April 22-28, 2012 is National Infertility Awareness Week®, a nationwide campaign intended to educate the public about infertility and the concerns of the infertility community.
Preparing for Assisted Reproductive Technology
Considering Assisted Reproductive Technology?
In the United States, more than 440 clinics provide services to patients seeking to overcome infertility. CDC’s annual report on ART Clinic Success Rates is one tool used by consumers to identify clinics offering medical care and other services. These materials, prepared by CDC, can help consumers considering ART services. Whether you are hoping to become pregnant or seeking information to help a person with infertility, these materialss present important information to help you.
These materials focus on the important period before beginning care in an ART clinic—when a person or couple is in the process of selecting a clinic or provider. ART is just one option available to overcome infertility. Specialists in male and female reproductive endocrinology should be consulted to determine if your needs can be met using other forms of infertility care.
Preparing for Pregnancy and Infertility Treatment
“When you go through something like In-Vitro Fertilization, you want to make sure you have the best chance possible.” ~April
This information is for women who are considering infertility treatment and care, focusing on being prepared for pregnancy. Much of the information is adapted from CDC’s Recommendations for Preconception Health Care.
Good for you—if you are doing these things now!
These actions may increase your chance of achieving a pregnancy, having a healthy pregnancy, and avoid complications that could affect your health and the outcome of your pregnancy.
- Started and continued taking 400 mcg of folic acid daily, in the form of a vitamin supplement or enriched foods.
- Stopped smoking cigarettes.
- Reduced or eliminated alcohol consumption.
- Reduced or eliminated caffeine intake.
- Started or continued an exercise regimen that helps control weight and provides relaxation and stress reduction benefits.
- Continued to control your chronic conditions under medical supervision (e.g., high blood pressure, diabetes, reproductive tract infections, dental disease, anxiety, lupus, arthritis, epilepsy.)
- Developed eating habits that can continue into pregnancy and beyond, consider smaller portions of high quality foods providing sound nutritional value.
- Had your immunization records reviewed and are up-to-date for vaccines to protect you from diseases such as rubella, tetanus, influenza, and whooping cough.
- Took advantage of wellness programs at work or in the community.
What you may change as you begin infertility treatment.
- Use of medications and treatment (prescription, over-the-counter, herbal/complementary) that could affect fertility treatment outcomes or may cause birth defects.
- If you choose any form of infertility treatment, including ART, your physician should review these medications because some may interfere with treatment outcomes.
- You also need to know what drugs and medications are not advisable for use during pregnancy (e.g., cause birth defects, pregnancy complications) or can be used in moderation or with increased supervision.
- Exposure to products and medicines that may be used in your household. These can include products such as pesticides, solvents, and even prescription medicines that you may handle or touch. This includes clothing or equipment used by a household member in their work or as part of a hobby. If a pregnancy occurs, these exposures could be dangerous during the first trimester.
“…The healthiest women, the healthiest couples have the healthiest babies. The healthiest couples are going to have the best chance of successful assisted reproduction…” ~Dr. Callaghan.
Don’t forget your emotional health during this time. It is one part of the construct of health and wellness. Some ART clinics and several national organizations can provide peer support programs for you and others involved in your life.
Data provided by U.S. clinics that provide Assisted Reproductive Technology (ART) services to treat infertility are a rich source of information about the factors that contribute to success—the delivery of a live-born infant. The Report, and related materials on the CDC Web site, give potential ART users an idea of their average chances of success.
The data for the annual reports come from fertility clinics in operation during a reporting period, normally a calendar year. These clinics provide and verify data on the outcomes of all ART cycles started in their clinics.
Sections 1–5 provide information about success using data about all cycles performed in the United States. This helps answer questions such as—
- Who used ART services?
- What are the average chances of success using a specific type of ART service/procedure?
- What were the experiences of others who made the decision to use their own eggs or embryos vs. donated eggs?
- What are some of the factors that may influence success?
- Does age or type of infertility diagnosis matter?
Tables and charts along with a narrative discussion help you learn more about ART and how it may meet your need to form a family.
A separate portion of the annual report presents summary data from all clinics in the United States, followed by individual clinic reports. Clinics are listed in alphabetical order by state, then city, then clinic name.
The latest ART Success Rates Report is available online. It appears in several forms. You have the options of downloading the Report in Adobe PDF or reading directly from the Web. The interactive version allows you to select and print information about individual clinics.
- Print or “bookmark” the National Summary table for use in comparing and contrasting data and information from individual clinics.
- If using donor eggs or embryos, review Sections 1 and 4 of the report.
- If using your own fresh eggs for ART, review Sections 1 and 2 of the report.
- Clinics in large cities may have a main office and other locations in suburban areas. Often, the report combines data from all clinics and offices associated with the ART practice.
Some ART procedures use a woman’s own eggs, and others use donated eggs or embryos. Although sperm used to create an embryo also may be either from a woman’s partner or from a sperm donor, information in the report is presented according to the egg source. In some procedures, the embryos that develop are transferred back to the woman (fresh embryo transfer); in others, the embryos are frozen (cryopreserved) for transfer at a later date. The reports include data on frozen embryos that were thawed and transferred in the calendar year, not in the year in which they were preserved.
Section 1: Overview
This section answers many questions, including—
- Where are U.S. ART clinics located, how many ART cycles did they perform, and how many infants were born from these ART cycles?
- What types of ART cycles were used in the United States?
- How old were women who used ART in the United States?
- What types of ART cycles were used among women of different ages?
Section 2: ART Cycles Using Fresh Nondonor Eggs or Embryos
This section focuses on the use of a woman’s own eggs or embryos produced using her eggs. These are fresh rather than frozen eggs or embryos.
It answers these questions for those considering the use of fresh, nondonor eggs and embryos.
- What are the steps for an ART cycle using fresh nondonor eggs or embryos?
- Why are some ART cycles discontinued?
- How are success rates of ART measured?
- What percentage of ART cycles result in a pregnancy?
- What percentage of pregnancies result in a live birth?
- What is the risk of having a multiple-fetus pregnancy or multiple-infant live birth?
- What is the risk for preterm birth?
- What is the risk of having low-birth-weight infants?
- What are the ages of women who use ART?
- Do percentages of ART cycles that result in pregnancies, live births, and singleton live births differ among women of different ages?
- How do percentages of ART cycles that result in pregnancies, live births, and singleton live births differ for women aged 40 years or older?
- How does the risk for miscarriage differ among women of different ages?
- How does the risk for pregnancy loss vary during pregnancy (through week 24) among women of different ages?
- How does a woman’s age affect her chances of progressing through the various stages of ART?
- What are the causes of infertility among couples who use ART?
- Does the cause of infertility affect the percentage of ART cycles that result in live births?
- How many women who use ART have previously given birth?
- Do women who have previously given birth have higher percentages of ART cycles that result in live births?
- Is there a difference in percentages of ART cycles that result in live births between women with previous miscarriages and women who have never been pregnant?
- How many current ART users have undergone previous ART cycles?
- Are percentages of ART cycles that result in live births different for women using ART for the first time and women who previously used ART but did not give birth?
- What is the percentage of ART cycles that result in live births for women who have had both previous ART and previous births?
- What were the specific types of ART performed among women who used fresh nondonor eggs or embryos in that calendar year?
- What is the percentage of egg retrievals that result in live births for different types of ART procedures?
- Is intracytoplasmic sperm injection (ICSI) used only for couples diagnosed with male factor infertility?
- What is the percentage of retrievals that result in live births for couples with male factor infertility when ICSI is used?
- What is the percentage of retrievals that result in live births for couples without a diagnosis of male factor infertility when ICSI is used?
- How many embryos are transferred in an ART procedure?
- In general, is an ART cycle more likely to be successful if more embryos are transferred?
- Are percentages of transfers that result in live births affected by the number of embryos transferred for women who have more embryos available than they choose to transfer?
- How long after egg retrieval does embryo transfer occur?
- In general, is an ART cycle more likely to be successful if embryos are transferred on day 5?
- Does the number of embryos transferred differ for day 3 and day 5 embryo transfers?
- In general, how does the multiple-infant birth risk vary by the day of embryo transfer?
- For day 5 embryo transfers, are percentages of transfers that result in live births affected by the number of embryos transferred for women who have more embryos available than they choose to transfer?
- How do percentages of transfers that result in live births for women who use gestational carriers compare with women who do not use gestational carriers?
- How is clinic size related to percentages of ART cycles that result in live births?
Section 3: ART Cycles Using Frozen Nondonor Eggs or Embryos
This section focuses on cycles using embryos that were developed from the woman’s own eggs and frozen for later use. Two important questions are answered using graphics and data from clinic reporting.
- What is the percentage of transfers that result in live births and singleton live births for ART cycles using frozen nondonor embryos?
- What is the risk of having a multiple-fetus pregnancy or multiple-infant live birth from an ART cycle using frozen nondonor embryos?
Section 4: ART Cycles Using Donor Eggs
This section is useful for those considering use of donor eggs. It answers these key questions.
- Are older women undergoing ART more likely to use donor eggs or embryos?
- Do percentages of transfers that result in live births differ by age for women who used ART with donor eggs compared with women who used ART with their own eggs?
- How successful is ART when donor eggs are used?
- What is the risk of having a multiple-fetus pregnancy or multiple-infant live birth from an ART cycle using fresh donor eggs?
- How do percentages of transfers that result in live births differ for ART cycles between women who use frozen donor embryos and those who use fresh donor embryos?
Section 5: ART TRENDS
In this section you will find answer to questions about—
- Is the use of ART increasing?
- Are there changes in the types of ART cycles performed among women who used fresh or frozen nondonor eggs or embryos?
- What are the changes in the types of ART cycles performed among women who used fresh or frozen donor eggs or embryos?
- Have there been changes in percentages of transfers that resulted in live births among women who used fresh or frozen nondonor eggs or embryos?
- Have there been changes in percentages of transfers that resulted in live births among women who used fresh or frozen donor eggs or embryos?
- Have there been changes in percentages of transfers that resulted in singleton live births among women who used fresh or frozen nondonor eggs or embryos?
- Have there been changes in percentages of transfers that resulted in singleton live births among women who used fresh or frozen donor eggs or embryos?
- Have there been changes in percentages of transfers that resulted in live births for all ART patients or only for those in particular age groups?
- Have there been changes in percentages of transfers that resulted in singleton live births for all ART patients or only for those in particular age groups?
- Has the number of embryos transferred changed in fresh, nondonor cycles?
- Has the number of embryos transferred changed in fresh, nondonor cycles for women younger than age 35 who have more embryos available than they choose to transfer?
- Have there been changes in percentages of transfers that resulted in live births, by number of embryos transferred?
- Have there been changes in percentages of transfers that resulted in live births for women younger than age 35 who have more embryos available than they choose to transfer?
- Have percentages of multiple-infant live births changed?
- Have percentages of multiple-infant live births for ART cycles using fresh nondonor eggs or embryos changed in particular age groups?
Elective single-embryo transfer (eSET) is a procedure in which one embryo, selected from a larger number of available embryos, is placed in the uterus or fallopian tube. The embryo selected for eSET might be from a previous IVF cycle (e.g., cryopreserved embryos (frozen)) or from the current fresh IVF cycle that yielded more than one embryo. The remaining embryos may be set aside for future use or cryopreservation.
eSET is a relatively new choice available to ART patients. It helps women avoid several risks to their own health that are associated with carrying multiples. It also helps families achieve success while preventing some risks known to be associated with giving birth to twins or what is called “high order multiple births” (three or more children born at the same time). Infants born in multiple births are more often born early (preterm), are smaller (low birth weight) and experience more adverse health outcomes than singleton infants. There is consensus among experts that the desired outcome of ART is a healthy singleton infant.
eSET, which is based on findings from research, assesses the chances of success (pregnancy and live birth) based upon the number of embryos transferred during an ART procedure. This research found that among women with a good chance of success with ART, those who chose to have a single embryo transferred had a similar number of live-birth deliveries compared to those who chose to transfer multiple embryos, but almost all of the infants they delivered were singletons.*Single embryo transfer is now considered appropriate for patients with good prognosis, usually women aged 35 years or younger and with eggs or embryos of good quality.
What if I have waited and tried many times to get pregnant unsuccessfully?
The desire for childbearing and parenthood can be compelling. There are so many decisions to make as you determine whether ART is the right option for you and identify clinics that provide services. Remember, the best decisions are knowing your options and selecting one compatible with your with your beliefs and values about pregnancy, childbearing, and parenting.
Women experiencing infertility or wanting to have another child may find having multiples to be an “acceptable risk” when considering ART services. But as you see in our videos, circumstances and thoughts may change as you go through this journey. We also find that many who call CDC mention feeling pressured to make the “right” decision in a short period of time, perhaps without adequate time to talk through the outcomes of your decision with a partner. We urge you to consider the value of single embryo transfer as option BEFORE starting ART services.
What are the risks associated with multiple births?
- Multiple births increase the risk of premature birth and low birth weight in infants. This can affect survival and well-being of newborns. These babies may require special care immediately after birth and at times, can face life-long problems such as developmental disabilities and delays.
- Women who carry multiples may be more likely to need Caesarean sections which may require a longer period of recovery, and at times, can increase the risk of hemorrhage during and after delivery.
- Some who become pregnancy with multiples may find one or more cannot survive to term or even a premature birth. This may lead to a medical need to perform fetal reduction.
- Women older than age 35 have an increased risk of pregnancy complications, some of which could be life threatening. Carrying multiples adds to this risk.
Do you have any advice?
Every person is different and every effort to begin or expand a family is different. Here are some suggestions that you might consider:
- Take a few moments to review what are the “practical” and personal limits related to your choice. For example, women who wish to breastfeed may find it even more challenging when they are mothers of multiples. Others speak of the difficulty in finding affordable and reliable child care options outside or in the home. Even the logistics of transporting multiples can be daunting to some, especially for keeping well-child appointments, seeking emergency care, or taking care of routine housekeeping duties.
- Identify the network of support you need now and will need during and after pregnancy.
- What can your employer or your partner’s employer provide in benefits (e.g., sick pay) or work options (e.g., alternative work schedules, telecommuting)?
- What would be the extra demands that multiples might place on your lifestyle?
- Do you have friends and family who can help, if needed?
- How long can you count on them to help?
- Discuss single embryo transfer and other options for infertility care with a trusted friend or family member. If you find it difficult to have this discussion, find a peer support group or a health care provider who can provide truthful and accurate information.
- In addition to talking with your infertility specialist, consider consulting the obstetrician who will help you through your pregnancy and the pediatrician who will take care of your children. You may want to discuss what to expect during the pregnancy, at delivery, and after giving birth if you have a multiple pregnancy, and use that information in deciding whether to ask for eSET.
Then what can I do?
If eSET seems appropriate to your circumstances, here are some things you can do.
- If you are using insurance or other benefits for infertility care, check with your carrier to determine if they have a “case manager” or “benefits counselor” who can guide you through understanding coverage or special considerations for eSET services.
- When selecting an ART provider, ask for information about the clinic’s policy and practices, as well as resources for decision making (e.g., counseling, case management).
- Ask when you must make choices, or will have time to re-consider decisions, and how long you will have to make the decision (e.g., a day, an hour, a week).
There will be many decisions to make and uncertainty about the outcomes. In the end, it will remain important to take care of yourself, whether you will be the person who carries the pregnancy or a person who will become a parent through this process.
We understand the journey to overcoming infertility can be a long one, and making the decision to pursue ART can be overwhelming. It is important to know the implications of all decisions you will make, especially those that present health risks during and after pregnancy. You also need to give yourself time to consider if the options you seek are consistent with your needs, values and beliefs.