Number Of In Vitro Fertilization Cycles Research Articles

What drives the demand for in vitro fertilization? a multivariate statistical analysis of the utilization of assisted reproductive technologies in the United States: 1995–2004

Despite a proliferation of fertility clinics and increasing public awareness of advanced reproductive technologies (ART), the annual growth of in vitro fertilization (IVF) cycles performed in the United States decreased each year from 2000–2004. This analysis examines independent variables and their correlations with the number of IVF cycles performed annually in order to assess current and future trends. Retrospective multivariate statistical analysis. Data from the 1995–2004 Centers for Disease Control ART annual reports were consolidated, including total fresh nondonor (FND) cycles and pregnancy rate per FND cycle. To allow for a significant sample size and consistent analysis with other variables, data from each reporting center were aggregated to that center's respective state. Additional state-level data were incorporated, including female population age 25–44, median income, and infertility insurance mandate status. Multiple regression analysis was conducted, using FND cycles per 100,000 females age 25–44 as the dependent variable, and all other variables as potential independent variables. Natural logarithm transformation for the dependent variable was used to improve the regression model explanatory power and residual characteristics. Median income and the presence of a mandate to cover infertility treatment were positively correlated with FND cycles per 100,000 females age 25–44. Pregnancy rate per FND cycle was negatively correlated. The resulting regression equation was ln FND cycles per 100,000 females age 25–44 = 2.56 + 0.000066 state median income + 0.442 mandate to cover – 0.0142 FND pregnancy rate (P<0.01 for each independent variable; R2 = 47.9%). Population demographics, median income, the presence of an insurance mandate to cover fertility treatment, and pregnancy rate all appear to be statistically significant variables for explaining the utilization of ART at the state level. Insurance mandates and pregnancy rate had the largest impact. The presence of a mandate to cover is associated with an increase of 1.56 FND cycles per 100,000 potential patients, and each percentage point increase in FND pregnancy rate is associated with a decrease of 1.01 FND cycles per 100,000 potential patients. This analysis can be combined with other models to develop better forecasts for the number of cycles performed in the future. This study also revealed state-level differences in ART utilization which are being analyzed further.

SDD/SDFA Testing in infertile men who have failed IUI – predictor of successful IVF outcomes?

Infertility evaluation focuses on female factors prior to initiating advanced reproductive techniques. A cursory evaluation of the male includes a semen analysis to ensure sufficient sperm for intra-uterine insemination (IUI). Once IUI fails, further testing of the male ensues, often with normal results but persistent failures of ART. We sought to determine the utility of sperm DNA decondensation (SDD) and fragmentation analysis (SDFA) to predict the success of in vitro fertilization (IVF). Retrospective review of 42 patients in accord with institutional review policies. We evaluated the records of 42 men who failed at least two IUI cycles previously and who presented for a male infertility evaluation. Data examined included patient and partner ages, conventional semen analysis parameters, Testosterone, FSH, LH and genetic evaluation results. SDD and SDFA results and IVF outcomes were also queried. Eleven men had abnormal results for both the SDD and SDFA tests, 14 had an abnormality of only one test and 17 men had normal tests (Table 1). Mean values are presented for hormonal tests and medians for semen analysis data in Table 1. Among men where both tests were abnormal, the median number of IVF cycles was two, and four men were unable to achieve pregnancies despite two, three and four (two men) IVF cycles. With one abnormal test, the median number of cycles was also two, and only two men were unable to achieve pregnancies despite one and two cycles respectively. Finally, men with two normal tests had a median of one IVF cycle. Thus far, three men each of whom has undergone one cycle have not had achieved pregnancies. Table 1Baseline and Demographic InformationBoth Tests AbnormalOne Test AbnormalBoth Tests NormalPatient Age36.236.635.8Partner Age34.833.934.6Testosterone ng/dL403.7411.1400.9FSH (IU/dL)5.64.84.3LH (IU/dL)4.03.74.0Sperm Conc (million/mL)47.525.568.5Motility (%)4266.558Morphology (Kruger)2.04.04.5% unable to conceive with IVF36% (4/11)14% (2/14)18% (3/17) Open table in a new tab SDD and SDFA testing in men with adequate sperm parameters to undergo IUI may be useful in predicting IVF outcomes. Among men with abnormal SDD and SDFA tests, more cycles of IVF were required to achieve pregnancy. Furthermore, a higher proportion of men with both tests abnormal were unable to achieve pregnancies. SDD/SDFA testing may be useful tools to help advise couples of their success rates with IVF after failing IUI.

Regional clinical practice patterns in reproductive endocrinology: A collaborative transnational pilot survey of in vitro fertilization programs in the Middle East

BackgroundThis research describes current clinical and demographic features sampled from reproductive endocrinology programs currently offering in vitro fertilization (IVF) in the Middle East.MethodsClinic leadership provided data via questionnaire on patient demographics, demand for IVF services, annual cycle volume, indications for IVF, number of embryos transferred, twinning frequency, local regulations governing range of available adjunct therapies, time interval between initial enrollment and beginning IVF as well as information about other aspects of IVF at each center.ResultsData were received from representative IVF clinics (n = 13) in Cyprus, Egypt, Iran, Israel, Jordan, Lebanon, Qatar, Saudi Arabia and Turkey. Mean (± SD) age of respondents was 47.8 ± 8 yrs, with average tenure at their facility of 11.2 ± 6 yrs. Estimated total number of IVF programs in each nation responding ranged from 1 to 91. All respondents reported individual participation in accredited CME activity within 24 months. 76.9% performed embryo transfers personally; blastocyst transfer was available at 84.6% of centers. PGD was offered at all sites. In this population, male factor infertility accounted for most IVF consultations and the majority (59.1%) of female IVF patients were < 35 yrs of age. Prevalence of smoking among female IVF patients was 7.2%. Average number of embryos transferred was 2.4 (± 0.4) for patients at age < 35 yrs, and 2.9 (± 0.8) at age > 41 yrs. For these age categories, twinning (any type) was observed in 22.6 (± 10.8)% and 13.7 (± 10.4)%, respectively. In 2005, the average number of IVF cycles completed at study sites was 1194 (range 363–3500) and 1266 (range 263–4000) in 2006. Frozen embryo transfers accounted for 17.2% of cycles at these centers in 2005. Average interval between initial enrollment and IVF cycle start was 8 weeks (range 0.3–3.5 months).ConclusionThis sampling of diverse IVF clinics in the Middle East, believed to be the first of its kind, identified several common factors. Government registry or oversight of clinical IVF practice was limited or nonexistent in most countries, yet number of embryos transferred was nevertheless fairly uniform. Sophisticated reproductive health services in this region are associated with minimal delay (often < 8 weeks) from initial presentation to IVF cycle start. Most Middle East nations do not maintain a comprehensive IVF database, and there is no independent agency to collect transnational data on IVF clinics. Our pilot study demonstrates that IVF programs in the Middle East could contribute voluntarily to collaborative network efforts to share clinical data, improve quality of care, and increase patient access to reproductive services in the region.

Are cause of subfertility and in vitro fertilization treatment risk factors for an earlier start of menopause?

To study whether women diagnosed with unexplained subfertility reach the menopause transition and natural menopause earlier than women with tubal subfertility, in an in vitro fertilization (IVF)-treated population, and to examine the influence of the number of IVF cycles on the occurrence of an early menopause transition and natural menopause. This retrospective cohort study included 12 IVF clinics in the Netherlands. A nationwide retrospective cohort study was conducted among women whose first IVF cycle was stimulated with gonadotrophins in the Netherlands between 1983 and 1995 (n = 7,842). Most of the women were in their late 30s at the end of the follow-up period (range 24-55 y). The main outcome measures were the relative risk (RR) of having reached natural menopause and the risks (RR) of having entered the menopause transition or natural menopause according to the cause of subfertility and the number of IVF cycles. Women with unexplained subfertility did not have an increased risk of entering the menopause transition or natural menopause (adjusted RR = 0.5; 95% CI, 0.2-1.5; and RR = 0.8; 95% CI, 0.6-1.1). After a 5-year follow-up period, we found no increased risk for entering the menopause transition or natural menopause among women who had undergone six or more IVF cycles when compared with women who had undergone only one IVF cycle (adjusted RR = 0.4; 95% CI, 0.1-1.7; and RR = 0.9; 95% CI, 0.6-1.6). Underlying causes of unexplained subfertility do not predispose women to an early start of menopause. Although the number of IVF cycles was not associated with early menopause, longer follow-up is needed.

Treatment efficacy of in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) in human immunodeficiency virus-1 (HIV-1) serodiscordant couples: A life table analysis

In-vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) has been offered to human immunodeficiency virus (HIV) serodiscordant couples where the man is infected and the woman seronegative to achieve pregnancy while minimizing the risk of HIV transmission. We assess the efficacy of IVF-ICSI in HIV-1 serodiscordant couples in terms of number of IVF cycles typically needed to achieve a successful pregnancy. A retrospective review of HIV-1 serodiscordant couples undergoing IVF-ICSI at a university-based program. Between 7/1997 − 4/2003, couples known to be HIV-1 serodiscordant (male HIV-1 seropositive) were screened for assisted reproduction. 108 of 142 (76%) were deemed suitable for enrollment. Male partners were aged (mean±SD, (range)) 37.1±5.4 years (22–48 years); females aged 33.4±4.5 years (21–43 years). Women were prescribed ovarian hyperstimulation, and IVF-ICSI was performed on retrieved oocytes. Main outcome measures were successful pregnancy (live birth or ongoing pregnancy) rate per IVF-ICSI cycle with embryo transfer (ET) and HIV seroconversion rate. Life table analysis was performed to estimate number of IVF-ICSI cycles needed to obtain a successful pregnancy. Data was further stratified by female age (Group 1: age under 34, Group 2: age 34–37, and Group 3: age 38–43). Fresh ET cycles were included for analysis as well as cumulative rates for cycles including frozen ET. 98 women underwent at least one IVF-ICSI cycle (156 oocyte retrievals) with 92 women undergoing embryo transfer (146 IVF-ET cycles). 10 ET were cancelled post-retrieval either due to no fertilization/poor embryo quality (n=5) or risk of severe ovarian hyperstimulation syndrome (n = 5). There were 54 successful pregnancies after IVF-ICSI. Six additional pregnancies resulted from FET cycles. Life table analysis illustrates that overall 28.2±4.2% of couples could expect a successful pregnancy after one completed fresh IVF-ET cycle, with 48.0±5.7% and 64.8±7.3% expected pregnancy rates after 2 and 3 fresh IVF-ET cycles, respectively. 36.3% of IVF-ET cycles produced enough embryos for fresh transfer and cryopreservation. The cumulative successful pregnancy rate (fresh IVF-ET and FET cycles) after one completed IVF-ET cycle was estimated to be 30.1±4.2%, with 52.7±5.6%, and 67.5±6.7% expected pregnancy rates after 2 and 3 IVF-ET cycles, respectively. Again, success rate was inversely related to age group. There were no seroconversions in treated patients or in delivered babies. The use of IVF-ICSI to avoid disease transmission in HIV-1 serodiscordant couples desiring children yields high rates of success and appears to be safe. Best candidates appear to be women of younger age.

The Changing Practice Pattern of Infertility Care in the U.S

Objectives: As in most areas of medicine, clinical practice patterns in the treatment of infertility undergo constant change. The change has, however, never been formally investigated though, anecdotally, in vitro fertilization (IVF) appears to increase in popularity while other treatment modalities, such as intrauterine inseminations (IUI), appear on the decline. This study was, therefore, designed to determine the objective switch in the utilization of principal treatments in one large practice over a 7-year period. Design: A retrospective analysis of utilization patterns for IVF and IUI between 1993 and 1999 was performed using statistical data prospectively collected in a computerized database over those years. Materials and Methods: Between 1993 and 1999 one practice served exclusively a patient population which grew from approximately 350,000 lives (1993) to over 800,000 (1999) and was contracted on a capitated risk basis during the study period. Physicians, therefore, had an incentive to provide cost-effective care. From a computer-generated database the number of IUI cycles after either ovarian stimulation with clomiphene citrate or gonadotropins was compared to the number of IVF cycles performed during the same time periods. Numbers of respective cycles were listed per 1000 insured lives. Patients had full infertility insurance coverage, inclusive of medication costs, for unlimited numbers of IUI cycles and up to 4 IVF cycles. Results: The proportional utilization of IUI and IVF cycles remained basically stable between 1993 and 1995. During that time period only approximately 12–15% of all treatment cycles involved IVF. By 1996, the proportional representation of IVF cycles started to increase and became ever more blatant between 1997 and 1999, with the single most striking increase taking place in 1999. By that point, IVF cycles represented approximately 35% of all treatment cycles, representing a 133% increase in relative utilization over IUI. Conclusions: (1) In a practice setting that offers comprehensive insurance coverage for fertility services, the utilization of IVF over other treatment modalities was increasing rapidly. (2) This increase took place despite the existence of a capitation contract which gave the providers an incentive to offer the most cost-effective care. (3) The possible cause for such a shift in practice pattern are probably multi-factorial and include (i) improving pregnancy rates with IVF; (ii) better control over multiple pregnancy rates with IVF than IUI; (iii) a maturing of the populations within existing treatment algorithms over time, leading to more patients reaching the IVF stage; and (iv) cost effectiveness considerations. IVF is quietly become the most frequently utilized infertility treatment.