Department of Health and Human Services
Centers for Disease Control and Prevention
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About the U.S. ART Clinic Reporting SystemBackground Information, Data Collection Methods, Content and Design of the Report, and Additional Information About ART in the United States 1. How many people in the United States have infertility problems? 2. What is assisted reproductive technology (ART)? 4. How do U.S. ART clinics report data to CDC about their success rates? 5. Why is the report of 2005 success rates being published in 2007? 6. Which clinics are represented in this report? 7. Why doesn’t CDC rank the clinics? 8. Does this report include all ART cycles performed by the reporting clinics? 9. How are the success rates determined? 10. What are my chances of getting pregnant using ART? 12.What factors that influence success rates are presented in this report? 13. What quality control steps are used to ensure data accuracy? 14. Why doesn’t the report contain specific medical information about ART? 16. Are there any medical guidelines for ART performed in the United States? 17. What is CDC doing to ensure that the report is helpful to the public? 18. Where can I get additional information on U.S. fertility clinics? 19. What’s new in the 2005 report?
The latest data on infertility available to the Centers for Disease Control and Prevention (CDC) are from the 2002 National Survey of Family Growth.
Although various definitions have been used for ART, the definition used in this report is based on the 1992 law that requires CDC to publish this report. According to this definition, ART includes all fertility treatments in which both eggs and sperm are handled. In general, ART procedures involve surgically removing eggs from a woman’s ovaries, combining them with sperm in the laboratory, and returning them to the woman’s body or donating them to another woman. They do NOT include treatments in which only sperm are handled (i.e., intrauterine—or artificial—insemination) or procedures in which a woman takes drugs only to stimulate egg production without the intention of having eggs retrieved. The types of ART include the following:
In addition, ART often is categorized according to whether the procedure used a woman’s own eggs (nondonor) or eggs from another woman (donor) and according to whether the embryos used were newly fertilized (fresh) or previously fertilized, frozen, and then thawed (frozen). Because an ART procedure includes several steps, it is typically referred to as a cycle of treatment. (What is an ART cycle?) Because ART consists of several steps over an interval of approximately 2 weeks, an ART procedure is more appropriately considered a cycle of treatment rather than a procedure at a single point in time. The start of an ART cycle is considered to be when a woman begins taking drugs to stimulate egg production or starts ovarian monitoring with the intent of having embryos transferred. (See Figure 5, for a full description of the steps in an ART cycle.) For the purposes of this report, data on all cycles that were started, even those that were discontinued before all steps were undertaken, are submitted to CDC through a Web-based data collection system called the National ART Surveillance System (NASS) and are counted in the clinic’s success rates. 
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CDC contracts with a statistical survey research organization, Westat, to obtain the data published in the ART success rates report. Westat maintains a list of all ART clinics known to be in operation and tracks clinic reorganizations and closings. This list includes clinics and individual providers that are members of the Society for Assisted Reproductive Technology (SART) as well as clinics and providers that are not SART members. Westat actively follows up reports of ART physicians or clinics not on its list to update the list as needed. Westat maintains NASS, the Web-based data collection system that all ART clinics use. Clinics either electronically enter or import data into NASS for each ART procedure they start in a given reporting year. The data collected include information on the client’s medical history (such as infertility diagnoses), clinical information pertaining to the ART procedure, and information on resulting pregnancies and births. See below (Why is the report of 2005 success rates being published in 2007?) for a complete description of the reporting process.
Before success rates based on live births can be calculated, every ART pregnancy must be followed up to determine whether a birth occurred. Therefore, the earliest that clinics can report complete annual data is late in the year after ART treatment was initiated (about 9 months past year-end, when all the births have occurred). Accordingly, the results of all the cycles initiated in 2005 were not known until October 2006. After ART outcomes are known, the following occurs before the report is published:
These steps are time-consuming but essential for ensuring that the report provides the public with correct information particularly regarding each clinic’s success rates.
The data in both the national report and the individual fertility clinic tables come from 422 fertility clinics that provided and verified information about the outcomes of the ART cycles started in their clinics in 2005. Although we believe that almost all clinics that provided ART services in the United States throughout 2005 are represented in this report, data for a few clinics or practitioners are not included because they either were not in operation throughout 2005 or did not report as required. Clinics and practitioners known to have been in operation throughout 2005 that did not report and verify their data are listed in this report as nonreporters, as required by law (see Appendix C, Nonreporting ART Clinics for 2005, by State,). We will continue to make every effort to include in future reports all clinics and practitioners providing ART services.
Because the decision to undergo ART treatment is a very personal decision, this report may not contain all of the information that a woman or a couple needs to decide which ART clinic or procedure is best for their treatment. Many factors contribute to the success rate of an ART procedure in particular patients, and a difference in success rates between two ART programs may reflect differences in the groups of patients treated, the types of procedures used, or other factors. More explanations on how to use the success rates and other statistics published in this report are in the Introduction to Fertility Clinic Tables. The report should be used to help people considering an ART procedure find clinics where they can meet personally with ART providers to discuss their specific medical situation and their likelihood of success using ART. Contacting a clinic also may provide additional information that could be helpful in deciding whether or not to use ART. Because ART offers several treatment options for infertility, there are many other factors that may affect the decision. Going through repeated ART cycles requires substantial commitments of time, effort, money, and emotional energy. Therefore, this report may be a helpful starting point for consumers to obtain information and consider their options.
This report includes data for the 134,260 cycles performed in 2005 by the 422 clinics that reported their data as required. A small number of ART cycles are not included in either the national data or the individual fertility clinic tables. These were cycles in which a new treatment procedure was being evaluated. Only 358 ART cycles fell into this category in 2005.
Three measures of success are presented in this report: (1) pregnancy, (2) birth of one or more living infants (the delivery of multiple infants is counted as one live birth), and (3 ) birth of a singleton live-born infant. The pregnancies reported here were diagnosed using an ultrasound procedure. All live-birth deliveries were reported to the ART physician by either the patient or her obstetric provider. Because this report is geared toward patients, the focus is on the percentage of cycles resulting in live births. Singleton live births are presented as a separate 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. Pregnancies, live births, and singleton live births were calculated based on all cycles started. As noted throughout the report, success rates were additionally calculated at various steps of the ART cycle to provide a complete picture of the chances for success as the cycle progresses.
This report presents several measures of success for ART (see Figure 7), including the proportion of ART cycles that result in a pregnancy. Many women ask this question because they assume that the pregnancy will lead to a live birth. Unfortunately, not all ART procedures that result in a pregnancy lead to the delivery of a live infant. For example, in 2005, 97,442 fresh–nondonor ART cycles were started. Of those, 33,101 (34%) led to a pregnancy, but only 27,047 (28%) resulted in a live birth. In other words, 18% of ART pregnancies did not result in a live birth. The percentage of cycles resulting in live births will give a more accurate answer to the question, “If I have an ART procedure, what is my chance that I will have a baby?” It is important to note that multiple-infant pregnancies and multiple-infant births are common with ART (see Figure 10). Multiple-infant births are associated with greater risk for adverse health outcomes for both the mother and the infants (see Figures 11 and 12 on preterm deliveries and low birth weight). This report also includes singleton live births as a measure of success because they have a lower risk of adverse health outcomes.
As required by law, this report presents ART success rates in terms of how many cycles were started each year, rather than in terms of how many women were treated. (A cycle starts when a woman begins taking fertility drugs or having her ovaries monitored for follicle production.) Clinics do not report to CDC the number of women treated at each facility. Because clinics report information only on outcomes for each cycle started, it is not possible to compute the success rates on a “per woman” basis, or the number of cycles that an average woman may undergo before achieving success.
The national report presents a more in-depth picture of ART than can be shown for each individual clinic. Success rates are presented in the context of various patient and treatment characteristics that may influence success. These characteristics include age, infertility diagnosis, history of previous births, previous miscarriages, previous ART cycles, number of embryos transferred, type of ART procedure, use of techniques such as ICSI, and clinic size.
To have their success rates published in this annual report, clinics have to submit their data in time for analysis and the clinics’ medical directors have to verify by signature that the tabulated success rates are accurate. Then, Westat conducts an in-house review and contacts the clinics if corrections are necessary. After the data have been verified, a quality control process called validation begins. This year, 30 of 422 reporting clinics were randomly selected for site visits. Two members of the Westat Validation Team visited these clinics and reviewed medical record data for a sample of the clinic’s ART cycles. For each cycle, the validation team abstracted information from the patient’s medical record. The abstracted information was then reviewed on site at Westat and compared with the data submitted for the report. CDC staff members participated as observers in some of the visits. For each clinic, the sample of cycles validated included all cycles that were reported to have ended in a live birth and a random sample of up to 50 additional cycles. In almost all cases, data on pregnancies and births in the medical records were consistent with reported data. Validation primarily helps ensure that clinics are being careful to submit accurate data. It also serves to identify any systematic problems that could cause data collection to be inconsistent or incomplete. The data validation process does not include any assessment of clinical practice or overall record keeping. See Appendix A, Technical Notes, for a more detailed presentation of findings from the validation visits.
This report describes a woman’s average chances of success using ART. Although the report provides some information about factors such as age and infertility diagnosis, individual couples face many unique medical situations. This population-based registry of ART procedures cannot capture detailed information about specific medical conditions associated with infertility. A physician in clinical practice should be consulted for the individual evaluation that will help a woman or couple understand their specific medical situation and their chances of success using ART.
The American Society for Reproductive
Medicine (ASRM)* and SART* issue
guidelines dealing with specific ART practice issues, such as the number
of embryos to be transferred in an ART procedure. Further information
can be obtained from ASRM* or
SART* (both at telephone
We continually review comments from patients and providers about things to
consider including in future reports. In early 2007, we asked ART
clinic staff about their experiences using the report. They suggested
specific ways to improve the report and specific analyses that might be
beneficial. We also conducted in-depth interviews with patients who have
used the report in the past and with patients who were currently seeking
ART services. The information will be used to improve the 2006 ART
Success Rates report that will be published in 2008.
For further information on specific clinics, contact the clinic directly. In addition, SART* can provide general information on its member clinics (telephone 205-978-5000, extension 109).
Implementation of the Fertility Clinic Success Rate and Certification Act of 1992 Assisted Reproductive Technology: Embryo Laboratory Page last reviewed: 12/12/07Page last modified: 12/12/07 Content source: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion |
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