Assessment of a Decade of Change in U.S. Assisted Reproductive Technology Cumulative Live-Birth Rates: 2004-2009 Compared With 2014-2020

Sarah F Wang, Wang SF, David B. Seifer, Seifer DB
Obstetrics and gynecology · 2024 · vol. 143(6) , pp. 839–848 · doi:10.1097/AOG.0000000000005598 · PMID:38696814
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-13 ⓘ

Assisted reproductive technology cumulative live-birth rates improved overall from 2014-2020 compared to 2004-2009, particularly for patients aged 35+ and most infertility diagnoses, alongside demographic and practice shifts.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-11 · read from full text ⓘ

This retrospective cohort study used the SART Clinic Outcome Reporting System (SART CORS) to compare cumulative live-birth rates across time periods by analyzing autologous linked cycles from patients undergoing their first retrieval between 2014 and 2019, with outcomes followed through 2020, and contrasting these with published 2004–2009 SART CORS data. It found that overall cumulative live-birth rates improved for patients aged 35 years or older and across most infertility diagnoses, while demographic composition shifted toward more people of color and toward diagnoses such as diminished ovarian reserve and ovulatory disorders, alongside a decrease in endometriosis, tubal, and male factor infertility; it also reported increased use of frozen embryo transfer and preimplantation genetic testing, with preimplantation genetic testing linked to different age-stratified cumulative live-birth rate patterns. A key limitation is reliance on retrospective registry data and comparisons to a prior published dataset rather than a single contemporaneous cohort, which may be affected by unmeasured changes over time. Relevance to endometriosis: the paper reports a decrease in the proportion of infertility patients classified as endometriosis within ART cohorts over time, though its main focus is decade-long changes in ART practices and cumulative live-birth outcomes rather than endometriosis-specific mechanisms or treatment effects.

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Abstract

OBJECTIVE: To assess the effects of demographic shifts, changes in contemporaneous clinical practices, and technologic innovation on assisted reproductive technology (ART) success rates by conducting an analysis of cumulative live-birth rates across different time periods, age groups, and infertility diagnoses. METHODS: We conducted a retrospective cohort study of autologous linked cycles comparing cumulative live-birth rates over successive cycles from patients undergoing their first retrieval between 2014 and 2019 in the SART CORS (Society for Assisted Reproductive Technology Clinic Outcome Reporting System) database. All cycles reported for these individuals up to 2020 were included for analysis. We compared cumulative live-birth rates stratified by age and infertility cause with published data from the 2004-2009 SART CORS database. RESULTS: From 2014 to 2019, 447,042 patients underwent their first autologous index retrieval, resulting in 1,007,374 cycles and 252,215 live births over the period of 2014 to 2020. In contrast, between 2004 and 2008, 246,740 patients underwent 471,208 cycles, resulting in 140,859 births by 2009. Noteworthy shifts in demographics were observed, with an increase in people of color seeking reproductive technology (57.9% vs 51.7%, P <.001). There was also an increase in patients with diminished ovarian reserve and ovulatory disorders and a decrease in endometriosis, tubal, and male factor infertility ( P <.001). Previously associated with decreased odds of live birth, frozen embryo transfer and preimplantation genetic testing showed increased odds in 2014-2020. Preimplantation genetic testing rose from 3.4% to 36.0% and was associated with a lower cumulative live-birth rate for those younger than age 35 years ( P <.001) but a higher cumulative live-birth rate for those aged 35 years or older ( P <.001). Comparing 2014-2020 with 2004-2009 shows that the overall cumulative live-birth rate improved for patients aged 35 years or older and for all infertility diagnoses except ovulatory disorders ( P <.001). CONCLUSION: This analysis provides insights into the changing landscape of ART treatments in the United States over the past two decades. The observed shifts in demographics, clinical practices, and technology highlight the dynamic nature of an evolving field of reproductive medicine. These findings may offer insight for clinicians to consider in counseling patients and to inform future research endeavors in the field of ART.
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Objective

To assess the effects of demographic shifts, changes in contemporaneous clinical practices, and technologic innovation on assisted reproductive technology (ART) success rates by conducting an analysis of cumulative live-birth rates across different time periods, age groups, and infertility diagnoses.

Methods

We conducted a retrospective cohort study of autologous linked cycles comparing cumulative live-birth rates over successive cycles from patients undergoing their first retrieval between 2014 and 2019 in the SART CORS (Society for Assisted Reproductive Technology Clinic Outcome Reporting System) database. All cycles reported for these individuals up to 2020 were included for analysis. We compared cumulative live-birth rates stratified by age and infertility cause with published data from the 2004–2009 SART CORS database.

Results

From 2014 to 2019, 447,042 patients underwent their first autologous index retrieval, resulting in 1,007,374 cycles and 252,215 live births over the period of 2014 to 2020. In contrast, between 2004 and 2008, 246,740 patients underwent 471,208 cycles, resulting in 140,859 births by 2009. Noteworthy shifts in demographics were observed, with an increase in people of color seeking reproductive technology (57.9% vs 51.7%, P<.001). There was also an increase in patients with diminished ovarian reserve and ovulatory disorders and a decrease in endometriosis, tubal, and male factor infertility (P<.001). Previously associated with decreased odds of live birth, frozen embryo transfer and preimplantation genetic testing showed increased odds in 2014–2020. Preimplantation genetic testing rose from 3.4% to 36.0% and was associated with a lower cumulative live-birth rate for those younger than age 35 years (P<.001) but a higher cumulative live-birth rate for those aged 35 years or older (P<.001). Comparing 2014–2020 with 2004–2009 shows that the overall cumulative live-birth rate improved for patients aged 35 years or older and for all infertility diagnoses except ovulatory disorders (P<.001).

Conclusion

This analysis provides insights into the changing landscape of ART treatments in the United States over the past two decades. The observed shifts in demographics, clinical practices, and technology highlight the dynamic nature of an evolving field of reproductive medicine. These findings may offer insight for clinicians to consider in counseling patients and to inform future research endeavors in the field of ART.

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Condition tags

endometriosisinfertility

MeSH descriptors

Live Birth Live Birth Live Birth Live Birth Live Birth Live Birth Live Birth Live Birth Live Birth Live Birth Live Birth Live Birth Live Birth Live Birth Live Birth Live Birth Live Birth Live Birth Live Birth Live Birth

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