Worldwide decline of IVF birth rates and its probable causes

Abstract

With steadily improving pregnancy and live birth rates, IVF over approximately the first two and a half decades evolved into a highly successful treatment for female and male infertility, reaching peak live birth rates by 2001–2002. Plateauing rates, thereafter, actually started declining in most regions of the world. We here report worldwide IVF live birth rates between 2004 and 2016, defined as live births per fresh IVF/ICSI cycle started, and how the introduction of certain practice add-ons in timing was associated with changes in these live birth rates. We also attempted to define how rapid worldwide ‘industrialization’ (transition from a private practice model to an investor-driven industry) and ‘commoditization’ in IVF practice (primary competitive emphasis on revenue rather than IVF outcomes) affected IVF outcomes. The data presented here are based on published regional registry data from governments and/or specialty societies, covering the USA, Canada, the UK, Australia/New Zealand (combined), Latin America (as a block) and Japan. Changes in live birth rates were associated with introduction of new IVF practices, including mild stimulation, elective single embryo transfer (eSET), PGS (now renamed preimplantation genetic testing for aneuploidy), all-freeze cycles and embryo banking. Profound negative associations were observed with mild stimulation, extended embryo culture to blastocyst and eSET in Japan, Australia/New Zealand and Canada but to milder degrees also elsewhere. Effects of ‘industrialization’ suggested rising utilization of add-ons (‘commoditization’), increased IVF costs, reduced live birth rates and poorer patient satisfaction. Over the past decade and a half, IVF, therefore, has increasingly disappointed outcome expectations. Remarkably, neither the profession nor the public have paid attention to this development which, therefore, also has gone unexplained. It now urgently calls for evidence-based explanations.

FSH treatment of male idiopathic infertility: Time for a paradigm change

“…It goes without need of complex calculations that the amount of FSH required for one cycle of ovarian stimulation (2000‐5000 IU) is much less than the amount which would be used in men (approximately 10 000‐30 000 IU). If FSH is really effective in improving semen quality and pregnancy rate, gonadotropin sales would increase (at least two‐six times) but the ART business might decrease if spontaneous pregnancies occur, reducing the revenues of ART centers . However, ART centers could become interested in different business models, involving male treatment.…”

“…Meanwhile, thanks to the introduction of novel inventions (eg, single embryo transfer, blastocyst culture, preimplantation genetic screening, and time lapse) and the enormous commercial interests behind them, ART performance is decreasing and the main goal of the big private owners of ART clinics seems to be the revenue rather than clinical outcome. New technologies led to a rapid evolution of reproduction toward a very profitable, sex‐free practice . Despite ART is co‐funded by public health services in several countries worldwide, in the vast majority of ART centers around the world it remains in private hands.…”

The 2019 PGDIS position statement on transfer of mosaic embryos within a context of new information on PGT-A

“…Attributed at least, in part to recently introduced addons, live birth rates following fresh non-donor in vitro fertilization (IVF) cycles have substantially declined [1]. This downward trend over the past decade has paralleled a marked increase in the use of preimplantation genetic testing (PGT-A) and of other so-called add-ons to IVF.…”

Believing that transferring more embryos will result in increased pregnancy rates: a flawed concept: a SWOT analysis

“…However, this concept is likely flawed. Recently, Gleisher et al published an article that argues that IVF success rates peaked in 2010 and have been decreasing since then [3]. They attribute this decrease to the increased use of elective single embryo transfer among other factors [3].…”

“…Recently, Gleisher et al published an article that argues that IVF success rates peaked in 2010 and have been decreasing since then [3]. They attribute this decrease to the increased use of elective single embryo transfer among other factors [3]. Although the use of single embryo transfer can decrease outcomes per transfer [4], particularly if the embryo selected turns out to be aneuploid, overall placing back more embryos will in many cases, not improve outcomes [5,6].…”