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

OBJECTIVE: To summarize the procedures and outcomes of assisted reproductive technologies (ART) that were initiated in the United States in 2001. DESIGN: 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. PARTICIPANT(S): 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. MAIN OUTCOME MEASURE(S): Incidence of clinical pregnancy, ectopic pregnancy, abortion, stillbirth, and delivery. RESULT(S): 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. CONCLUSION(S): In 2001, there were more programs reporting ART treatment and a significant increase in reported cycles compared with 2000.

A prospective study of the effects of female and male marijuana use on in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT) outcomes.

OBJECTIVE: This study was undertaken to examine whether marijuana use affects in vitro fertilization and gamete intrafallopian transfer (IVF/GIFT). STUDY DESIGN: Prospective study of 221 IVF/GIFT couples. RESULTS: Amount of lifetime heavy marijuana use adversely affected IVF/GIFT. Women smoking more than 90 times in their lifetime had 27% fewer oocytes retrieved (P = .03) and 1 fewer embryo transferred (P < .05). Women smoking marijuana more than 10 times in their lifetime had infants 17% (P = .01) smaller at birth. If men smoked marijuana 11 to 90 times in their lifetime, there was a 15% decrease in infant birth weight (P = .03); if this increased to more than 90 times, there was a 23% decrease (P = .01). Timing also played a role. Women smoking marijuana 1 year before IVF/GIFT had 25% fewer oocytes retrieved (P = .03), whereas couples had 28% (P = .04) fewer oocytes fertilized. Women and men who smoked in the past 15 years, had 12% (P = .04) and 16% (P = .03) smaller infants, respectively. CONCLUSION: Both timing and amount of marijuana use negatively affected IVF/GIFT.

Ethnic background and in vitro fertilization outcomes.

OBJECTIVE: To compare IVF outcomes among women of different ethnic backgrounds. METHOD: This was a retrospective cohort study. Between August 1994 and March 1998, the first IVF cycles of 1039 white, 43 African American, 18 Hispanic, and 35 Asian women were examined. RESULT: Ages and day 3 FSH levels did not differ significantly among patients. African Americans weighed more than other ethnic groups and were also more likely to have tubal factor infertility than whites. IVF cycle characteristics did not vary among the ethnic groups with the exception that African Americans had a higher level of estradiol on day of HCG than whites. Pregnancy outcomes did not differ among the ethnic groups. The percentage of ectopic pregnancies, spontaneous abortions, and successful live births was similar among the groups. CONCLUSION: Our data showed no significant difference in pregnancy outcomes with IVF among the ethnic groups.

Pregnancy complications, obstetric risks, and neonatal outcome in singleton and twin pregnancies after GIFT and IVF.

PURPOSE: In vitro fertilization (IVF) and to a lower extent gamete intra-fallopian transfer (GIFT) have become routine infertility treatments in industrialized countries. Our purpose is to compare the obstetric and neonatal characteristics of singleton and twin pregnancies after GIFT and IVF with those conceived spontaneously. METHODS: This case-control study was conducted in a tertiary care medical center. The 322 singleton and 78 twin pregnancies after GIFT or IVF from 1991 through 1996 were evaluated and compared with each other, and with a control group that conceived spontaneously and matched for parity, maternal and gestational age. Statistical significance of differences was assessed by chi(2) test or two-tailed Fisher exact test. Continuous variables were compared by the paired t-test. RESULTS: Pregnancy-induced hypertension (PIH) and vaginal bleeding were significantly more frequent maternal complications in the GIFT/IVF singleton groups compared to controls. In twin pregnancies the rate of cesarean sections, vaginal bleeding and preterm labor were more common after GIFT/IVF but did not reach statistical significance. Assisted reproduction was associated with low birth weight only in twin pregnancies when controlled for confounding variables, however perinatal outcome was comparable. There was no significant difference in the outcome measures between GIFT and IVF pregnancies. CONCLUSION: After controlling for parity, maternal and gestational age, singleton pregnancies conceived by GIFT/IVF are at increased obstetrical risk, however the perinatal outcome is comparable despite a lower average birth weight.

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.

A minimally monitored assisted reproduction stimulation protocol reduces cost without compromising success.

OBJECTIVE: To determine if a fixed-dose stimulation protocol with monitoring limited to a single ultrasound can provide acceptable outcomes in assisted reproduction technologies (ART) procedures in appropriately selected patients. DESIGN: Prospective study of all minimally monitored ART cycles from 1996 through 1998. SETTING: University ART program. PATIENTS: Eligibility included Institutional Review Board consent, age 18-37, basal FSH < or = 10, normal semen parameters, and regular menses. IVF (n = 81) and GIFT (n = 14). INTERVENTIONS: A single ultrasound was performed after 8 or 9 days of stimulation in a fixed-schedule long luteal phase leuprolide protocol. No hormone levels were obtained. Human chorionic gonadotropin was administered when at least 2 follicles were projected to reach 18 mm. MAIN OUTCOME MEASURES: Pregnancy, delivery, and implantation rates. RESULTS: The clinical pregnancy rates were 51% for IVF and 36% for GIFT. Delivery rates were 42% for IVF and 29% for GIFT. The implantation rates for IVF were 23% and 17% for GIFT. No patient was admitted for ovarian hyperstimulation. CONCLUSIONS: We were able to achieve satisfactory pregnancy and delivery rates in properly selected patients with a minimal monitoring protocol, limited to a single ultrasound near the end of a fixed-stimulation regimen. The reduced time commitment and cost led to a very high patient acceptance of this approach.

A one-year experience with a capitated health care plan for infertility.

OBJECTIVE: To report on a one-year experience participating in a capitated healthcare plan for infertility. DESIGN: Prospective study. SETTING: University population. PATIENT(S): Reproductive-age women 15 to 50 years. INTERVENTION(S): The first-generation Lewin infertility algorithm and CATHI software were used to negotiate infertility services under a capitated arrangement for $0.50 per member per month. The following reports our experience for the fiscal year 1997. MAIN OUTCOME MEASURE(S): Infertility services rendered, pregnancy rate, cost of services, collection rates. RESULT(S): Five thousand forty-six women representing 39,689 member months generated 39 new and 198 return visits. Thirty-two percent of the patients required three visits or less; six patients generated 22% of the visits. Fifty-one percent listed infertility as one of their chief complaints; 31% had mixed diagnoses. Eight (7.6%) patients required surgery, 11 (10.5%) patients underwent either IVF or GIFT cycles. Total charges submitted were $176,636; the amount assigned to specialty care was $135,277, and to IVF/GIFT, $33,433. Total capitated payments, including copayments, was $126,256 under the reproductive medicine agreement and $32,891 under the infertility rider. This resulted in a 71% gross collections rate. CONCLUSION(S): This study indicates that entering into a capitated health care plan to provide an infertility benefit can produce a successful result.

[The influence of infertility treatment and assisted reproduction techniques on multiple pregnancy rates]. / Wplyw leczenia nieplodnosci i technik wspomaganego rozrodu na czestosc wystepowania ciaz wieloplodowych.

It has to be remembered that pregnancies resulting from assisted reproductive technologies are more complicated that spontaneous pregnancies. There are higher rates of spontaneous abortions, ectopic, and multiple pregnancies. This work summarizes the latest year's experiences from the best world's clinics with multifetal pregnancy incidence in assisted reproductive technologies programs.

Anaesthesia for assisted conception: a survey of UK practice.

A telephone survey was undertaken of all UK centres (total 70) licensed for performing in vitro fertilization (IVF) and gamete intra-fallopian transfer (GIFT) by the Human Fertilisation and Embryology Authority (HFEA). The survey was carried out during the months of November and December 1997. Thirty-seven (52.1%) centres were in the NHS sector and 33 (47.8%) in the private sector. A response was available from 60 (84%) centres. A standard questionnaire was used which requested information about the procedures carried out, anaesthetic technique and pharmacological agents used. Forty-seven centres carried out IVF, two centres GIFT and 11 centres both. Out of 58 centres carrying out IVF, sedation was used in 28, general anaesthesia in 17, sedation combined with regional anaesthesia in seven and regional anaesthesia in one. Five centres gave a choice. Out of 22 centres using general anaesthesia for IVF, 12 used inhalational agents (isoflurane eight, enflurane four, sevoflurane two), eight used total intravenous anaesthesia (TIVA) with propofol and two centres inhalational agents or TIVA. Propofol was the induction agent in all but two centres. For IVF under sedation, 18 centres used midazolam, five used diazepam, three used opioids, one used entonox and the remaining ones a combination. When sedation was combined with regional anaesthesia, four centres used midazolam, two used propofol, one used midazolam with propofol, one used opioids and one used entonox. The regional technique in the 11 centres was either paracervical block with lignocaine (eight) or subarachnoid block with bupivacaine (three). Systemic analgesia was secured with fentanyl (22), pethidine (16), alfentanil (15), diclofenac (14), piroxicam (two), ketorolac (one) and ibuprofen (one). Five centres did not use any opioids; 40 centres did not use any nonsteroidal agents (NSAIDs). Out of the 13 centres that carried out GIFT, 12 used general anaesthesia while the thirteenth gave the patient a choice between general or regional anaesthesia. 11 centres used inhalational agents (isoflurane nine, enflurane two) while two used TIVA with propofol; propofol was the induction agent used in six centres while thiopentone was used in five. The range of analgesics was wide--fentanyl in six centres, alfentanil in three, morphine in two, diclofenac in five and ketorolac in one. Two centres did not use any opioids and seven centres did not use an NSAID. The only agreement at present appears to be that halothane is an unwise choice for IVF. No other technique has yet been proven to be either advantageous or detrimental.

Age-related pregnancy rates in GIFT patients.

OBJECTIVE: Fecundity and fertility decline with increasing age beginning as early as age 30 and decrease more precipitously after age 40. The purpose of this study was to determine if pregnancy rates of patients attempting gamete intrafallopian transfer (GIFT) are lower for women between the ages of 35 and 40. METHODS: A retrospective chart review was performed to assess the age-specific pregnancy rates for patients in our GIFT program. We report the results of GIFT at Walter Reed Army Medical Center and the National Naval Medical Center during the period from July 1, 1994, to July 1, 1995. RESULTS: Fifty-six women aged 21 to 39 underwent one to three cycles of gamete intrafallopian transfer. The 72 tubal transfers performed resulted in 25 pregnancies (34.7% pregnancy rate per transfer). CONCLUSIONS: In this series, pregnancy rates did not differ significantly in women older than 35 years versus women younger than 35 years. The number of eggs collected decreased significantly with increasing age but was not significantly different between pregnant and nonpregnant patients. Previous reports demonstrate a clear decline in fertility and poor pregnancy rates with assisted reproductive technology in older women. We did not find age-related differences in pregnancy rates among women younger than 40 years undergoing GIFT during the period studied.

The influence of advanced age on the outcome of assisted reproduction.

PURPOSE: Our purpose was to determine the influence of age on the outcome of assisted reproduction, with particular interest in women aged 40 years or older. METHODS: A retrospective review of the 779 patients enrolled in the Royal Hospital for Women Fertility Group fertility program between 1987 and 1994 was performed. The results for women aged 40 years or older were compared with those for women between 36 and 39 years and those younger than 36 years. The main outcome measures were pregnancy rate, pregnancy outcome, fertilization rate, and ovarian response. RESULTS: Compared with those in younger women, pregnancy rate, pregnancy outcome, fertilization rate, and ovarian response to controlled ovarian stimulation were significantly worse in women aged 40 years or older. CONCLUSIONS: The outcome of assisted reproduction in women of 40 years of age or older was extremely poor. Compared with those in younger women, pregnancy outcome and ovarian response to controlled ovarian stimulation were significantly worse in women of 40 years or more.

Assisted reproductive technology in the United States and Canada: 1995 results generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry.

OBJECTIVE: To summarize the procedures and outcomes of assisted reproductive technology (ART) initiated in the United States and Canada in 1995. DESIGN: Data were collected in the Society for Assisted Reproductive Technology database program and cycle reporting forms and were submitted to the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry. PARTICIPANT(S): Two hundred eighty-one programs submitted data on procedures performed in 1995. Data were collected after November 1996 so that outcome of all pregnancies established would be known. MAIN OUTCOME MEASURE(S): Procedural outcomes measured included clinical pregnancy, ectopic pregnancy, abortion, stillbirth, delivery, and congenital abnormality. RESULT(S): Programs reported initiating 59,142 cycles of ART treatment, including frozen embryo and donor oocyte cycles. Of these, 41,087 cycles initiated were IVF (with and without micromanipulation) with 22.5% deliveries per retrieval; 3,741 were cycles of gamete intrafallopian transfer with 27.0% deliveries per retrieval; 1,078 were cycles of zygote intrafallopian transfer with 27.9% deliveries per retrieval. In addition to these cycles initiated in 1995, 8,453 frozen embryo thaw procedures were reported, either as separate procedures or in combination with other ART procedures with 15.2% deliveries per transfer, 3,555 donor oocyte cycles were initiated with an overall success of 36.0% deliveries per transfer, 1,028 cryopreserved embryo thaw procedures from donated oocyte procedures with an overall success of 16.8% deliveries per transfer, and 200 ART treatment cycles in which a host uterus was used were initiated with an overall success of 34.9% deliveries per ET. As a result of all procedures, a total of 11,631 deliveries were reported, resulting in 16,520 neonates. CONCLUSION(S): In 1995, there were more programs reporting ART treatment and a significant (19.3%) increase in reported cycles. In comparable cycle types, overall average success rates (deliveries per transfer) exhibited a 0.6% increase or a 2.5% increase over the rates in the 1994 reported summaries.

Secondary donation of frozen embryos is more common after pregnancy initiation with donated eggs than after in vitro fertilization-embryo transfer and gamete intrafallopian transfer.

OBJECTIVE: To determine the availability of donated cryopreserved embryos. DESIGN: Retrospective review. SETTING: Community hospital-based donor oocyte program. PATIENT(S): Eighty-nine consecutive infertile couples and women who had 94 sets of embryos cryopreserved after pregnancy initiation with unfertilized donated eggs between January 1, 1991 and December 31, 1996. INTERVENTION(S): Cryopreservation of fertilized ova or cleaving embryos. MAIN OUTCOME MEASURE(S): Disposition of frozen embryos as of June 1, 1997. RESULT(S): Of the 94 sets of frozen embryos, 52 (55.3%) were thawed into the original recipient. At an average of 30 months since the treatment cycle, 26 (27.7%) sets of embryos remain in storage. Of the 16 sets of embryos not thawed for transfer, 11 sets (11.7%) were donated and 5 sets (5.3%) were destroyed. The fraction of spare embryos donated was much higher after pregnancy initiation with unfertilized donated eggs than after IVF-ET and GIFT (68.8% versus 19.1%, respectively). CONCLUSION(S): Couples and women who did not use their frozen embryos after pregnancy initiation with unfertilized donated eggs were twice as likely to donate them as to have them destroyed. Secondary donation of cryopreserved embryos was much more common after pregnancy initiation with unfertilized donated eggs than after standard IVF-ET and GIFT.

Treatment of endometriosis-associated infertility.

The choice of treatment options for endometriosis-associated infertility has been both controversial and complex, largely because of lack of data. In the last 10 years, better data from numerous studies with improved design support laparoscopic ablation and/or resection of lesions as the most successful for both minimal/mild and moderate/severe/extensive disease. Laparotomy should be performed when necessary. Observation alone is sometimes indicated in young women with minimal/mild disease. Hormonal suppression has no identifiable role, except perhaps for severe/extensive disease, before IVF or GIFT. Ovarian stimulation with clomiphene or gonadotropins and concomitant intrauterine insemination is indicated for minimal/mild disease. IVF and GIFT are often best for those who have failed other treatments, have advanced age, prolonged infertility, and/or multiple-factor infertility.

Vigencia de la transferencia intratubaria de gametos (G.I.F.T.) en el momento actual / Standing of G.I.F.T. in the present moment

Hemos analizado los resultados obtenidos en 180 ciclos consecutivos de 131 pacientes en las que se realizó una transferencia intratubaria de gametos entre los años 1993-1996 en el Instituto de Ginecología y Fertilidad (IFER). La edad promedio de las mismas era de 33,8ñ4,1 años, siendo de 28,7ñ5,4 en las menores de 37 años y de 39,2ñ2,1 en las mayores de 37 años. El promedio de años de esterilidad era de 4,1ñ2,8 años, siendo el tiempo de esterilidad de 3,8ñ2,5 en las menores de 37 años y de 4,6ñ3,2 en las de edad mayor o igual a 37 años. Las causas por las que se realizó el procedimiento fueron: 45 ciclos de endometriosis, 40 de esterilidad sin causa aparente, 30 de factor masculino, 24 de factor tubo peritoneal y 26 de síndrome de ovario poliquístico. El porcentaje de embarazos global fue de 35,7 por ciento por ciclo de captación con un 16,9 por ciento de abortos y un porcentaje de nacidos vivos de 29,7 por ciento, con un 23,7 de embarazos múltiples y un 1,6 de embarazos ectópicos. El índice de implantación fue del 12 por ciento. Los resultados obtenidos más los datos aportados por la bibliografía nos permiten sostener que este procedimiento mantiene su vigencia al momento actual, en todas las indicaciones de infertilidad a excepción del factor masculino severo, siendo la edad de las pacientes un factor importante en el logro de embarazos

Vigencia de la transferencia intratubaria de gametos (G.I.F.T.) en el momento actual / Standing of G.I.F.T. in the present moment

Hemos analizado los resultados obtenidos en 180 ciclos consecutivos de 131 pacientes en las que se realizó una transferencia intratubaria de gametos entre los años 1993-1996 en el Instituto de Ginecología y Fertilidad (IFER). La edad promedio de las mismas era de 33,8ñ4,1 años, siendo de 28,7ñ5,4 en las menores de 37 años y de 39,2ñ2,1 en las mayores de 37 años. El promedio de años de esterilidad era de 4,1ñ2,8 años, siendo el tiempo de esterilidad de 3,8ñ2,5 en las menores de 37 años y de 4,6ñ3,2 en las de edad mayor o igual a 37 años. Las causas por las que se realizó el procedimiento fueron: 45 ciclos de endometriosis, 40 de esterilidad sin causa aparente, 30 de factor masculino, 24 de factor tubo peritoneal y 26 de síndrome de ovario poliquístico. El porcentaje de embarazos global fue de 35,7 por ciento por ciclo de captación con un 16,9 por ciento de abortos y un porcentaje de nacidos vivos de 29,7 por ciento, con un 23,7 de embarazos múltiples y un 1,6 de embarazos ectópicos. El índice de implantación fue del 12 por ciento. Los resultados obtenidos más los datos aportados por la bibliografía nos permiten sostener que este procedimiento mantiene su vigencia al momento actual, en todas las indicaciones de infertilidad a excepción del factor masculino severo, siendo la edad de las pacientes un factor importante en el logro de embarazos (AU)