Society For Assisted Reproductive Technology Research Articles

The status of public reporting of clinical outcomes in assisted reproductive technology

To assess the transparency of assisted reproductive technology (ART) surveillance reports published by the Centers for Disease Control and Prevention (CDC) and by the Society for Assisted Reproductive Technologies (SART). Retrospective analysis. Private clinical ART and research center. We analyzed ART data for the years 2005-2010, which were reported under federal mandate to the CDC (818,927 completed cycles) and voluntarily to SART (812,400 initiated cycles). None. Initiated cycles excluded from final outcome reporting were used to evaluate transparency. Only SART, but not CDC, reported initiated cycles, allowing analysis of excluded cycles. Excluded cycles increased significantly from 3.3% to 7.4% between 2005 and 2010. By 2010, 13/341 (3.8%) ART centers accounted for 50% of excluded cycles, representing an average of 37.3% of their cycles. These 13 clinics reported significantly better pregnancy and cancellations rates than national averages and collectively increased by 19.9% their share of U.S. ART cycles. Our data indicate decreasing transparency in public ART reporting in the United States, likely due to changes in practice and reporting patterns. A few clinics accounted for the majority of excluded cycles, leading to improved reported clinical outcomes and increasing market share. CDC and SART should ensure that all ART clinics publicly report the outcomes of all initiated cycles including embryo-banking cycles. ART surveillance and quality of care may be improved by prospectively tracking the total reproductive potential of each initiated cycle.

Number of supernumerary vitrified blastocysts is positively correlated with implantation and live birth in single-blastocyst embryo transfers

To estimate whether live birth in single-blastocyst transfers is correlated with the number of sibling supernumerary vitrified blastocysts (embryos not transferred) generated from that same cycle. Retrospective cohort study. A large academic assisted reproduction clinic. All single-blastocyst transfers in 2010 graded as "good" embryos by Society for Assisted Reproductive Technologies (SART) criteria. None. Implantation and live birth. Of the 655 single-blastocyst transfers that met inclusion criteria, implantation occurred in 65% and live birth in 54% of cycles. In chi-square analysis, patients with supernumerary vitrified blastocysts had a statistically higher implantation rate (65% versus 50%) and live-birth rate (56% versus 41%) when compared with patients without supernumerary blastocysts. Univariate logistic regression demonstrated an increase in implantation (OR 1.09; 95% CI, 1.03-1.15) and live birth (OR 1.06; 95% CI, 1.02-1.09) with increasing number of supernumerary blastocysts. Multivariate logistic regression analysis demonstrated that patient age and the number of supernumerary blastocysts were statistically significantly associated with implantation and live birth. The number of supernumerary vitrified blastocysts correlated positively with the odds of implantation and live birth in good quality single-blastocyst transfers. Patients with supernumerary blastocysts are good candidates for single-embryo transfer.

Past performance of assisted reproduction technologies as a model to predict future progress: a proposed addendum to Moore’s law

The ultimate goal of IVF is to achieve healthy, single, live births following each single-embryo transfer. A timeline for this eventuality has never been defined. National implantation rates from 2003–2010 provided by the Society for Assisted Reproductive Technologies (SART) in the USA were evaluated. Regression analysis was applied to the annual trends. A high correlation was noted showing a linear increase from year to year ranging between 0.3% and 1.5% when maternal age was not higher than 42. This relationship can be retrospectively applied to earlier SART data reports. This incline may be partly technology driven and resembles Moore’s law, which describes annual improvements in microchip performance. Based on the assumption that technology will continue to drive progress, the length of time required to reach 100% implantation was calculated. The interval varied between 43years (AD 2053) for the youngest age group (<35years old) and 294years for the 41–42-year age group. The timeframe is shifted for the younger patients to an earlier date of 2027 if a subset of clinics with high implantation regression slopes and low variance is selected. The implications of these findings for infertility treatment and fertility preservation are discussed.Success after IVF has steadily improved. Data from US-based clinics are annually collected by the Society for Assisted Reproductive Technologies (SART; www.sart.org). Through SART, individual clinic’s outcomes may be assessed. Although live birth and pregnancy are considered the gold standard of success, the investigators took the approach that those outcomes are often biased due to transfer of multiple embryos. The present analysis was therefore performed on individual embryos, by using the implantation rate to compare national and individual clinic datasets. National implantation rates show a linear increase from year to year ranging between 0.3% and 1.5% for patients aged <43years. We postulate that this linear trend can be traced back to 1985 even though statistical analysis could only be applied to the implantation data from 2003–2010. We expect that this annual incline is partly technology driven. This is an intriguing effect also seen in the computer industry where there has been a doubling of computer speed and memory for the past 47years, a phenomenon anticipated by Moore’s law. We predict that the annual increase in implantation will also continue as new technologies become available. Based on current trends, the length of time for 100% implantation rates was calculated. Time to achieving 100% implantation varied between 43years (AD 2053) for the youngest age group (<35years old) to 294years for women 41–42years old. Some clinics may report a perfect success earlier than others. However, implantation does not guarantee birth.

Weighing the evidence: accuracy of perinatal outcomes reported to the society for assisted reproductive technologies (SART) database

Many studies rely on the SART database to assess perinatal outcomes. The accuracy of these outcomes, reported to fertility centers by patients and aggregated by SART, must be demonstrated. The objective of this study is to determine the accuracy of reported outcomes at a single center.

Race matters: a systematic review of racial/ethnic disparity in Society for Assisted Reproductive Technology reported outcomes

To systematically review the reporting of race/ethnicity in Society for Assisted Reproductive Technology (SART) Clinic Outcome Reporting System (CORS) publications. Systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology of literature published in PubMed on race/ethnicity that includes data from SART CORS. Not applicable. Not applicable. In vitro fertilization cycles reported to SART. Any outcomes reported in SART CORS. Seven publications were identified that assessed racial/ethnic disparities in IVF outcomes using SART data. All reported a racial/ethnic disparity. However, more than 35% of cycles were excluded from analysis because of missing race/ethnicity data. Review of current publications of SART data suggests significant racial/ethnic disparities in IVF outcomes. However, the potential for selection bias limits confidence in these findings, given that fewer than 65% of SART reported cycles include race/ethnicity. Our understanding of how race/ethnicity influences ART outcome could be greatly improved if information on race/ethnicity was available for all reported cycles.

Recurrent IVF failure: other factors

IVF failure is a problem for a couple in the singular but can be a tragedy in the plural. Recurrent IVF failure has multiple known causes but many which are not routinely considered as part of the posttreatment analysis. The reason is there are several causes associated with lifestyle and other causes related to pre-existing conditions that have only a tenuous or no apparent connection to fertility. This article examines the impact of obesity, cigarette smoke, uterine anatomy, body mass index, thyroid dysfunction, immune factors, the hereditary and acquired thrombophilias, and embryo transfer technique on recurrent IVF failure.

A persistent misperception: assisted reproductive technology can reverse the “aged biological clock”

Delaying motherhood should be a free choice made in full knowledge of all the consequences, but modern women have alarming misconceptions about their own reproductive systems and the effectiveness of assisted reproductive technologies. Doctors and health professionals must begin to discuss fertility preservation with their patients and make sure that young women truly understand all their options. Preventing age-related infertility is the responsibility not only of doctors and medical practitioners but also of society at large. Social, economic, and personal pressures are causing women to decide to conceive later in life, yet those who choose to delay motherhood are stigmatized as being selfish and unconcerned about starting a family. This stigma must be banished, and age-related infertility should be faced as a medical problem.

The ART of social networking: how SART member clinics are connecting with patients online

To study and describe the use of social networking websites among Society for Assisted Reproductive Technology (SART) member clinics. Cross-sectional study. University-based practice. Not applicable. Not applicable. Prevalence of social networking websites among SART member clinics and evaluation of content, volume, and location (i.e.,mandated state, region) using multivariate regression analysis. A total of 384 SART-registered clinics and 1,382 social networking posts were evaluated. Of the clinics, 96% had a website and 30% linked to a social networking website. The majority of clinics (89%) with social networking websites were affiliated with nonacademic centers. Social networking posts mostly provided information (31%) and/or advertising (28%), and the remaining offered support (19%) or were irrelevant (17%) to the target audience. Only 5% of posts involved patients requesting information. Clinic volume correlated with the presence of a clinic website and a social networking website. Almost all SART member clinics have a website. Nearly one-third of these clinics host a social networking website such as Facebook, Twitter, and/or a blog. Large-volume clinics commonly host social networking websites. These sites provide new ways to communicate with patients, but clinics should maintain policies on the incorporation of social networks into practice.

Use of preimplantation genetic diagnosis and preimplantation genetic screening in the United States: a Society for Assisted Reproductive Technology Writing Group paper

To comprehensively report Society for Assisted Reproductive Technology (SART) member program usage of preimplantation genetic testing (PGT), preimplantation genetic diagnosis (PGD) for diagnosis of specific conditions, and preimplantation genetic screening for aneuploidy (PGS). Retrospective study. United States SART cohort data. Women undergoing a PGT cycle in which at least one embryo underwent biopsy. PGT. PGT use, indications, and delivery rates. Of 190,260 fresh, nondonor assisted reproductive technology (ART) cycles reported to SART CORS in 2007-2008, 8,337 included PGT. Of 6,971 cycles with a defined indication, 1,382 cycles were for genetic diagnosis, 3,645 for aneuploidy screening (PGS), 527 for translocation, and 1,417 for elective sex election. Although the total number of fresh, autologous cycles increased by 3.6% from 2007 to 2008, the percentage of cycles with PGT decreased by 5.8% (4,293 in 2007 and 4,044 in 2008). As a percentage of fresh, nondonor ART cycles, use dropped from 4.6% (4,293/93,433) in 2007 to 4.2% (4,044/96,827) in 2008. The primary indication for PGT was PGS: cycles performed for this indication decreased (-8.0%). PGD use for single-gene defects (+3.2%), elective sex selection (+5.3%), and translocation analysis (+0.5%) increased. PGT usage varied significantly by geographical region. PGT usage in the United States decreased between 2007 and 2008 owing to a decrease in PGS. Use of elective sex selection increased. High transfer cancellation rates correlated with reduced live-birth rates for some PGT indications.

Utility of the national embryo morphology data collection by the Society for Assisted Reproductive Technologies (SART): correlation between day-3 morphology grade and live-birth outcome

Analysis of the "grade" field in the first embryo morphology data collected under the classification system developed by Society for Assisted Reproductive Technology (SART) and reported to the SART Clinic Outcomes Reporting System (SART CORS) database showed that when two embryos of the same grade were transferred on day 3, the live-birth rate declined with decreasing grade (<35 years old: good = 50.4%; fair = 42.2%; poor = 22.0%; ≥ 35 years old: good = 35.1%; fair = 23.4%; poor = 20.0%). These findings provide the first evidence that collecting the "grade" field in the national morphology collection system is valid and can be developed into a standard for use by individual SART programs for quality assurance assessment and for improved embryo selection.

Utilization and success rates of unstimulated in vitro fertilization (IVF) in the United States: an analysis of the Society for Assisted Reproductive Technology (SART) database

OBJECTIVE: The purpose of this study was to examine the utilization of unstimulated IVF in the United States and the outcomes of those cycles reported to SART/CORS in 2006 and 2007. DESIGN: Retrospective analysis of data provided to SART by participating ART clinics in 2006 and 2007. MATERIALS AND METHODS: The SART/CORS database was queried regarding unstimulated IVF cycles reported in 2006 and 2007. The total number of unstimulated IVF cycles and the percentage of unstimulated cycles compared with stimulated cycles was obtained. Outcome data from these unstimulated IVF cycles was examined in regards to pregnancy and livebirth rates. RESULTS: In 2006, of the 344 clinics performing stimulated IVF, 44 reported unstimulated IVF (12.8%), averaging 6.55 cycles representing <1% of the total ART cycles performed at those clinics. In 2007, of the 358 clinics performing stimulated IVF, 57 of those performed unstimulated IVF (16%), averaging 8.89 cycles representing 1.36% of the total ART cycles at those clinics. The average age of patients undergoing unstimulated IVF was 38 years in 2006 and 39 years in 2007 compared with 35 years for stimulated IVF. Data for 2006 and 2007: Percentage of cancellations 2006: 32.29 2007: 27.02 Percentage of cycles resulting in pregnancies 2006: 10.76 2007: 8.88 Percentage of cycles resulting in live births 2006: 8.33 2007: 6.71 Percentage of retrievals resulting in live births 2006: 12.31 2007: 9.19 Percentage of transfers resulting in live births 2006: 23.3 2007: 18.09. CONCLUSION: This study represents the first assessment of unstimulated IVF utilization in the United States. Unstimulated IVF has gained in popularity worldwide but U.S. clinics have been slow to adopt this approach to fertility treatment. Although the cycle cancellation rate approaches 30%, the pregnancy rate as a percentage of embryo transfers was 23% in 2006 and 18% in 2007 which is promising. The use of unstimulated IVF should be investigated further in a wide range of patients to gain more insight into its potential application.

Standardization of grading embryo morphology

Standardization of morphologic assessment for an embryo grading system was developed and is being implemented by the Society for Assisted Reproductive Technology (SART). A recent European consensus conference of embryologists from Europe and America is working toward adopting an embryo classification system modeled similarly to that of SART that, if adopted, would produce a de facto international standard to aid cross-border collaboration.

Standardization of grading embryo morphology

Standardization of morphological assessment for embryo grading system was developed and is being implemented by the Society for Assisted Reproductive Technology (SART). A recent European consensus conference of embryologists from Europe and America is working toward adopting an embryo classification system modeled similarly to that of SART which, if adopted, would produce a de facto international standard to aid cross border collaboration.

Embryo transfer practices in the United States: a survey of clinics registered with the Society for Assisted Reproductive Technology

To gain a better understanding of factors influencing clinicians' embryo transfer practices. Cross-sectional survey. Web-based survey conducted in December 2008 of individuals practicing IVF in centers registered with the Society for Assisted Reproductive Technology (SART). None. None. Prevalence of clinicians reporting following embryo transfer guidelines recommended by the American Society for Reproductive Medicine (ASRM), prevalence among these clinicians to deviate from ASRM guidelines in commonly encountered clinical scenarios, and practice patterns related to single embryo transfer. Six percent of respondents reported following their own, independent guidelines for the number of embryos to transfer after IVF. Of the 94% of respondents who reported routinely following ASRM embryo transfer guidelines, 52% would deviate from these guidelines for patient request, 51% for cycles involving the transfer of frozen embryos, and 70% for patients with previously failed IVF cycles. All respondents reported routinely discussing the risks of multiple gestations associated with standard embryo transfer practices, whereas only 34% reported routinely discussing single embryo transfer with all patients. Although the majority of clinicians responding to our survey reported following ASRM embryo transfer guidelines, at least half would deviate from these guidelines in a number of different situations.

Trends of racial disparities in assisted reproductive technology outcomes in black women compared with white women: Society for Assisted Reproductive Technology 1999 and 2000 vs. 2004–2006

To determine trends in assisted reproductive technology (ART) in black and white women by comparing Society for Assisted Reproductive Technology (SART) database outcomes for 2004-2006 with previously reported outcomes for 1999 and 2000. Retrospective, cohort study. The SART member clinics that performed at least 50 cycles of IVF and reported race in more than 95% of cycles. Women receiving 158,693 IVF cycles. In vitro fertilization using nondonor embryos. Live birth rate per cycle started. Reporting of race increased from 52% to 60%. The proportion of black, non-Hispanic (BNH) women increased from 4.6% to 6.5%. For BNH women using fresh embryos and no prior ART, significant increasing trends were observed for older age, male factor, uterine factor, diminished ovarian reserve, and ovulation disorders. The BNH women were 2.5 times more likely to have tubal factor for those cycles with no prior ART. The proportion of live births per cycle started increased across all groups over time, although greater increases occurred for white women. There seems to be widening disparities in IVF outcomes between BNH and white women, perhaps attributable to poor prognostic factors among black women. Race continues to be a marker for prognosis for ART outcomes and should be reported.

Access to assisted reproductive technology centers in the United States

To describe the disparity of assisted reproductive technology (ART) centers in the United States as they relate to residential locations of populations in their reproductive years and state-mandated coverage for infertility services. Cross-sectional study. Population in reproductive years (women 20-44 years; men 20-49 years) based on US Census 2000 data. Assisted reproductive technology centers registered with the Society for Assisted Reproductive Technology (SART) in 2005. Populations within service area served by in-state and neighboring state ART centers as defined by a 60-minute travel time along road networks from each center. Service areas for 387 of 390 ART centers were calculated. Fourteen states had some form of mandated coverage. Underserved states included Alaska, Montana, Wyoming, and West Virginia. The northeastern United States had the greatest percentage of overserved population with 66%-100% study population within 60 minutes of an ART center. Female age stratification showed the highest age group (35-44 years) per state in northern New England and the youngest in Utah and District of Columbia. Median total study population within 60 minutes of an ART center in their own state was higher in mandated versus nonmandated states. Disparity of access to care for infertility services exists from the standpoint of population service areas for ART centers and state-mandated coverage. Female age stratification may help anticipate future need for services with existing resource distribution.

Low risk of multiple pregnancies in assisted reproductive technology (ART) for women over age 40

OBJECTIVE: Society for Assisted Reproductive Technology (SART) guidelines limit the number of embryos to be transferred in women younger than 40, with the goal of decreasing the rate of multiple pregnancies. However, there are no recommendations for women over the age of 40. We determined the rate of multiple pregnancies in this cohort of older in vitro fertilization (IVF) patients.DESIGN: Analysis of non-donor IVF/ICSI cycle outcomes at 2 university based fertility centers.MATERIALS AND METHODS: Outcomes for non-donor IVF/ICSI cycles performed in women aged 41 – 44 from 2004 to 2007 were analyzed. Clinical pregnancy rate (CPR), defined as a fetal heart beat detected by ultrasound, spontaneous abortion (SAB), live birth rate (LBR), and multiple pregnancy rates were considered for analysis.RESULTS: 363 cycles in patients aged 41-42 and 192 cycles in patients aged 43-44 were initiated, and outcomes are summarized in the table. While the average number of embryos transferred was 3.6 in each age group, the majority of live births were singleton (82% and 77% for age 41-42 and 43-44 respectively), and the chance of a multiple gestation live birth from cycle initiation was 2.5% and 1.6% for age 41-42 and 43-44 respectively. SAB rate in both age groups was 35%.Tabled 141 - 4243 - 44Cycles363192Transfers235149Cycles with no transfer128 (35.3%)43 (22.4%)No. embryos transferred3.63.6CPR (%)21.210.4SAB (%)35.135.0LBR (%)13.86.8- % singleton8277- % twin1623- % triplet20Singleton LBR / transfer (%)17.46.7Twin LBR / transfer (%)3.42.0Triplet LBR / transfer (%)0.40.0Multiple pregnancy LBR / cycle start (%)2.51.6 Open table in a new tab OBJECTIVE: Society for Assisted Reproductive Technology (SART) guidelines limit the number of embryos to be transferred in women younger than 40, with the goal of decreasing the rate of multiple pregnancies. However, there are no recommendations for women over the age of 40. We determined the rate of multiple pregnancies in this cohort of older in vitro fertilization (IVF) patients. DESIGN: Analysis of non-donor IVF/ICSI cycle outcomes at 2 university based fertility centers. MATERIALS AND METHODS: Outcomes for non-donor IVF/ICSI cycles performed in women aged 41 – 44 from 2004 to 2007 were analyzed. Clinical pregnancy rate (CPR), defined as a fetal heart beat detected by ultrasound, spontaneous abortion (SAB), live birth rate (LBR), and multiple pregnancy rates were considered for analysis. RESULTS: 363 cycles in patients aged 41-42 and 192 cycles in patients aged 43-44 were initiated, and outcomes are summarized in the table. While the average number of embryos transferred was 3.6 in each age group, the majority of live births were singleton (82% and 77% for age 41-42 and 43-44 respectively), and the chance of a multiple gestation live birth from cycle initiation was 2.5% and 1.6% for age 41-42 and 43-44 respectively. SAB rate in both age groups was 35%.

A decision analysis of treatments for nonobstructive azoospermia associated with varicocele

To examine the economic impact of initial treatments for varicocele-associated nonobstructive azoospermia, specifically varicocelectomy versus microsurgical testicular sperm extraction (TESE) with IVF/intracytoplasmic sperm injection (ICSI). Decision analytic model based on 1) outcomes data from Society for Assisted Reproductive Technology (SART) database and peer-reviewed literature and 2) costing data from Medicare Resource-Based Relative Value Scale and sampling of high volume US IVF centers. Academic medical center. Simulation with a decision analytic model. Variation of successful spontaneous live delivery after varicocelectomy versus rate of successful live delivery after IVF/ICSI. Cost-effectiveness. Microsurgical TESE was more cost effective than varicocelectomy. In 1999, initial treatment with microsurgical TESE was more cost effective ($65,515) than varicocelectomy ($76,878). Relative cost-effectiveness was unchanged in 2005: $69,731 versus $79,576. The cost-effectiveness of both treatments improved in relation to projections by inflation. Sensitivity analyses suggest that the relative cost-effectiveness of TESE versus varicocelectomy can only be changed with either substantial improvement in spontaneous live delivery rates after varicocelectomy or with deterioration in IVF success rates. Microsurgical TESE appears to be more cost effective than varicocelectomy for treatment of varicocele-associated nonobstructive azoospermia when indirect costs are considered. The cost-effectiveness of both treatments has improved with time. These results may be tailored with institution-specific data to allow more individualized results.

What Is Happening to the Price of Eggs?

Egg donation and the compensation of egg donors are much in the news these days. In the year 2000 the Ethics Committee of the American Society of Reproductive Medicine (ASRM) recommended that women providing oocytes be paid a fair amount but not so much that prospective donors will ignore the attendant risks. The committee recognized that there is no consensus on an appropriate fee, but stated that sums of $5000 or more must be justified and that sums exceeding $10,000 are excessive. The authors report the findings of a survey of reproductive medical programs belonging to the Society for Assisted Reproductive Technology (SART). Of the 394 SART clinic programs surveyed, 207 (53%) responded and 191 of these had an ovum donor program. Most clinics reported using multiple strategies for recruiting egg donors, including patients' families, donor agencies, and their own recruitment programs. More than 85% of SART clinics offered the same compensation to all paid donors. The overall national average compensation was $4216. Fees were highest in the East/Northeast and West, averaging about $5000, and lowest in the Northwest at $2900. When a maximum fee was specified, the national average was $4576. The range of compensation was wide, with maximum and minimum payments of $15,000 and $1500, respectively. The findings of this survey-the largest performed to date-are encouraging in that a large majority of clinics are following ASRM/SART recommendations when offering monetary compensation to egg donors.

Changes over time of testicular sperm extraction (TESE) with IVF/ICSI for treatment of male factor infertility

We examined the effectiveness of testicular sperm extraction (TESE) with in vitro fertilization and intracytoplasmic sperm injection (IVF/ICSI) over time. TESE with IVF/ICSI enhances the ability to treat male factor infertility. We examined temporal changes in TESE outcomes for all types of azoospermia, using live delivery and multiple gestation pregnancy rates as primary outcome measures. The Society for Assisted Reproductive Technology (SART) database was queried for TESE patient data in 1999, the earliest year for which robust SART data existed for TESE and in 2005, the most recent year for which SART data was available. The total number of fresh IVF cycles using autologous eggs with ICSI and cervical transfer were recorded, as were the number of cycles for TESE patients in whom sperm was successfully retrieved. The live delivery and multiple gestation pregnancy rates in each year were recorded. All statistical analyses were performed using the χ2 test. The total number of IVF cycles increased from 62,991 to 88,422 between 1999 to 2005. The percentage of IVF cycles undergone for male factor infertility however did not change significantly: 36.9% to 36.6% (P=0.375). Only 1.6% of such cycles used TESE with IVF/ICSI to treat male factor infertility in 1999 (1,029 cycles); this remained unchanged for 2005 (1,425 cycles). The live delivery rate for TESE cycles increased from 28.3% to 33.6% (P=0.042) in couples where sperm was successfully retrieved. While the multiple gestation pregnancy rate decreased from 37% to 31.9% for all IVF cycles, it did not do so for TESE cycles (29.6% to 28.0%, P=0.737). However, the percentage of cycles resulting in triplet or more infants in the latter group did decline from 5.8% to 2.1% (P=0.008). The utilization of both TESE and IVF treatments increased from 1999 to 2005. TESE with IVF/ICSI has improved in its ability to treat male factor infertility over time, with a higher live delivery rate. The overall number of multiple gestation pregnancies associated with TESE-driven IVF cycles however did not significantly change.