Table 2.
Outcomes | Conventional IVF | ICSI | Relative Risk (95% CI) | P Valueb | |||
---|---|---|---|---|---|---|---|
Total No. | No. (%) With Outcome | Total No. | No. (%) With Outcome | Unadjusted | Adjusted | ||
Male Factor Infertility | |||||||
Cycle canceled before transferc | 12 648 | 1715 (13.6) | 164 263 | 10 295 (6.3) | 0.47 (0.42-0.54) | 0.50 (0.45-0.56)d | <.001 |
Among transfers | |||||||
Implantation ratee | 22 886 | 5863 (25.6) | 321 419 | 82 006 (25.5) | 0.94 (0.88-1.00) | 0.95 (0.91-0.98)f | .02 |
Clinical intrauterine pregnancy | 10 933 | 5232 (47.9) | 153 968 | 73 850 (48.0) | 0.97 (0.93-1.02) | 0.98 (0.95-1.01)f | >.99 |
Live birth | 10 933 | 4296 (39.3) | 153 968 | 61 450 (39.9) | 0.97 (0.92-1.03) | 0.98 (0.95-1.02)f | >.99 |
Among pregnancies | |||||||
Miscarriage | 5232 | 839 (16.0) | 73 850 | 10 946 (14.8) | 1.00 (0.92-1.08) | 0.97 (0.91-1.04)f | >.99 |
Among live births | |||||||
Multiple live birth | 4296 | 1469 (34.2) | 61 450 | 19 002 (30.9) | 0.88 (0.84-0.94) | 0.87 (0.83-0.91)f | <.001 |
Preterm delivery | 4287 | 1250 (29.2) | 61 347 | 16 822 (27.4) | 0.94 (0.88-1.01) | 0.93 (0.88-0.98)f | .06 |
Low birth weight in any infant | 4230 | 1242 (29.4) | 60 273 | 16 936 (28.1) | 0.95 (0.89-1.00) | 0.93 (0.88-0.98)f | .06 |
Non-Male Factor Infertility | |||||||
Cycle canceled before transferc | 112 877 | 8985 (8.0) | 205 119 | 16 911 (8.2) | 1.03 (0.93-1.13) | 0.88 (0.81-0.97)d | .06 |
Among transfers | |||||||
Implantation ratee | 216 125 | 54 362 (25.2) | 395 054 | 90 987 (23.0) | 0.92 (0.88-0.97) | 0.93 (0.91-0.95)f | <.001 |
Clinical pregnancy | 103 892 | 49 732 (47.9) | 188 208 | 84 578 (44.9) | 0.94 (0.91-0.97) | 0.95 (0.93-0.97)f | <.001 |
Live birth | 103 892 | 40 703 (39.2) | 188 208 | 68 735 (36.5) | 0.93 (0.90-0.97) | 0.95 (0.93-0.97)f | <.001 |
Among pregnancies | |||||||
Miscarriage | 49 732 | 7921 (15.9) | 84 578 | 13 978 (16.5) | 1.03 (0.99-1.07) | 1.03 (1.00-1.06)f | .97 |
Among live births | |||||||
Multiple live birth | 40 703 | 12 633 (31.0) | 68 735 | 20 671 (30.1) | 0.97 (0.93-1.00) | 0.93 (0.91-0.95)f | <.001 |
Preterm delivery | 40 642 | 11 490 (28.3) | 68 533 | 19 324 (28.2) | 1.00 (0.96-1.03) | 0.97 (0.95-1.00)f | .30 |
Low birth weight in any infant | 39 999 | 11 415 (28.5) | 67 178 | 19 087 (28.4) | 1.00 (0.96-1.03) | 0.96 (0.94-0.99)f | .03 |
Abbreviations: ICSI, intracytoplasmic sperm injection; IVF, in vitro fertilization.
All models included generalized estimating equations to account for clustering by clinic. Conventional IVF was the reference for all comparisons.
P values are adjusted for the 8 outcomes assessed in the stratum using Bonferroni correction.
Cycle canceled between retrieval and transfer.
Male factor infertility model was adjusted for maternal age, number of prior live births, number of prior spontaneous abortions, number of prior assisted reproductive technology cycles, number of oocytes retrieved, number of embryos cryopreserved, donor egg/embryo, donor sperm, use of preimplantation genetic testing, and infertility diagnosis (tubal factor, endometriosis, uterine factor, ovulatory disorder, and diminished ovarian reserve). Non–male factor infertility model was adjusted for all of the above and for unexplained infertility.
Calculated as the number of embryos implanted divided by the total number of embryos transferred; if number of fetal heartbeats and number of live and stillborn infants was missing, then implantation rate was considered missing.
Male factor infertility models were adjusted for maternal age, number of prior live births, number of prior spontaneous abortions, number of prior assisted reproductive technology cycles, number of oocytes retrieved, number of embryos transferred, embryo stage at transfer, number of embryos cryopreserved, use of assisted hatching, donor egg/embryo, donor sperm, use of preimplantation genetic testing, and infertility diagnosis (tubal factor, endometriosis, uterine factor, ovulatory disorder, and diminished ovarian reserve).