Zygote Intrafallopian Transfer Research Articles

Strategies for designing an efficient insurance fertility benefit: a 21st century approach

Creating a 21st century insurance benefit for infertility should be cost effective. Savings can be realized by eliminating hidden infertility costs, eliminating payments for ineffective treatments, and providing coverage for effective 21st century treatments, thus reducing costs associated with iatrogenic multiple pregnancies. The new benefit allows patients to attempt 21st century forms of infertility treatments while being managed by certified infertility providers. Industry and insurance carriers might save money by examination and implementation of this concept.

Current Outcomes of Zygote Intrafallopian Transfer (ZIFT) Compared With Conventional Embryo Transfer in Women of Advanced Maternal Age: Is There a Benefit?

Background: Success rates with assisted reproductive techniques are significantly lower for women of advanced maternal age (AMA). Although early studies reported improved implantation and pregnancy rates with ZIFT compared with traditional in vitro fertilization–embryo transfer (IVF-ET) for patients with recurrent implantation failure, recent randomized controlled trials have shown no difference in outcomes. However, no studies have examined the efficacy of ZIFT specifically for patients of AMA.Objective: To determine whether ZIFT improves clinical pregnancy rates in women of AMA compared with IVF-ET.Materials and Methods: Records from January 2004 through October 2007 were reviewed, and all patients who underwent ZIFT were identified. Only patients who were ≥38 years old were included. Cycles involving donor eggs and/or frozen embryos were excluded. A control population of patients undergoing IVF-ET during the same time period was chosen using the same criteria. Two controls were selected randomly for each case.Results: 32 ZIFT and 64 IVF-ET cycles were used in the final analysis. Although the controls were chosen with the same inclusion criteria, the mean age of the ZIFT group was statistically higher than that of the controls (41.2 ± 1.7 years vs. 40.3 ± 2.1 years; P<.05). The ZIFT group had significantly more previously failed cycles than the controls (2.78 ± 2.2 vs. 0.61 ± 0.95; P<.01). The ZIFT group and the controls had a similar number of days of stimulation (9.7 ± 1.3 vs. 9.8 ± 2.2) as well as total number of ampules administered (62.9 ± 17.6 vs. 63.8 ± 22.6). There was no significant difference in the clinical pregnancy rate between the ZIFT group and the controls (25% vs. 26%). Additionally, mean implantation rates did not differ between the two groups (ZIFT 7.6 ± 0.2% vs. IVF 9.0 ± 0.2%).Conclusions: ZIFT is a viable treatment option for women of AMA. Despite a higher mean age and a higher number of previously failed cycles, ZIFT patients had pregnancy outcomes and implantation rates similar to patients undergoing IVF-ET. Therefore, ZIFT may impart an advantage over IVF-ET for older patients, especially in the setting of recurrent implantation failure. Background: Success rates with assisted reproductive techniques are significantly lower for women of advanced maternal age (AMA). Although early studies reported improved implantation and pregnancy rates with ZIFT compared with traditional in vitro fertilization–embryo transfer (IVF-ET) for patients with recurrent implantation failure, recent randomized controlled trials have shown no difference in outcomes. However, no studies have examined the efficacy of ZIFT specifically for patients of AMA. Objective: To determine whether ZIFT improves clinical pregnancy rates in women of AMA compared with IVF-ET. Materials and Methods: Records from January 2004 through October 2007 were reviewed, and all patients who underwent ZIFT were identified. Only patients who were ≥38 years old were included. Cycles involving donor eggs and/or frozen embryos were excluded. A control population of patients undergoing IVF-ET during the same time period was chosen using the same criteria. Two controls were selected randomly for each case. Results: 32 ZIFT and 64 IVF-ET cycles were used in the final analysis. Although the controls were chosen with the same inclusion criteria, the mean age of the ZIFT group was statistically higher than that of the controls (41.2 ± 1.7 years vs. 40.3 ± 2.1 years; P<.05). The ZIFT group had significantly more previously failed cycles than the controls (2.78 ± 2.2 vs. 0.61 ± 0.95; P<.01). The ZIFT group and the controls had a similar number of days of stimulation (9.7 ± 1.3 vs. 9.8 ± 2.2) as well as total number of ampules administered (62.9 ± 17.6 vs. 63.8 ± 22.6). There was no significant difference in the clinical pregnancy rate between the ZIFT group and the controls (25% vs. 26%). Additionally, mean implantation rates did not differ between the two groups (ZIFT 7.6 ± 0.2% vs. IVF 9.0 ± 0.2%). Conclusions: ZIFT is a viable treatment option for women of AMA. Despite a higher mean age and a higher number of previously failed cycles, ZIFT patients had pregnancy outcomes and implantation rates similar to patients undergoing IVF-ET. Therefore, ZIFT may impart an advantage over IVF-ET for older patients, especially in the setting of recurrent implantation failure.

Assisted reproductive technology in the United States: 2001 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology registry

To summarize the procedures and outcomes of assisted reproductive technologies (ART) that were initiated in the United States in 2001. Data were collected electronically using the Society for Assisted Reproductive Technology (SART) Clinic Outcome Reporting System software and submitted to the American Society for Reproductive Medicine/SART Registry. Three hundred eighty-five clinics submitted data on procedures performed in 2001. Data were collated after November 2002 [corrected] so that the outcomes of all pregnancies would be known. Incidence of clinical pregnancy, ectopic pregnancy, abortion, stillbirth, and delivery. Programs reported initiating 108,130 cycles of ART treatment. Of these, 79,042 cycles involved IVF (with and without micromanipulation), with a delivery rate per retrieval of 31.6%; 340 were cycles of gamete intrafallopian transfer, with a delivery rate per retrieval of 21.9%; 661 were cycles of zygote intrafallopian transfer, with a delivery rate per retrieval of 31.0%. The following additional ART procedures were also initiated: 8,147 fresh donor oocyte cycles, with a delivery rate per transfer of 47.3%; 14,509 frozen ET procedures, with a delivery rate per transfer of 23.5%; 3,187 frozen ETs employing donated oocytes or embryos, with a delivery rate per transfer of 27.4%; and 1,366 cycles using a host uterus, with a delivery rate per transfer of 38.7%. In addition, 112 cycles were reported as combinations of more than one treatment type, 8 cycles as research, and 85 as embryo banking. As a result of all procedures, 29,585 deliveries were reported, resulting in 41,168 neonates. In 2001, there were more programs reporting ART treatment and a significant increase in reported cycles compared with 2000.

Timing intra-Fallopian transfer procedures

With the gradual decline in the use of zygote intra-Fallopian transfer (ZIFT), current practice is to offer ZIFT almost exclusively to patients with repeated implantation failure (RIF). For practical reasons, the procedure is sometimes deferred by 1 day and embryo intra-Fallopian transfer (EIFT) is performed. The aim of the present study was to compare the reproductive outcome of ZIFT versus EIFT. In a retrospective analysis, 176 patients who failed in 7.65 ± 3.7 previous IVF cycles underwent 200 ZIFT and 73 EIFT procedures. Implantation and live birth rates were compared for both groups. Patients in both groups were found comparable for demographic and clinical parameters. Similar numbers of oocytes were retrieved and fertilized in both groups, and 5.2 ± 1.2 zygotes/embryos were transferred. Implantation and live birth rates (10.5 and 26.5% versus 10.9 and 24.7% for ZIFT and EIFT respectively) were comparable. It is concluded that tubal transfer of zygotes and day-2 cleavage stage embryos are equally effective.

Favorable influence of local injury to the endometrium in intracytoplasmic sperm injection patients with high-order implantation failure

Local injury to the endometrium prior to controlled ovarian stimulation may considerably improve implantation rates and pregnancy outcomes in intracytoplasmic sperm injection patients with high-order implantation failure (> or =4 IVF trials and > or =12 transferred embryos).

P-274: Combined gamete or zygote intrafallopian transfer (GIFT or ZIFT) and in vitro fertilization-embryo transfer (IVF-ET) in women with prior failed cycles: Significantly improved success rates compared with IVF alone

P-274: Combined gamete or zygote intrafallopian transfer (GIFT or ZIFT) and in vitro fertilization-embryo transfer (IVF-ET) in women with prior failed cycles: Significantly improved success rates compared with IVF alone

Investigation and treatment of repeated implantation failure following IVF-ET

Pregnancy rate following one cycle of IVF and ET can be as high as 60%. But even in the very successful units, some couples fail repeatedly. The causes for repeated implantation failure (RIF) may be because of reduced endometrial receptivity, embryonic defects or multifactorial causes. Various uterine pathologies, such as thin endometrium, altered expression of adhesive molecules and immunological factors, may decrease endometrial receptivity, whereas genetic abnormalities of the male or female, sperm defects, embryonic aneuploidy or zona hardening are among the embryonic reasons for failure of implantation. Endometriosis and hydrosalpinges may adversely influence both. In this mini review, we discuss the suggested methods for evaluation and treatment of RIF: repeated hysteroscopy, myomectomy, endometrial stimulation, immunotherapy, preimplantation genetic screening (PGS), assisted hatching, zygote intra-Fallopian transfer (ZIFT), co-culture, blastocyst transfer, cytoplasmic transfer, tailoring stimulation protocols and salpingectomy for hydrosalpinges.

Ectopic Pregnancy Risk With Assisted Reproductive Technology Procedures

To assess the ectopic pregnancy risk among women who conceived with assisted reproductive technology (ART) procedures. The ectopic rate for ART pregnancies was calculated from population-based data of pregnancies conceived with ART in U.S. clinics in 1999-2001. Variation in ectopic risk by patient and ART treatment factors was assessed by using bivariate analyses and multivariable logistic regression. Of 94,118 ART pregnancies, 2,009 (2.1%) were ectopic. Variation was observed by procedure type. In comparison with the ectopic rate (2.2%) among pregnancies conceived with in vitro fertilization and transcervical transfer of freshly fertilized embryos from the patient's oocytes (fresh, nondonor IVF-ET), the ectopic rate was significantly increased when zygote intrafallopian transfer (ZIFT) was used (3.6%) and significantly decreased when donor oocytes were used (1.4%) or when a gestational surrogate carried the pregnancy (0.9%). Among fresh nondonor IVF-ET procedures, the risk for ectopic pregnancy was increased among women with tubal factor infertility (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.7-2.4; referent group = ART for male factor), endometriosis (OR 1.3, 95% CI 1.0-1.6), and other nontubal female factors of infertility (OR 1.4, 95% CI 1.2-1.6) and decreased among women with a previous live birth (OR 0.6, 95% CI 0.5-0.7). Transfer of embryos with an indication of high implantation potential was associated with a decreased ectopic risk when 2 or fewer embryos were transferred (OR 0.7, 95% CI 0.5-0.9), but not when 3 or more embryos were transferred. Ectopic risk among ART pregnancies varied according to ART procedure type, reproductive health characteristics of the woman carrying the pregnancy, and estimated embryo implantation potential. II-2.

Zygote Intrafallopian Transfer (ZIFT) in Patients With Repeated Implantation Failure: Ten Years Experience of a Single Center

The application of ZIFT in the general IVF population has gradually declined worldwide over the years. A meta-analysis of randomized, controlled trials found no difference in pregnancy and implantation rates between women undergoing ZIFT and IVF-ET {Habana and Palter; Fertil Steril 2001}. For the last ten years, the therapeutic approach at our institution has been to offer IVF with ZIFT to patients with repeated implantation failure (RIF), whenever permitted by tubal status. In previous publications, we have clearly demonstrated the superiority of ZIFT over conventional embryo transfer (ET) {Levran et al.

Comparison of zygote intrafallopian tube transfer and transcervical uterine embryo transfer in patients with repeated implantation failure

Objective: This study was designed to evaluate the role of zygote intrafallopian transfer (ZIFT) procedure in patients with repeated failure of implantation. Study Design: A total of 141 ZIFT cycles of 132 women and 145 embryo transfer (ET) cycles of 97 women in whom five or more embryos were transferred were included in this study. Transcervical uterine embryo transfer and ZIFT cycle outcome in patients with five or more previous implantation failure were compared. Embryos were transferred by laparoscopy into the fallopian tube 24–27 h following oocytes retrieval in the ZIFT group. In the ET group, embryos were transferred transcervically on the third day following oocytes retrieval. Results: The mean age was 34 ± 4.9 and 34.9 ± 5.0 years in ZIFT and ET group, respectively. No difference was determined between the two groups regarding the basal FSH, E2 value on the day of HCG injection and the number of oocytes retrieved or fertilized. The implantation rate was 6.5% versus 7.2%, clinical pregnancy rate was 22.7% versus 24.8% and live birth rate was 21.2% versus 16.5% in ZIFT and ET groups, respectively. Conclusions: Implementation of ZIFT procedure in patients with repeated implantation failure is not superior to transcervical uterine embryo transfer.

Combined Gamete or Zygote Intrafallopian Transfer (GIFT or ZIFT) and In Vitro Fertilization-Embryo Transfer (IVF-ET) in Women With Prior Failed Cycles: Significantly Improved Success Rates Compared With GIFT or ZIFT Alone

Introduction: The roles of GIFT and ZIFT have recently been diminished as laboratory and transfer techniques in IVF-ET have improved. However, data on combination treatment of GIFT or ZIFT with IVF-ET are lacking. Objective: To assess whether combination treatment of GIFT/IVF or ZIFT/IVF offers any benefit over GIFT or ZIFT alone in women with prior failed IVF. Material & Methods: From January 1997 through December 2000, 56 patients with a prior history of at least one failed IVF cycle underwent a total of 62 tubal transfer procedures, following standard ovarian hyperstimulation and egg retrieval. Of those, 42 cycles were of combined GIFT/IVF (35 cycles in 30 patients) or ZIFT/IVF (7 cycles in 7 patients), and 20 cycles were of GIFT (11 cycles in 10 patients) or ZIFT (9 cycles in 9 patients) only. In combined procedures, laparoscopic tubal gamete or zygote transfer was followed with trans-cervical ET of day-3 embryos three or two days later, respectively. Patients underwent a GIFT or combined GIFT/IVF procedure unless intracytoplasmic sperm injection was necessary, in which case a ZIFT or combined ZIFT/IVF was performed. For the purpose of comparing the number of embryos transferred, a 75% fertilization rate was assumed for all GIFT cycles. Statistical analysis was by Chi Square and Student’s t test. Results: Mean age and number of prior failed IVF cycles were similar between patients undergoing combined GIFT/IVF or ZIFT/IVF (34.5 ± 4.1 years, 1.9 ± 1.2 cycles) and those undergoing GIFT or ZIFT alone (36.1 ± 4.1 years, 1.8 ± 1.7 cycles, p=NS). Combined procedures resulted in a significantly higher mean number of total embryos transferred (tubes + uterus), compared with GIFT or ZIFT alone (5.9 ± 1.0 versus 4.3 ± 1.6 embryos, p>0.01). Compared with GIFT or ZIFT only cycles, patients undergoing a combined GIFT/IVF or ZIFT/IVF procedure had a significantly higher clinical pregnancy rate (69.0% versus 30.0%, OR=5.2, p>0.01), delivery rate (57.1% versus 30.0%, OR=3.1, p>0.05), and implantation rate (19.4% versus 7.2%, OR=3.1, p>0.01). Combined cycles had a 37.9% twin and 10.3% triplet gestation rate. There were no multiple gestations in GIFT or ZIFT only cycles. Conclusion: In this study, in women with prior IVF failure, combined GIFT/IVF or ZIFT/IVF resulted in significantly higher clinical pregnancy, delivery, and implantation rates compared with GIFT or ZIFT alone.

Follicle-stimulating hormone and estradiol levels independently predict the success of assisted reproductive technology treatment

To evaluate the relationship between early follicular phase levels of FSH and E(2) and outcomes of therapy with assisted reproductive technologies (ART). Retrospective cohort study. ART centers in the United States. Women receiving 19,682 ART procedures performed in 135 clinics. None. Rates of clinical pregnancy, live birth delivery, and high ovarian response (>/=10 oocytes retrieved after stimulation). The ratio of each FSH or E(2) value to the respective upper limit of normal value for the clinic was computed. Within each age group, rates of pregnancy, live birth, and high ovarian response decreased linearly as FSH levels increased. For example, among women 35 years of age and younger, pregnancy rates (PR) ranged from 41.1% (FSH ratio 0-0.5) to 18.5% (FSH ratio >2.0). The three outcomes exhibited a similar downward trend as E(2) ratios increased. When both hormone ratios were elevated, outcomes were least favorable. These relationships remained statistically significant after we adjusted for diagnosis, number of embryos transferred, previous births, previous ART therapy, and use of GIFT, zygote intrafallopian transfer (ZIFT), intracytoplasmic sperm injection (ICSI), or assisted hatching. The FSH and E(2) ratios predict ART success independent of age and other clinical prognostic factors.

Risks of birth defects and other adverse outcomes associated with assisted reproductive technology.

Approximately 1 million children world-wide have been born through assisted reproductive technology (ART),1 which helps many motivated couples give birth to healthy infants. Children conceived through ART comprise as many as 1% to 2% of total births in some countries.2,3 High rates of multiple births, with attendant complications of prematurity and low birth weight, are well documented. Concerns are now emerging about associated increased risks for congenital anomalies. Use of newer techniques may bring additional hazards, especially those requiring more biologic manipulation than artificial insemination and other, older ART methods. Outcomes data through ART registries permit risk estimates, although some data ascertainment is incomplete, especially in the United States. This report reviews ART outcomes, with focus on the potential risks of birth defects and their possible mechanisms, as well as limitations of current risk assessments. Moreover, it suggests ways to improve ART tracking and outcomes. ART is broadly defined as conception through any procedure or medication assisting in achieving pregnancy, including ovulation induction and intrauterine insemination. The Centers for Disease Control and Prevention (CDC) defines ART more narrowly as “any procedure that entails the handling of both eggs and sperm or of embryos for the purpose of establishing a pregnancy.”4 These procedures include in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). In IVF, fertilization is achieved by mixing eggs and sperm together in the laboratory. In ICSI, fertilization consists of direct microinjection of 1 sperm into 1 egg. In both, fertilized eggs are implanted after several days of ex vivo cell growth. Techniques of surgical embryo transfer include gamete intrafallopian transfer and zygote intrafallopian transfer. Emerging techniques involve additional gamete and embryo manipulation such as in vitro oocyte maturation.1 Complete data for the numbers of ART-related births, specific ART methods used, and birth …

Assisted reproductive technology in the United States: 2000 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry

Objective To summarize the procedures and outcomes of ART initiated in the United States in 2000. Design Data were collected electronically using the SART Clinical Outcome Reporting System software and submitted to the American Society for Reproductive Medicine/ Society for Assisted Reproductive Technology Registry. Participant(s) Three hundred eighty-three programs submitted data on procedures performed in 2000. Data were collated after November 2000 so that the outcome of all pregnancies established would be known. Main outcome measure(s) Incidence of clinical pregnancy, ectopic pregnancy, abortion, stillbirth, and delivery. Result(s) Programs reported initiating 99,989 cycles of ART treatment. Of these, 73,406 cycles involved fresh nondonor IVF (46.6% with intracytoplasmic sperm injection [ICSI]), with a delivery rate per retrieval of 29.9%; 549 were cycles of gamete intrafallopian transfer, with a delivery rate per retrieval of 24.7%; 763 were cycles of zygote intrafallopian transfer, with a delivery rate per retrieval of 29.9%. The following additional ART procedures were also initiated: 7,581 fresh donor oocyte cycles, with a delivery rate per transfer of 43.7%; 13,083 frozen embryo transfer procedures, with a delivery rate per transfer of 20.4%; 2,721 frozen embryo transfers using donated oocytes or embryos, with a delivery rate per transfer of 23.5%, and 1,200 cycles using a host uterus, with a delivery rate per transfer of 35.8%. In addition, 326 cycles were reported as combinations of more than one treatment type, 41 cycles as research, and 319 as embryo banking. As a result of all procedures, 25,394 deliveries were reported, resulting in 35,345 neonates, of which 35,031 were live born and 314 stillborn. Conclusion(s) In 2000, there were more programs reporting ART treatment and a significant (13.5%) increase in reported cycles compared to 1999. In comparable cycle types, overall success rate (deliveries per retrieval) exhibited an actual increase of 0.6%, which represents an increase of 2.2% when compared to the success rate for 1999.

Comparison of Zygote Intrafallopian Transfer and Intrauterine Embryo Transfer for Male-factor Infertility After Intracytoplasmic Sperm Injection

In vitro fertilization and embryo transfer (IVF-ET) have been increasingly used for treating male-factor infertility. However, zygote intrafallopian transfer (ZIFT) allows early embryo development to occur within the natural environment of the tubal lumen. The purpose of this study was to analyze whether the mode of embryo transfer, ZIFT versus intrauterine ET, affected the pregnancy outcome in the IVF cycle after intracytoplasmic sperm injection (ICSI) for the treatment of male-factor infertility. A total of 140 ICSI procedures (69 ET, 71 ZIFT) were analyzed. A maximum of four cleaving embryos were transferred into the fallopian tube or uterine cavity 48 and 72 hours after oocyte retrieval, respectively. Several variables, including mean age, IVF cycle day 2 hormone levels, peak E2 level, number of oocytes retrieved, number of embryos transferred, endometrial thickness, pulsatility index and resistance index of the uterine artery, and clinical pregnancy rate, were analyzed. The clinical pregnancy rate for ET was 25.4%, versus 24.7% for ZIFT. There was no significant difference between the two groups in the other variables, except for mean age. The data presented in this report demonstrate that there was no therapeutic improvement associated with the increased complexity of ZIFT as compared with intrauterine ET after ICSI for the treatment of male-factor infertility. With the advent of improvements in culture techniques in the IVF laboratory, intrauterine ET remains the technique of choice.

Recalcitrant cervical stenosis unresponsive to traditional attempts at cervical dilatation. successful intrauterine pregnancy following frozen embryo transfer after fluoroscopically guided cervical dilatation and stenting

Recalcitrant cervical stenosis unresponsive to traditional attempts at cervical dilatation. successful intrauterine pregnancy following frozen embryo transfer after fluoroscopically guided cervical dilatation and stenting

Junctional zone contractions during zygote intrafallopian transfer

Objective: Several studies have focused on junctional zone contractions (JZC) frequency and the outcome of IVF-ET. Fanchin et al. (1988) have noticed a stepwise decrease in pregnancy and implantation rates with increasing JZC frequency before ET. One possible mechanism for repeated implantation failure (RIF) in IVF-ET could be an abnormal pattern of JZC during the periovulatory period and at the time of ET, causing the expulsion of embryos from the uterine cavity. ZIFT has been suggested as a powerful clinical tool for the treatment of patients with RIF (Levran et al., 1998). Our objective was to evaluate and characterize the pattern of JZC in patients with RIF undergoing ZIFT.

Spontaneous abortion among pregnancies conceived using assisted reproductive technology in the United States

Objective To examine rates and risk factors for spontaneous abortion among pregnancies conceived using assisted reproductive technology (ART). Methods Subjects were 62,228 clinical pregnancies resulting from ART procedures initiated in 1996–1998 in US clinics. Spontaneous abortion was based on ART clinic report and was defined as loss of the entire pregnancy. Spontaneous abortion rates for ART pregnancies were compared with spontaneous abortion rates from the National Survey of Family Growth, a population-based survey of US women 15–44 years. Results The spontaneous abortion rate among ART pregnancies was 14.7%. This was similar to rates among pregnancies reported in the National Survey of Family Growth. Among pregnancies conceived with the patient’s oocytes and freshly fertilized embryos, the spontaneous abortion risk ranged from 10.1% among women 20–29 years to 39.3% among women older than 43. Spontaneous abortion risk among pregnancies conceived with donor eggs was 13.1% with little variation by patient age. Spontaneous abortion risk was increased for pregnancies conceived with frozen and thawed embryos and decreased among multiple-gestation pregnancies. Spontaneous abortion risk was increased among women reporting previous spontaneous abortions and ART attempts, and among women who used clomiphene or zygote intrafallopian transfer. Pregnancies conceived by young women, but gestated by a surrogate, were at increased risk for spontaneous abortion in comparison with young women who gestated their own pregnancies. Conclusion These findings suggest that ART does not pose a risk for spontaneous abortion. Factors related to oocyte or embryo quality are of primary importance in assessing spontaneous abortion risk.

Progress we can be proud of: U.S. trends in assisted reproduction over the first 20 years

Objective: Documentation of the significant progress of assisted reproductive technology (ART) therapy in the United States. Design: Tabulation of data from the annual published reports of ART activity in the United States for the years 1985 through 1999. Setting: ART centers in the United States that report their results to the Centers for Disease Control and Prevention (CDC) via the Society for Assisted Reproductive Technology (SART). Patient(s): The annual reports included 647,208 cycles of treatment. Intervention(s): None. Main Outcome Measure(s): The number of clinics and cycles, and the rates of pregnancy, delivery, miscarriage, and multiple pregnancy were examined. Practice trends were also examined. Result(s): The number of clinics and cycles has grown steadily. The 155,661 clinical pregnancies led to 128,608 births and 177,745 babies born. The advent of intracytoplasmic sperm injection (ICSI) and the fall of GIFT and zygote intrafallopian transfer (ZIFT) are noted. Pregnancy rates have risen steadily in all therapies, and the number of deliveries of triplets or more has declined dramatically in the most recent reporting years. Conclusion(s): Over the years, ART therapies have steadily become more effective, with notable reductions in multiple pregnancies, the ability to avoid laparoscopy (for egg retrieval and in some cases tubal transfers), and effective therapy for serious sperm, egg, and uterine problems, none of which was true in the early years. This has occurred owing to the dedication and ingenuity of practitioners, and, notably, without federal regulation of clinical practice.

Assisted reproductive technology in the United States: 1999 results generated from the American Society for reproductive medicine/society for assisted reproductive technology registry

Objective: To summarize the procedures and outcomes of ART initiated in the United States in 1999. Design: Data were collected electronically by using the SART Clinical Outcome Reporting System software and submitted to the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry. Participant(s): Three hundred sixty programs submitted data on procedures performed in 1999. Data were collated after November 2000 so that the outcome of all pregnancies established would be known. Main Outcome Measure(s): Incidence of clinical pregnancy, ectopic pregnancy, abortion, stillbirth, and delivery. Result(s): Programs reported initiating 88,077 cycles of ART treatment. Of these, 63,639 cycles involved IVF (with and without micromanipulation), with a delivery rate per retrieval of 29.4%; 838 were cycles of gamete intrafallopian transfer, with a delivery rate per retrieval of 27.9%; 945 were cycles of zygote intrafallopian transfer, with a delivery rate per retrieval of 29.8%. The following additional ART procedures were also initiated: 6,509 fresh donor oocyte cycles, with a delivery rate per transfer of 41.8%; 12,005 frozen embryo transfer procedures, with a delivery rate per transfer of 18.6%; 2,488 frozen embryo transfers using donated oocytes or embryos, with a delivery rate per transfer of 23.6%, and 821 cycles using a host uterus, with a delivery rate per transfer of 33.6%. In addition, 398 cycles were reported as combinations of more than one treatment type, 18 cycles as research, and 416 as embryo banking. As a result of all procedures, 21,904 deliveries were reported, resulting in 30,967 neonates. Conclusion(s): In 1999, more programs reported ART treatment and reported cycles increased significantly (7.5%) compared to 1998. In comparable cycle types, the overall success rate (deliveries per retrieval) increased by 0.4%, which represents an increase of 1.2% compared to the success rate for 1998.