This page contains figures  25–32
Section 2A | Section 2B | Section 2C

What were the specific types of ART performed among women who used fresh nondonor eggs or embryos in 2001?

For just under half (49%) of ART procedures that used fresh nondonor eggs or embryos in 2001, 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 another 49% 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 25: Types of ART Procedures Using Fresh Nondonor Eggs or Embryos, 2001.

What are the success rates for different types of ART procedures?

Figure 26 shows the percentage of egg retrievals that resulted in a live birth for each type of ART procedure started in 2001. Although the rate appears to be slightly higher for cycles that used a combination of IVF and either GIFT or ZIFT, this rate was based on a small number of cycles (only 0.1% of the total number of fresh–nondonor cycles used a combination of procedures) and should be interpreted with caution. Success rates for the two predominant types of ART, IVF without ICSI and IVF with ICSI, were similar. The success rate for GIFT procedures was much lower. This finding was observed in all age groups and thus is not explained by the differential use of GIFT among older women. However, there may be other differences in patients who use GIFT that are not measured in this registry. See Figures 27–29 for further details on IVF procedures that used ICSI.

Figure 26: Live Births per Retrieval for Different Types of ART Procedures Using Fresh Nondonor Eggs or Embryos, 2001.

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 2001, 39,973 ICSI cycles were performed. Although the majority of couples using ICSI had a diagnosis of male factor infertility, a sizable portion of ICSI cycles (42%) were performed for couples without a diagnosis of male factor infertility.

Figure 27: Use of ICSI in Fresh–Nondonor Cycles Among Couples With and Without Diagnoses of Male Factor Infertility, 2001.

What are the success rates for couples with male factor infertility when ICSI is used?

ICSI was developed to overcome problems with fertilization that sometimes occur in couples diagnosed with male factor infertility. In 2001, about 78% of couples diagnosed with male factor infertility used IVF with ICSI. Figure 28 presents the success rates for these ICSI procedures among couples diagnosed with male factor infertility. For comparison, these rates are presented alongside the success rates for ART cycles that used standard IVF without ICSI. This standard IVF comparison group includes couples with all diagnoses except male factor. Because ICSI can be performed only when at least one egg has been retrieved, the live birth per retrieval rates are presented.

In every age group, success rates for the IVF with ICSI group were similar to the success rates for the groups that used standard IVF without ICSI. These results show that when ICSI was used for couples diagnosed with male factor infertility, their success rates were close to those achieved by couples who were not diagnosed with male factor infertility.

Figure 28: Live Births per Retrieval for ART Cycles Using Fresh Nondonor Eggs or Embryos Among Couples Diagnosed with Male Factor Infertility Who Used IVF with ICSI in Comparison to IVF Without ICSI, by Woman’s Age, 2001.

What are the success rates for couples without a diagnosis of male factor infertility when ICSI is used?

As shown in Figure 27, a large number of ICSI procedures are now performed even when couples are not diagnosed with male factor infertility. Figure 29 presents success rates per retrieval for those cycles compared with ART cycles among couples who used IVF without ICSI. For every age group, the ICSI procedures were less successful. Information was not available to completely determine whether this finding was directly related to the ICSI procedure or whether the patients who used ICSI were somehow different from those who used IVF alone. However, separate evaluation of various groups of patients with an indication of being difficult to treat revealed a pattern of results consistent with those presented below. These difficult-to-treat groups included couples with previous failed ART cycles, couples diagnosed with diminished ovarian reserve, and couples diagnosed with a low number of eggs retrieved (fewer than five). Within each of these groups, ART cycles that used IVF with ICSI had lower success rates compared with cycles that used IVF without ICSI.

Figure 29: Live Births per Retrieval for ART Cycles Using Fresh Nondonor Eggs or Embryos Among Couples Not Diagnosed with Male Factor Infertility, by Use of ICSI and Woman’s Age, 2001.

What are the success rates for women who use gestational carriers?

In some cases a woman has trouble carrying a pregnancy. In such cases the couple may use ART with a gestational carrier, sometimes called a surrogate. A gestational carrier is a woman who agrees to carry the developing embryo for a couple with infertility problems (the intended parents). Gestational carriers were used in 0.7% of ART cycles using fresh nondonor embryos in 2001 (571 cycles). Figure 30 compares success rates per transfer for ART procedures that used a gestational carrier in 2001 with cycles that did not. In all age groups, success rates for ART cycles that used gestational carriers were higher than success rates for those cycles that did not. However, the age of the ART patient (source of the egg) was a strong predictor of success regardless of whether a gestational carrier was used.

Figure 30: Comparison of Live Births per Transfer Between Cycles That Used Gestational Carriers and Those That Did Not (Both Using Fresh Nondonor Embryos), by ART Patient’s Age, 2001.

Are success rates affected by the day of embryo transfer?

Once an ART cycle has progressed from egg retrieval to successful fertilization, the embryo(s) can be transferred into the woman’s uterus anytime from 1 to 6 days after the eggs were retrieved. Figure 31 shows live birth rates per transfer for cycles that used fresh nondonor embryos by the day embryo transfer occurred. In 2001, about 76% of embryo transfers occurred on day three. Using advanced laboratory techniques, embryo growth in the laboratory can be extended beyond day three, most commonly to day five. Among those ART cycles that progressed to the embryo transfer stage, the success rate was higher for embryos that had been cultured for 5 days than for those cultured for only 3 days. This pattern of results was seen for all age groups. However, it should be noted that embryo culture for 5 days may not be the best treatment option for all patients undergoing ART, because there is a risk that some embryos may not survive to day five.

Figure 31: Live Births per Transfer for ART Cycles Using Fresh Nondonor Eggs or Embryos, by Day of Embryo Transfer, 2001.

Does the size of the clinic affect its success rate?

The number of ART procedures carried out every year varies among fertility clinics in the United States. In 2001, success rates tended to be slightly higher among clinics that performed more cycles. For Figure 32, clinics were divided equally into four groups (called quartiles) based on the size of the clinic as determined by the number of cycles it carried out. The percentage for each quartile represents the average success rate for clinics in that quartile. For the exact number of cycles and success rates at an individual clinic, refer to the clinic table section of this report.

Figure 32: Live Birth Rates for ART Cycles Using Fresh Nondonor Eggs or Embryos, by Clinic Size, 2001.

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