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2001 Assisted Reproductive Technology (ART) Report: Section 2, ART
Cycles Using Fresh, Nondonor Eggs or Embryos |
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This page contains
figures 14–24
Section 2A | Section
2B | Section 2C
What
are the causes of infertility among couples who use ART?
Figure 14 shows the infertility
diagnoses reported among couples who had an ART procedure using fresh
nondonor eggs or embryos in 2001. 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.
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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.
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Ovulatory dysfunction means that the ovaries are not producing eggs
normally. Such dysfunctions include polycystic ovary syndrome and multiple
ovarian cysts.
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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.
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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.
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Uterine
factor means a structural or functional disorder of the uterus that
results in reduced fertility.
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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.
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Other
causes of infertility include immunological problems, chromosomal
abnormalities, cancer chemotherapy, and serious illnesses.
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Unexplained cause means that no cause of infertility was found in
either the woman or the man.
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Multiple
factors, female only, means that more than one female cause was
diagnosed.
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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, 2001.](sectionimage/figure14.jpg)
Figure
14:
Diagnoses Among Couples Who Had ART Cycles Using Fresh Nondonor Eggs or Embryos,
2001.
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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 27%,
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, 2001. |
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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 2001. Most of these women (about
74%) had no previous births, although they may have had a pregnancy that
resulted in a miscarriage or an induced abortion. About 19% of women using
ART in 2001 reported one previous birth, and about 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, including the infertility of a new partner.
![Figure 16: Number of Previous Births Among Women Who Had ART Cycles Using Fresh, Nondonor Eggs or Embryos, 2001.](sectionimage/figure16.jpg)
Figure
16: Number of Previous Births Among Women Who Had ART Cycles Using
Fresh Nondonor Eggs or Embryos, 2001. |
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Do
women who have previously given birth have higher ART success rates?
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, 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, 2001.](sectionimage/figure17.jpg)
Figure
17: Live
Birth Rates for ART Cycles Using Fresh Nondonor Eggs or Embryos, by
Woman’s Age and Number of Previous Live Births, 2001. |
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Is there a
difference in ART success rates between women with previous miscarriages
and women who have never been pregnant?
Slightly
more than 59,650 ART cycles were performed among women who had not
previously given birth (see Figure
16). However, about 26% 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
18:
Live Birth Rates for ART Cycles Using Fresh Nondonor Eggs or Embryos, by
Woman’s Age and History of Miscarriage, Among Women With No Previous
Births, 2001. |
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How
many current ART users have undergone previous ART cycles?
Figure 19 presents ART cycles
that used fresh nondonor eggs or embryos in 2001 according to whether
previous ART cycles had been performed. For about 47%, 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 2001 with Fresh Nondonor Eggs or Embryos.](sectionimage/figure19.jpg)
Figure
19: Number of Previous ART Cycles Among Women Undergoing ART in 2001
with Fresh Nondonor Eggs or Embryos. |
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Are
success rates different for women using ART for the first time and women
who previously used ART but did not give birth?
Figure 20 shows the
relationship between the success of ART cycles performed in 2001 using
fresh nondonor eggs or embryos and a history of previous ART cycles among
women with no previous births. In all 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, 2001. |
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What
are the success rates for women who have had both previous ART and
previous births?
Figure 21 shows the
relationship between the success of ART cycles performed in 2001 using
fresh nondonor eggs or embryos and a history of both previous ART cycles
and previous births. We do not have information on whether the previous
births were the result of ART or were conceived naturally. However, among
women with previous births, there was no decline in success rates if they
had undergone previous ART cycles.
Taken
together, Figures 20 and
21 show that having undergone
previous ART cycles may be related to the success of the current ART
cycle. However, it is important to consider the outcomes of previous
cycles and whether the woman has given birth in the past.
![Figure 21: 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 One or More Previous Births, 2001.](sectionimage/figure21.jpg)
Figure
21: 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 One or More Previous Births, 2001.
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How
many embryos are transferred in an ART procedure?
Figure 22 shows that
approximately 66% of ART cycles that used fresh nondonor eggs or
embryos and progressed to the embryo transfer stage in 2001 involved the
transfer of three or more embryos, about 32% of cycles involved the
transfer of four or more, and 11% of cycles involved the transfer of five
or more embryos.
![Figure 22: Number of Embryos Transferred During ART Cycles Using Fresh Nondonor Eggs or Embryos, 2001.](sectionimage/figure22.jpg)
Figure
22: Number of Embryos Transferred During ART Cycles Using Fresh Nondonor Eggs or Embryos, 2001.
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In
general, is an ART cycle more likely to be successful if more embryos are
transferred?
Figure 23 shows the
relationship between the number of embryos transferred during an ART
procedure in 2001 and the number of infants born alive as a result of that
procedure. The success rate increased when two or more embryos were
transferred; however, transferring multiple embryos also poses a risk of
having a multiple-infant birth. Multiple-infant births cause concern
because of the additional health risks they create for both mothers and
infants. Also, pregnancies with multiple fetuses can be associated with
the possibility of multifetal reduction.
The
relationships between number of embryos transferred, success rates, and
multiple-infant births are complicated by several factors, such as age and
embryo quality. See Figure 24
for more details on women most at risk for multiple births.
![Figure 23: Live Births per Transfer and Percentages of Multiple-Infant Births for ART Cycles Using Fresh Nondonor Eggs or Embryos, by Number of Embryos Transferred, 2001.](sectionimage/figure23.jpg)
Figure
23: Live Births per Transfer and Percentages of Multiple-Infant Births
for ART Cycles Using Fresh Nondonor Eggs or Embryos, by Number of Embryos
Transferred, 2001. |
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Are
live birth rates affected by the number of embryos transferred for women
who have more embryos available than they choose to transfer?
Although,
in general, transferring more than one embryo tends to improve the chance
for a successful ART procedure (see
Figure 23), other factors are also important. Previous research
suggests that the number of embryos fertilized and thus available for ART
is just as, if not more, important in predicting success as the number of
embryos transferred. Additionally, younger women tend to have both higher
success rates and higher multiple-infant birth rates.
Figure 24 shows the
relationship between the number of embryos transferred, success rates, and
multiple-infant births for a subset of ART procedures in which the woman
was younger than 35 and the couple chose to set aside some embryos for
future cycles rather than transfer all available embryos at one time.
For this
group, the chance for a live birth using ART was about 52% when only two
embryos were transferred. Although the total live birth rate increased
when two embryos were transferred, if one measures success as the
singleton live birth rate there was essentially no difference between one-
and two-embryo transfers. However, the singleton live birth rate was lower
when three or more embryos were transferred.
The
proportion of live births that were multiple-infant births was about 41%
with two embryos and 47% with three embryos. Transferring three or more
embryos also created an additional risk for higher-order multiple births
(i.e., triplets or more).
Figure
24: Live Births per Transfer and Percentages of Multiple-Infant Births
for ART Cycles in Women Who Were Younger Than 35, Used Fresh Nondonor
Eggs or Embryos, and Set Aside Extra Embryos for Future Use, by Number of
Embryos Transferred, 2001. |
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Section
1 | Section 2 |
Section
3 | Section 4 |
Section
5
Previous ART Reports
Implementation of the Fertility
Clinic Success Rate and Certification Act of 1992
Assisted Reproductive Technology: Embryo
Laboratory
Date last reviewed:
03/27/2006
Content source: Division
of Reproductive Health,
National Center for Chronic Disease
Prevention and Health Promotion
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