Figure 14 shows the infertility diagnoses reported among couples who had an ART procedure using fresh nondonor eggs or embryos in 2003. Diagnoses range from one infertility factor in one partner to multiple factors in either one or both partners. However, diagnostic procedures may vary from one clinic to another, so the categorization may be inexact.

• Tubal factor means that the woman’s fallopian tubes are blocked or damaged, making it difficult for the egg to be fertilized or for an embryo to travel to the uterus.
• Ovulatory dysfunction means that the ovaries are not producing eggs normally. Such dysfunctions include polycystic ovary syndrome and multiple ovarian cysts.
• Diminished ovarian reserve means that the ability of the ovary to produce eggs is reduced. Reasons include congenital, medical, or surgical causes or advanced age.
• Endometriosis involves the presence of tissue similar to the uterine lining in abnormal locations. This condition can affect both fertilization of the egg and embryo implantation.
• Uterine factor means a structural or functional disorder of the uterus that results in reduced fertility.
• Male factor refers to a low sperm count or problems with sperm function that make it difficult for a sperm to fertilize an egg under normal conditions.
• Other causes of infertility include immunological problems, chromosomal abnormalities, cancer chemotherapy, and serious illnesses.
• Unexplained cause means that no cause of infertility was found in either the woman or the man.
• Multiple factors, female only, means that more than one female cause was diagnosed.
• Multiple factors, female and male, means that one or more female causes and male factor infertility were diagnosed.

Figure 14: Diagnoses Among Couples Who Had ART Cycles Using Fresh Nondonor Eggs or Embryos, 2003.

Does the cause of infertility affect the chances of success using ART?

Figure 15 shows the percentage of live births after an ART procedure according to the causes of infertility. (See Figure 14 or the Glossary in Appendix B for an explanation of the diagnoses.) Although the national average success rate was slightly more than 28% (see Figure 5), success rates varied somewhat depending on diagnosis; however, the definitions of these diagnoses may vary from clinic to clinic. In general, couples diagnosed with tubal factor, ovulatory dysfunction, endometriosis, male factor, or unexplained infertility had above-average success rates. The lowest success rate was observed for those with diminished ovarian reserve. Additionally, couples with uterine factor, “other” causes, or multiple infertility factors had below-average success rates.

Figure 15: Live Birth Rates Among Women Who Had ART Cycles Using Fresh Nondonor Eggs or Embryos, by Diagnosis, 2003.

How many women who use ART have previously given birth?

Figure 16 shows the number of previous births among women who had an ART procedure using fresh nondonor eggs or embryos in 2003. Most of these women (about 73%) had no previous births, although they may have had a pregnancy that resulted in a miscarriage or an induced abortion. About 20% of women using ART in 2003 reported one previous birth, and 7% reported two or more previous births. However, we do not have information about how many of these were ART births and how many were not. These data nonetheless point out that women who have previously had children can still face infertility problems.

Figure 16: Number of Previous Births Among Women Who Had ART Cycles Using Fresh Nondonor Eggs or Embryos, 2003.

Figure 17 shows the relationship between the success of an ART cycle and the history of
previous births. Previous live-born infants were conceived naturally in some cases and through ART in others. In all age groups up to age 42, women who had a previous live birth were more likely to have a successful ART procedure.

Figure 17: Live Birth Rates for ART Cycles Using Fresh Nondonor Eggs or Embryos, by Woman's Age and Number of Previous Live Births, 2003.

In 2003, 66,343 ART cycles were performed among women who had not previously given birth (see Figure 16). However, about 27% of those cycles were reported by women with one or more previous pregnancies that had ended in miscarriage. We do not have information on whether the previous pregnancies were the result of ART or were conceived naturally. Figure 18 shows the relationship between the success of an ART cycle and the history of previous miscarriage. In all age groups women who had a previous miscarriage had live birth rates that were comparable to the live birth rates among women who had never been pregnant. Thus, a history of unsuccessful pregnancy does not appear to be associated with reduced chances for success during ART.

Figure 19 presents ART cycles that used fresh nondonor eggs or embryos in 2003 according to whether previous ART cycles had been performed. For about 44%, one or more previous cycles were reported. (This percentage includes previous cycles using either fresh or frozen embryos.) This finding illustrates that it is not uncommon for a couple to undergo multiple ART cycles. We do not have information on when previous cycles were performed, nor do we have information on the outcomes of those previous cycles.

Figure 19: Number of Previous ART Cycles Among Women Undergoing ART in 2003 with Fresh Nondonor Eggs or Embryos.

Figure 20 shows the relationship between the success of ART cycles performed in 2003 using fresh nondonor eggs or embryos and a history of previous ART cycles among women with no previous births. In most age groups, success rates were lower for women who had previously undergone an unsuccessful ART cycle.

Figure 20: Live Birth Rates for ART Cycles Using Fresh Nondonor Eggs or Embryos, by Woman's Age and History of Previous ART Cycles, Among Women with No Previous Births, 2003.

For about 44% of ART procedures that used fresh nondonor eggs or embryos in 2003, 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 more than half (56%) of ART procedures, 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 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). 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.