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2004 Assisted Reproductive Technology (ART) Report: Section 2—ART
Cycles Using Fresh, Nondonor Eggs or Embryos |
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This
page contains figures 16–26
Section
2A | Section
2B | Section 2C
What
are the causes of infertility among couples who use ART?
Figure 16 shows the infertility
diagnoses reported among couples who had an ART procedure using fresh
nondonor eggs or embryos in 2004. 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 also vary.
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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 16: Diagnoses Among
Couples Who Had ART Cycles Using Fresh Nondonor Eggs or Embryos, 2004.
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Does the cause of infertility affect the
chances of success using ART?
Figure 17 shows the percentage of
live births per ART cycle according to the causes of infertility. (See
Figure 16 or the Glossary in
Appendix B for an explanation of the
diagnoses.) Although the national average success rate was about 28%
(see Figure 7), 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. Please
note, however, that review of select clinical records revealed that
reporting of infertility causes may be incomplete. Therefore,
differences in success rates by causes of infertility should be
interpreted with caution. (See
Findings from Validation Visits for 2004 ART Data for additional
information.)
Figure 17: Live
Birth Rates Among Women Who Had ART Cycles Using Fresh Nondonor Eggs or
Embryos, by Diagnosis, 2004. |
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How
many women who use ART have previously given birth?
Figure 18 shows the number of
previous births among women who had an ART procedure
using fresh nondonor eggs or embryos in 2004. Most of these women (about
72%) had no
previous births, although they may have had a pregnancy that resulted in
a miscarriage or an
induced abortion. About 21% of women using ART in 2004 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 18: Number
of Previous Births Among Women Who Had ART Cycles Using Fresh Nondonor
Eggs or Embryos, 2004. |
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Do
women who have previously given birth have higher ART success rates?
Figure 19 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 19: Live
Birth Rates for ART Cycles Using Fresh Nondonor Eggs or Embryos, by
Woman’s Age and Number of Previous Live Births, 2004. |
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Is there a
difference in ART success rates between women with previous miscarriages
and women who have never been pregnant?
In 2004, 67,983 ART cycles were performed among women who
had not previously given birth. 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 20 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 20: 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,
2004.
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How
many current ART users have undergone previous ART cycles?
Figure 21 presents
ART cycles that used fresh nondonor eggs or embryos in 2004 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 21: Number
of Previous ART Cycles Among Women Undergoing ART in 2004 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 22 shows the relationship
between the success of ART cycles performed in 2004 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 22: 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, 2004. |
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What
are the success rates for women who have had both previous ART and
previous births?
Figure 23 shows the
relationship between the success of ART cycles performed in 2004 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, success rates were comparable if they
had undergone previous ART cycles.
Taken together, Figures
22 and 23 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 23: 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, 2004.
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What were the specific types of ART
performed among women who used fresh nondonor eggs or embryos in 2004?
For about 42% of ART procedures that used fresh nondonor
eggs or embryos in 2004, 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 (58%) 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.
Figure 24: Types of
ART Procedures Using Fresh Nondonor Eggs or Embryos, 2004.
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What are the success rates for
different types of ART procedures?
Figure 25 shows the percentage of egg
retrievals that resulted in a live birth for each type of ART procedure
started in 2004. Success rates for the two predominant types of ART, IVF
without ICSI and IVF with ICSI, were similar. The success rates for
cycles that used GIFT were much lower than for cycles that used other
ART procedures. See Figures 26–28 for further details on IVF procedures
that used ICSI.
Figure 25: Live Births per Retrieval
for Different Types of ART Procedures Using Fresh Nondonor Eggs or
Embryos, 2004.
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Is ICSI used only for couples diagnosed with male factor
infertility?
ICSI was developed to overcome problems with fertilization
that sometimes occur in couples diagnosed with male factor infertility.
In 2004, 54,203 ICSI cycles were performed. Although the majority of
couples using ICSI had a diagnosis of male factor infertility, a sizable
portion of ICSI cycles (about 49%) were performed for couples
without a diagnosis of male factor infertility. However, please note
that diagnostic procedures may vary from one clinic to another, so the categorization of causes of infertility may also vary.
Figure 26: Use of ICSI in Fresh–Nondonor
Cycles Among Couples with and Without Diagnoses of Male Factor
Infertility, 2004.
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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:
01/14/2007
Content source: Division
of Reproductive Health,
National Center for Chronic Disease
Prevention and Health Promotion
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