Effect of Embryo Banking on U.S. National Assisted Reproductive Technology Live Birth Rates.

Vitaly A Kushnir,Sarah K Darmon,David H Barad,Norbert Gleicher,David F Albertini,Yang Yu

doi:10.1371/journal.pone.0154620

Abstract

BackgroundAssisted Reproductive Technology (ART) reports generated by the Centers for Disease Control and Prevention (CDC) exclude embryo banking cycles from outcome calculations.MethodsWe examined data reported to the CDC in 2013 for the impact of embryo banking exclusion on national ART outcomes by recalculating autologous oocyte ART live birth rates. Inflation of reported fresh ART cycle live birth rates was assessed for all age groups of infertile women as the difference between fresh cycle live births with reference to number of initiated fresh cycles (excluding embryo banking cycles), as typically reported by the CDC, and fresh cycle live births with reference to total initiated fresh ART cycles (including embryo banking cycles).ResultsDuring 2013, out of 121,351 fresh non-donor ART cycles 27,564 (22.7%) involved embryo banking. The proportion of banking cycles increased with female age from 15.5% in women <35 years to 56.5% in women >44 years. Concomitantly, the proportion of thawed cycles decreased with advancing female age (P <0.0001). Exclusion of embryo banking cycles led to inflation of live birth rates in fresh ART cycles, increasing in size in parallel to advancing female age and utilization of embryo banking, reaching 56.3% in women age >44. The inflation of live birth rates in thawed cycles could not be calculated from the publically available CDC data but appears to be even greater.ConclusionsUtilization of embryo banking increased during 2013 with advancing female age, suggesting a potential age selection bias. Exclusion of embryo banking cycles from national ART outcome reports significantly inflated national ART success rates, especially among older women.PrécisExclusion of embryo banking cycles from US National Assisted Reproductive Technology outcome reports significantly inflates reported success rates especially in older women.

Highlights

The US National Assisted Reproductive Technology (ART) Surveillance System (NASS), under the Fertility Clinic Success Rate and Certification Act (FCSRCA) administered by the Centers for Disease Control and Prevention (CDC), was intended to give the public access to transparent and understandable ART pregnancy success rates in reference to number of ovarian stimulation procedures attempted. [1,2] Since this legislation was passed, ART in the U.S has undergone considerable changes
Exclusion of embryo banking cycles led to inflation of live birth rates in fresh ART cycles, increasing in size in parallel to advancing female age and utilization of embryo banking, reaching 56.3% in women age >44
Embryo banking cycles were more frequently performed with advancing female age, increasing from 15.5% in women 44 years old (Fig 1)

Summary

Introduction

The US National Assisted Reproductive Technology (ART) Surveillance System (NASS), under the Fertility Clinic Success Rate and Certification Act (FCSRCA) administered by the Centers for Disease Control and Prevention (CDC), was intended to give the public access to transparent and understandable ART pregnancy success rates in reference to number of ovarian stimulation procedures attempted. [1,2] Since this legislation was passed, ART in the U.S has undergone considerable changes. [3] This practice is often accompanied by accumulation of embryos from multiple fresh cycles Another recent addition to ART, preimplantation genetic screening (PGS) at blastocyst stage, often involves cryopreservation of all embryos without immediate transfer. We reported in 2013, that some ART centers which performed a disproportionally large numbers of banking cycles, especially in poor-prognosis patients, reported inflated success rates reflecting preferentially selected more favorable-prognosis patients. We suggested that reporting loopholes such as this, could incentivize centers to divert especially poorer prognosis patients into banking cycles enabling elimination of poor prognosis patients from statistical outcome considerations. Assisted Reproductive Technology (ART) reports generated by the Centers for Disease Control and Prevention (CDC) exclude embryo banking cycles from outcome calculations

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Results

Conclusion