Locations of ART Clinics in the United States and Puerto Rico, 2013 - - PowerPoint PPT Presentation

Locations of ART Clinics in the United States and Puerto Rico, 2013

Number of ART clinics in the United States in 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 497 Number of ART clinics that submitted data in 2013 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 467 Total number of ART cycles started in 2013 at clinics reporting data . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190,773* Number of live-birth deliveries resulting from ART cycles started in 2013 . . . . . . . . . . . . . . . . . . . . . . . . 54,323 Number of infants born as a result of ART cycles started in 2013. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67,996 * This number includes 27,564 cycles with the intent to freeze and bank all resulting eggs or embryos. The remaining 163,209 cycles in 2013 were performed with the intent to transfer at least one egg or embryo, and this is the number of cycles from which data for live- birth deliveries and infants born are based. The 190,773 total cycles in 2013 does not include 67 cycles in which a new treatment procedure was being evaluated.

Types of ART Cycles—United States,* 2013

Fresh nondonor 49.1% (93,787 cycles) Frozen nondonor 24.5% (46,779 cycles) Egg/embryo banking 14.4% (27,564 cycles) Fresh donor 5.1% (9,718 cycles) Frozen donor 5.4% (10,270 cycles) Frozen egg 1.4% (2,655 cycles) New treatment procedure <0.1% (67 cycles)

* Total does not equal 100% due to rounding.

ART Use by Age Group—United States,*† 2013

Age: <35 37.5% Age: 35–37 20.2% Age: 38–40 19.1% Age: 41–42 10.8% Age: 43–44 6.9% Age: >44 5.4%

* Based on 190,773 cycles.

† Total does not equal 100% due to rounding.

Types of ART Cycles by Age Group—United States,* 2013

Percent 20 40 60 80 100 Age (years) <35† 35–37 38–40† 41–42 43–44† >44 97% 4% 94% 6% 89% 10% 80% 20% 63% 38% 27% 73% (63) (60) (61) (59) (48) (17) (5) (10) (19) (31) (34) (34) (28) (21) (15) (10) (5) (10) (19) (42) Fresh nondonor Fresh donor Frozen nondonor Frozen donor

* Percentages of ART cycles that used fresh or frozen embryos from nondonor or donor eggs are in parentheses.

† Total does not equal 100% due to rounding.

Percentages of ART Cycles That Resulted in Live Births, by Type of ART and Clinic Size—United States, 2013

Percent 10 20 30 40 50 60 Clinic Size (number of ART cycles performed in 2013) <88 88–180 181–409 >409 30 30 31 28 33 33 36 38 44 50 50 49 35 35 36 38 Fresh nondonor Frozen nondonor Fresh donor Frozen donor

Outcomes of ART Cycles Using Fresh Nondonor Eggs or Embryos, by Stage, 2013

Number 20,000 40,000 60,000 80,000 100,000 93,787 cycles started 84,868 retrievals 73,571 transfers 33,425 pregnancies 27,406 live-birth deliveries

Reasons ART Cycles Using Fresh Nondonor Eggs or Embryos Were Canceled,* 2013

No or not enough egg production 83.8% Patient withdrawal for other reasons 11.6% Over response to

• varian stimulation

medication 3.5% Concurrent illness 1.1%

* Based on 8,919 ART cycles.

Percentages of ART Cycles and Transfers Using Fresh Nondonor Eggs or Embryos That Resulted in Pregnancies, Live Births, and Single-Infant Live Births, 2013

Percent 10 20 30 40 50 Pregnancies Live births Single-infant live births 35.6 29.2 21.4 45.4 37.3 27.3 Cycles Transfers

Outcomes of ART Cycles Using Fresh Nondonor Eggs or Embryos, 2013

No pregnancy 63.7% Ectopic pregnancy 0.7% Single-fetus pregnancy 23.5% Multiple- fetus pregnancy 9.9% Not able to determine number

• f fetuses 2.2%

Clinical pregnancy 35.6%

Outcomes of Pregnancies That Resulted from ART Cycles Using Fresh Nondonor Eggs or Embryos,*† 2013

Stillbirth 0.5% Miscarriage 15.8% Induced abortion 0.9% Unknown 0.7% Single-infant birth 60.2% Multiple-infant birth 21.8% Total live births 82.0%

* Maternal deaths prior to birth are not displayed due to small number (n = 5).

† Total does not equal 100% due to rounding.

Distribution of Multiple-Fetus Pregnancies and Multiple-Infant Live Births Among ART Cycles Using Fresh Nondonor Eggs or Embryos, 2013

• A. 33,425 pregnancies

Single fetuses 66.0% Twins 26.1% Triplets or more 1.6% Not able to determine number of fetuses 6.3%

• B. 27,406 live births

Single infants 73.4% Twins 25.7% Triplets or more 0.9%

Percentages of Preterm Infants or Infants with Low Birth Weight from ART Cycles Using Fresh Nondonor Eggs or Embryos, by Number of Infants Born, 2013

Percent 20 40 60 80 100 Number of Infants Born Single infants from single-fetus pregnancies Single infants from multiple-fetus pregnancies Twins Triplets or more 11.3 17.3 57.8 95.8 9.0 17.1 56.2 92.3 Preterm infants Low birth weight infants

Age Distribution of Women Who Had ART Cycles Using Fresh Nondonor Eggs or Embryos, 2013

Percent 1 2 3 4 5 6 7 8 9 10 Age (years) <24 24 26 28 30 32 34 36 38 40 42 44 46 48 >48 Mean Median

Percentages of ART Cycles Using Fresh Nondonor Eggs or Embryos That Resulted in Pregnancies, Live Births, and Single-Infant Live Births, by Age of Woman,* 2013

Percent 10 20 30 40 50 60 Age (years) <24 24 26 28 30 32 34 36 38 40 42 44 >44 Pregnancies Live births Single-infant live births

* For consistency, all percentages are based on cycles started.

Percentages of ART Cycles Using Fresh Nondonor Eggs or Embryos That Resulted in Pregnancies, Live Births, and Single-Infant Live Births Among Women Aged 40 or Older,* 2013

Percent 10 20 30 Age (years) 40 41 42 43 44 > 44 25 21 16 12 8 4 17 13 9 6 3 2 14 11 8 6 3 1 Pregnancies Live births Single-infant live births

* For consistency, all percentages are based on cycles started.

Percentages of ART Cycles Using Fresh Nondonor Eggs or Embryos That Resulted in Miscarriage, by Age of Woman, 2013

Percent 10 20 30 40 50 60 Age (years) <24 24 26 28 30 32 34 36 38 40 42 44 >44

Outcomes of ART Cycles Using Fresh Nondonor Eggs or Embryos, by Stage and Age Group, 2013

Percent 20 40 60 80 100 Age (years) <35 35–37 38–40 41–42 43–44 >44 94 91 88 84 82 76 84 80 75 69 64 54 46 38 29 19 10 4 40 32 21 11 5 2 Retrieval Transfer Pregnancy Live birth

Percentages of ART Cycles Using Fresh Nondonor Eggs or Embryos, by Infertility Diagnosis,* 2013

Percent 10 20 30 40 Diagnosis 14.4 13.2 29.5 9.5 4.9 34.8 12.9 14.7 11.0 17.5

* Total percentages are greater than 100% because more than one diagnosis can be reported for each cycle.

Percentages of ART Cycles Using Fresh Nondonor Eggs or Embryos That Resulted in Live Births, by Infertility Diagnosis, 2013

Percent 10 20 30 40 Diagnosis 28.3 37.3 17.4 31.3 23.2 33.3 24.0 33.6 21.9 28.5

Percentages of ART Cycles Using Fresh Nondonor Eggs or Embryos That Resulted in Live Births, by Age Group and Number of Previous Live Births, 2013

Percent 10 20 30 40 50 Age (years) <35 35–37 38–40 41–42 43–44 >44 40 31 20 11 5 2 42 34 24 12 6 1 38 33 21 12 4 2 No previous live births 1 previous live birth 2 or more previous live births

Percentages of ART Cycles Using Fresh Nondonor Eggs or Embryos That Resulted in Live Births, by Age Group and History of Miscarriage, Among Women with No Previous Births,* 2013

Percent 10 20 30 40 50 Age (years) <35 35–37 38–40 41–42 43–44 >44 39.8 30.4 19.9 9.4 4.3 1.8 38.6 30.8 20.7 12.6 6.0 1.3 No previous pregnancies 1 or more previous miscarriages

* Women reporting only previous ectopic pregnancies or pregnancies that ended in induced abortion are not included.

Percentages of ART Cycles Using Fresh Nondonor Eggs or Embryos That Resulted in Live Births, by Age Group and Number of Previous ART Cycles, Among Women with No Previous Live Births, 2013

Percent 10 20 30 40 50 Age (years) <35 35–37 38–40 41–42 43–44 >44 42 33 22 11 5 1 35 28 19 11 5 2 32 27 18 11 5 3 29 22 18 9 5 1 No previous cycles 1 previous cycle 2 previous cycles 3 or more previous cycles

Percentages of Retrievals Using Fresh Nondonor Eggs or Embryos That Used ICSI, 2013

Percent 20 40 60 80 100 Age (years) <35 35–37 38–40 41–42 43–44 >44 95.1 93.7 92.6 91.2 92.3 93.3 65.5 65.6 67.2 68.6 72.1 78.0 ICSI, with male factor ICSI, no male factor

Percentages of Fresh Nondonor Retrievals That Resulted in Live Births Among Patients with or Without Diagnosed Male Factor Infertility, by Age Group and Use of ICSI,* 2013

Percent 10 20 30 40 50 Age (years) <35 35–37 38–40 41–42 43–44 >44 45 37 26 15 8 3 39 33 23 12 6 2 43 36 26 15 6 2 ICSI, with male factor ICSI, no male factor No ICSI, no male factor

* Cycles using donor sperm and cycles using GIFT or ZIFT are excluded.

Numbers of Embryos Transferred Among All Transfers Using Fresh Nondonor Eggs or Embryos,* 2013

One 23.6% Two 55.7% Three 14.6% Four 4.0% Five 1.5% Six 0.3% Seven or more 0.1% Zero or unknown <0.1%

* Total does not equal 100% due to rounding.

Percentages of Embryos Transferred That Implanted Using Fresh Nondonor Eggs or Embryos, by Age Group, 2013

Percent 10 20 30 40 50 Age (years) <35 35–37 38–40 41–42 43–44 >44 39.9 30.8 20.0 10.7 5.0 2.3

Percentages of Transfers Using Fresh Nondonor Eggs or Embryos That Resulted in the Live Birth of a Single, Term, and Normal Birth Weight Infant, by Number of Embryos Transferred, 2013

Percent 10 20 30 40 Number of Embryos Transferred 1 2 3 4+ 28.7 23.1 16.8 13.0

Percentages of Transfers Using Fresh Nondonor Eggs or Embryos That Resulted in Live Births and Distribution of Number of Infants Born, by Number of Embryos Transferred,* 2013

Percent 10 20 30 40 50 Number of Embryos Transferred 1 2† 3 4+ 34.2% 42.8% 28.3% 20.0% (98.2) (64.9) (72.5) (78.8) (1.7) (34.4) (24.7) (19.4) (0.1) (0.8) (2.8) (1.8) Single infants Twins Triplets or more

* Percentages of transfers resulting in live births are shown on top of each bar graph. Percentages of live births that were single infants, twins, and triplets or more are in parentheses.

† Total does not equal 100% due to rounding.

Percentages of Transfers Using Fresh Nondonor Eggs or Embryos That Resulted in Live Births and Distribution of Number of Infants Born Among Good-Prognosis Women, by Number of Embryos Transferred,* 2013

Percent 10 20 30 40 50 60 70 Number of Embryos Transferred 1† 2 3 4+ 51.0% 55.8% 45.0% 37.1% (98.2) (56.0) (59.0) (61.5) (1.8) (42.9) (36.1) (38.5) (0.1) (1.1) (4.9) Single infants Twins Triplets or more

* Percentages of transfers resulting in live births are shown on top of each bar graph. Percentages of live births that were single infants, twins, and triplets or more are in parentheses.

† Total does not equal 100% due to rounding.

Day of Embryo Transfer* Among All ART Transfers Using Fresh Nondonor Eggs or Embryos,† 2013

Day 1 0.1% Day 2 3.9% Day 3 40.1% Day 4 1.7% Day 5 50.4% Day 6 3.8%

* Number of days following egg retrieval.

† Cycles using GIFT or ZIFT are excluded. Missing or implausible values for day of embryo transfer (i.e., 0 or greater than 6) are not included.

Percentages of Day 3 and Day 5 Embryo Transfers Using Fresh Nondonor Eggs or Embryos That Resulted in Live Births, by Age Group,* 2013

Percent 10 20 30 40 50 60 Age (years) <35 35–37 38–40 41–42 43–44 >44 38.5 31.9 23.1 13.2 6.3 2.8 52.5 45.8 35.5 22.0 12.5 4.8 Day 3 Day 5

* Cycles using GIFT or ZIFT are excluded. Embryo transfers performed on days 1, 2, 4, and 6 are not included because each of these accounted for a small proportion of procedures.

Numbers of Embryos Transferred on Day 3 and Day 5 Among All Transfers Using Fresh Nondonor Eggs or Embryos,* 2013

Day 3

One 16.0% Two 49.2% Three 23.4% Four or more 11.4%

Day 5†

One 27.8% Two 62.5% Three 8.0% Four or more 1.6%

* Cycles using GIFT or ZIFT are excluded. Embryo transfers performed on days 1, 2, 4, and 6 are not included because each of these accounted for a small proportion of procedures.

† Total does not equal 100% due to rounding.

Distribution of Number of Infants Born Among Day 3 and Day 5 Embryo Transfers Using Fresh Nondonor Eggs or Embryos That Resulted in Live Births,* 2013

Day 3 Single infants 76.5% Twins 22.5% Triplets

• r more

1.0%

• A. 8,123 live births

Day 5 Single infants 71.5% Twins 27.7% Triplets

• r more

0.8%

• B. 17,041 live births

* Cycles using GIFT or ZIFT are excluded. Embryo transfers performed on days 1, 2, 4, and 6 are not included because each of these accounted for a small proportion of procedures.

Percentages of Day 5 Transfers Using Fresh Nondonor Eggs or Embryos That Resulted in Live Births and Distribution of Number of Infants Born Among Good-Prognosis Women, by Number of Embryos Transferred,* 2013

Percent 10 20 30 40 50 60 70 Number of Embryos Transferred 1† 2 3+ 52.1% 58.3% 40.3% (98.3) (52.8) (54.8) (1.7) (46.0) (39.7) (0.1) (1.2) (5.5) Single infants Twins Triplets or more

* Percentages of transfers resulting in live births are shown on top for each bar graph. Percentages of live births that were single infants, twins, and triplets or more are in parentheses. Cycles using GIFT or ZIFT are excluded.

† Total does not equal 100% due to rounding.

Comparison of Percentages of Transfers Using Fresh Nondonor Eggs or Embryos That Resulted in Live Births Between ART Cycles That Used Gestational Carriers and Those That Did Not, by Age Group,* 2013

Percent 10 20 30 40 50 60 Age (years) <35 35–37 38–40 41–42 43–44 >44† 55.3 43.2 38.3 27.9 16.2 47.3 39.3 28.3 16.1 8.1 3.0 Used a gestational carrier Did not use a gestational carrier

* Age categories reflect the age of the ART patient, not the age of the gestational carrier. † There were no transfers resulting in live births among ART patients older than age 44 who used gestational carriers.

Percentages of Embryos Transferred That Implanted Using Frozen Nondonor Embryos, by Age Group, 2013

Percent 10 20 30 40 50 Age (years) <35 35–37 38–40 41–42 43–44 >44 39.6 35.6 31.5 25.4 18.6 13.1

Percentages of Transfers Using Frozen or Fresh Nondonor Embryos That Resulted in Pregnancies, Live Births, and Single-Infant Live Births, 2013

Percent 10 20 30 40 50 60 Pregnancies Live births Single-infant live births 49.9 39.6 31.5 45.4 37.3 27.3 Frozen nondonor Fresh nondonor

Distribution of Multiple-Fetus Pregnancies and Multiple-Infant Live Births Among ART Cycles Using Frozen Nondonor Embryos, 2013

• A. 21,766 pregnancies

Single fetuses 70.2% Twins 19.8% Triplets

• r more

1.2% Not able to determine number of fetuses 8.8%

• B. 17,240 live births

Single infants 79.7% Twins 19.6% Triplets

• r more

0.7%

Percentages of ART Cycles Using Donor Eggs, by Age of Woman, 2013

Percent 10 20 30 40 50 60 70 80 90 100 Age (years) <24 24 26 28 30 32 34 36 38 40 42 44 46 48 >48

Percentages of Transfers Using Fresh Embryos from Donor or Nondonor Eggs That Resulted in Live Births, by Age of Woman, 2013

Percent 10 20 30 40 50 60 70 80 90 100 Age (years) <30 30 32 34 36 38 40 42 44 46 >47 Donor eggs Nondonor eggs

Distribution of Multiple-Fetus Pregnancies and Multiple-Infant Live Births Among ART Cycles Using Fresh Embryos from Donor Eggs, 2013

• A. 5,673 pregnancies

Single fetuses 60.8% Twins 32.3% Triplets

• r more

1.3% Not able to determine number of fetuses 5.6%

• B. 4,803 live births

Single infants 67.2% Twins 32.2% Triplets

• r more

0.6%

Percentages of Transfers Using Frozen or Fresh Donor Embryos That Resulted in Pregnancies, Live Births, and Single-Infant Live Births, 2013

Percent 10 20 30 40 50 60 70 Pregnancies Live births Single-infant live births 50.1 40.2 32.0 66.0 55.9 37.5 Frozen donor Fresh donor

Numbers of ART Cycles Performed, Live-Birth Deliveries, and Infants Born Using ART, 2004–2013

Number 20,000 40,000 60,000 80,000 100,000 120,000 140,000 160,000 180,000 Year 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Art cycles Live-birth deliveries Infants born

Numbers of ART Cycles Performed for Banking All Fresh Nondonor Eggs or Embryos, 2004–2013

Number 5,000 10,000 15,000 20,000 25,000 30,000 Year 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Numbers of ART Cycles Using Donor Eggs or Embryo, 2004–2013

Number 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 18,000 20,000 22,000 Year 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Percentages of Retrievals Using Fresh Nondonor or Donor Eggs or Embryos That Used ICSI, 2004–2013

Percent 10 20 30 40 50 60 70 80 90 100 Year 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Overall Male factor No male factor

Percentages of Transfers Using Fresh Nondonor Eggs or Embryos That Resulted in Single-Infant Live Births, by Age Group, 2004–2013

Percent 10 20 30 40 Year 2004 2005 2006* 2007* 2008 2009 2010 2011 2012 2013

Age Group:

<35 35–37 38–40 41–42 >42 43–44 >44

* Through 2006, data for women older than age 42 were combined. Starting in 2007, data for women older than age 42 were reported as women aged 43–44 and women older than age 44.

Percentages of Fresh Nondonor Transfers of One, Two, Three, or Four or More Embryos, 2004–2013

Percent Year 2004 2005* 2006* 2007* 2008 2009 2010 2011 2012 2013* Number of Embryos Transferred 8.2 9.3 10.7 11.6 11.9 13.5 15.5 16.6 19.5 23.6 39.4 43.4 46.0 48.1 49.8 51.5 52.8 53.9 55.0 55.7 31.8 29.5 27.6 26.0 24.8 23.4 21.3 20.1 17.7 14.6 20.6 17.9 15.8 14.4 13.5 11.6 10.4 9.4 7.8 6.0 One Two Three Four or more

* Totals do not equal 100% due to rounding.

Percentages of Elective Single Embryo Transfer (eSET) Among All Transfers Using Fresh Nondonor Eggs or Embryos, by Age Group,* 2004–2013

Percent 2 4 6 8 10 12 14 16 18 20 22 Year 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Age Group:

<35 35–37 38–40 >40

* All ages older than 40 years are reported together due to the small number of transfers performed with eSET.

Percentages of Transfers Using Fresh Nondonor Eggs or Embryos That Resulted in Live Births, by Number of Embryos Transferred, 2004–2013

Percent 10 20 30 40 50 Year 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Number of Embryos Transferred One Two Three Four or more

Percentages of Live Births Using Fresh Nondonor Eggs or Embryos That Resulted in Multiple Infants Born, by Age Group, 2004–2013

Percent 10 20 30 40 50 Year 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Age Group:

<35 35–37 38–40 41–42 >42

Percentages of Single Infants, Twins, and Triplets or More Among ART Transfers Using Fresh Nondonor Eggs or Embryos That Resulted in Live Births, 2004–2013

Percent Year 2004 2005 2006 2007 2008 2009 2010 2011* 2012 2013 67.5 68.0 69.3 68.8 68.4 69.5 69.7 71.3 72.6 73.4 29.9 29.6 28.8 29.4 29.8 28.9 28.8 27.5 26.4 25.7 2.6 2.4 1.9 1.8 1.8 1.6 1.5 1.3 1.0 0.9 Single infants Twins Triplets or more

* Total does not equal 100% due to rounding.