ovarian hyperstimulation syndrome, fluid noted in the uterine cavity, or failed fertilization of eggs. Consequently, the LB/ET rate is usually slightly higher than the LB/egg-retrieval rate. A prior live birth conceived naturally or by ART modestly increases the success rate with IVF. A prior unsuccessful IVF cycle slightly decreases the success rate in the subsequent cycle. A history of miscarriage has no significant influence on IVF outcome.

Although there is no age precluding the chance of success, egg donation offers a dramatically higher live birth rate in women 40 years of age and older. Chromosomally abnormal embryos that result from DOR may cause a steep rise in the rate of miscarriages for women in their late 30s, approaching 50% for women in their 40s.