Table 3.
Reproductive Outcomes for Conventional IVF and ICSI Among Fresh IVF Cycles With Selected Non-Male Factor Infertility Indications, 2008-2012a
| Outcomes | Conventional IVF | ICSI | Relative Risk (95% CI) | P Valueb | |||
|---|---|---|---|---|---|---|---|
| Total No. | No. (%) With Outcome | Total No. | No. (%) With Outcome | Unadjusted | Adjusted | ||
| Unexplained Infertility | |||||||
| Cycle canceled before transferc | 25 253 | 1570 (6.2) | 38 820 | 2160 (5.6) | 0.91 (0.80-1.04) | 0.84 (0.75-0.94)d | .04 |
| Among transfers | |||||||
| Implantation rate | 49 325 | 12 467 (25.2) | 78 208 | 18 674 (23.9) | 0.93 (0.85-1.00) | 0.94 (0.90-0.98)e | .02 |
| Clinical pregnancy | 23 683 | 11 392 (48.1) | 36 660 | 17 064 (46.6) | 0.96 (0.90-1.01) | 0.95 (0.91-0.99)e | .09 |
| Live birth | 23 683 | 9467 (40.0) | 36 660 | 14 176 (38.7) | 0.95 (0.89-1.01) | 0.95 (0.92-0.99)e | .09 |
| Among pregnancies | |||||||
| Miscarriage | 11 392 | 1711 (15.0) | 17 064 | 2537 (14.9) | 1.02 (0.96-1.08) | 1.01 (0.96-1.07)e | >.99 |
| Among live births | |||||||
| Multiple live birth | 9467 | 2758 (29.1) | 14 176 | 4211 (29.7) | 1.00 (0.95-1.06) | 0.93 (0.90-0.97)e | .001 |
| Preterm delivery | 9455 | 2313 (24.5) | 14 158 | 3614 (25.5) | 1.04 (0.98-1.10) | 0.98 (0.93-1.03)e | >.99 |
| Low birth weight in any infant | 9320 | 2398 (25.7) | 13 879 | 3743 (27.0) | 1.04 (0.99-1.10) | 0.98 (0.94-1.02)e | >.99 |
| ≥2 Prior ART Cycles and No Prior Live Births | |||||||
| Cycle canceled before transferc | 14 077 | 1160 (8.2) | 33 512 | 2808 (8.4) | 1.01 (0.85-1.19) | 0.92 (0.81-1.03)f | >.99 |
| Among transfers | |||||||
| Implantation rate | 30 621 | 5798 (18.9) | 70 590 | 12 850 (18.2) | 0.92 (0.86-0.98) | 0.92 (0.89-0.95)g | <.001 |
| Clinical pregnancy | 12 917 | 5402 (41.8) | 30 704 | 12 262 (39.9) | 0.93 (0.89-0.97) | 0.94 (0.92-0.97)g | <.001 |
| Live birth | 12 917 | 4292 (33.2) | 30 704 | 9647 (31.4) | 0.92 (0.87-0.96) | 0.93 (0.90-0.96)g | <.001 |
| Among pregnancies | |||||||
| Miscarriage | 5402 | 985 (18.2) | 12 262 | 2379 (19.4) | 1.09 (1.01-1.17) | 1.09 (1.02-1.17)g | .10 |
| Among live births | |||||||
| Multiple live birth | 4292 | 1371 (31.9) | 9647 | 2967 (30.8) | 0.94 (0.87-1.01) | 0.93 (0.88-0.99)g | .14 |
| Preterm delivery | 4286 | 1296 (30.2) | 2869 | 2869 (29.8) | 0.98 (0.91-1.05) | 0.97 (0.91-1.04)g | >.99 |
| Low birth weight in any infant | 4184 | 1285 (30.7) | 9406 | 2822 (30.0) | 0.98 (0.90-1.05) | 0.96 (0.90-1.02)g | >.99 |
| Advanced Maternal Age (≥38 y) | |||||||
| Cycle canceled before transferc | 46 058 | 4349 (9.4) | 93 488 | 8747 (9.4) | 0.98 (0.87-1.11) | 0.86 (0.78-0.94)h | .01 |
| Among transfers | |||||||
| Implantation rate | 99 496 | 16 057 (16.1) | 193 476 | 31 480 (16.3) | 0.93 (0.86-1.00) | 0.92 (0.90-0.95)i | <.001 |
| Clinical pregnancy | 41 709 | 16 606 (39.8) | 84 741 | 32 333 (38.2) | 0.93 (0.88-0.97) | 0.94 (0.92-0.96) | <.001 |
| Live birth | 41 709 | 12 375 (29.7) | 84 741 | 24 427 (28.8) | 0.92 (0.87-0.98) | 0.93 (0.91-0.96)i | <.001 |
| Among pregnancies | |||||||
| Miscarriage | 16 606 | 3794 (22.9) | 32 333 | 7146 (22.1) | 01.02 (0.98-1.07) | 1.02 (0.99-1.07)i | >.99 |
| Among live births | |||||||
| Multiple live birth | 12 375 | 3428 (27.7) | 24 427 | 6606 (27.0) | 0.93 (0.88-0.98) | 0.92 (0.89-0.96)i | <.001 |
| Preterm delivery | 12 350 | 3234 (26.2) | 24 359 | 6718 (27.6) | 1.02 (0.97-1.07) | 1.01 (0.97-1.06)i | >.99 |
| Low birth weight in any infant | 12 087 | 3140 (26.0) | 23 840 | 6340 (26.6) | 0.99 (0.94-1.04) | 0.98 (0.94-1.02)i | >.99 |
| Low Oocyte Yield (<5 Oocytes) | |||||||
| Cycle canceled before transferc | 13 711 | 3430 (25.0) | 29 233 | 5624 (19.2) | 0.76 (0.69-0.83) | 0.74 (0.66-0.83)j | <.001 |
| Among transfers | |||||||
| Implantation rate | 17 905 | 2476 (13.8) | 38 982 | 4401 (11.3) | 0.85 (0.79-0.92) | 0.86 (0.81-0.91)k | <.001 |
| Clinical pregnancy | 10 281 | 2778 (27.0) | 23 609 | 5264 (22.3) | 0.85 (0.80-0.91) | 0.89 (0.84-0.93)k | <.001 |
| Live birth | 10 281 | 2085 (20.3) | 23 609 | 3758 (15.9) | 0.82 (0.77-0.88) | 0.86 (0.81-0.91)k | <.001 |
| Among pregnancies | |||||||
| Miscarriage | 2778 | 627 (22.6) | 5264 | 1319 (25.1) | 1.06 (0.98-1.15) | 1.06 (0.98-1.15)k | >.99 |
| Among live births | |||||||
| Multiple live birth | 2085 | 362 (17.4) | 3758 | 568 (15.1) | 0.88 (0.76-1.01) | 0.90 (0.79-1.02)k | .78 |
| Preterm delivery | 2077 | 412 (19.8) | 3743 | 715 (19.1) | 0.95 (0.85-1.07) | 0.97 (0.86-1.08)k | >.99 |
| Low birth weight in any infant | 2048 | 375 (18.3) | 3676 | 678 (18.4) | 1.01 (0.90-1.12) | 1.02 (0.92-1.14)k | >.99 |
| Preimplantation Genetic Testing Used | |||||||
| Cycle canceled before transferc | 3235 | 727 (22.5) | 15 958 | 3458 (21.7) | 1.02 (0.88-1.19) | 1.01 (0.87-1.17)l | >.99 |
| Among transfers | |||||||
| Implantation rate | 4190 | 1188 (28.4) | 20 723 | 6148 (29.7) | 0.99 (0.88-1.11) | 0.97 (0.88-1.07)m | >.99 |
| Clinical pregnancy | 2508 | 1132 (45.1) | 12 500 | 5807 (46.5) | 0.99 (0.91-1.07) | 0.98 (0.90-1.06)m | >.99 |
| Live birth | 2508 | 949 (37.8) | 12 500 | 4855 (38.8) | 0.97 (0.88-1.08) | 0.96 (0.87-1.06)m | >.99 |
| Among pregnancies | |||||||
| Miscarriage | 1132 | 155 (13.7) | 5807 | 828 (14.3) | 1.13 (0.91-1.39) | 1.13 (0.91-1.40)m | >.99 |
| Among live births | |||||||
| Multiple live birth | 949 | 220 (23.2) | 4855 | 1213 (25.0) | 1.07 (0.93-1.22) | 1.04 (0.93-1.17)m | >.99 |
| Preterm delivery | 949 | 193 (20.3) | 4841 | 1154 (23.8) | 1.15 (1.02-1.30) | 1.13 (1.00-1.27)m | .37 |
| Low birth weight in any infant | 930 | 194 (20.9) | 4723 | 109 (23.2) | 1.09 (0.96-1.25) | 1.07 (0.93-1.23)m | >.99 |
Abbreviations: ART, assisted reproductive technology; 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.
Model adjusted for maternal age, number of prior live births, number of prior spontaneous abortions, number of prior ART cycles, number of oocytes retrieved, number of embryos cryopreserved, donor egg/embryo, donor sperm, and use of preimplantation genetic testing.
Models adjusted for maternal age, number of prior live births, number of prior spontaneous abortions, number of prior ART 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, and use of preimplantation genetic testing.
Model adjusted for maternal age, number of prior spontaneous abortions, 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, diminished ovarian reserve, and unexplained).
Models adjusted for maternal age, number of prior spontaneous abortions, 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, diminished ovarian reserve, and unexplained).
Model adjusted for number of prior live births, number of prior spontaneous abortions, number of prior ART 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, diminished ovarian reserve, and unexplained).
Models adjusted for number of prior live births, number of prior spontaneous abortions, number of prior ART 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, diminished ovarian reserve, and unexplained).
Model adjusted for maternal age, number of prior live births, number of prior spontaneous abortions, number of prior ART cycles, number of embryos cryopreserved, donor egg/embryo, donor sperm, use of preimplantation genetic testing, and infertility diagnosis (tubal factor, endometriosis, uterine factor, ovulatory disorder, diminished ovarian reserve, and unexplained).
Models adjusted for maternal age, number of prior live births, number of prior spontaneous abortions, number of prior ART cycles, 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, diminished ovarian reserve, and unexplained).
Model adjusted for maternal age, number of prior live births, number of prior spontaneous abortions, number of prior ART cycles, number of oocytes retrieved, number of embryos cryopreserved, donor egg/embryo, donor sperm, and infertility diagnosis (tubal factor, endometriosis, uterine factor, ovulatory disorder, diminished ovarian reserve, and unexplained).
Models adjusted for maternal age, number of prior live births, number of prior spontaneous abortions, number of prior ART 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, and infertility diagnosis (tubal factor, endometriosis, uterine factor, ovulatory disorder, diminished ovarian reserve, and unexplained).