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.

Keywords: IVF; PGS; all-freeze cycles; blastocyst-stage embryo transfer; elective single embryo transfer; embryo banking; live birth rate; preimplantation genetic testing for aneuploidy.

Figure 1

US annual live birth rates following fresh autologous IVF cycles from 1995 to 2016. The data for this figure are derived from annual CDC ART Success Rate Reports (www.cdc.gov/art/artdata/), accessed 10 August 2018 and again 7 March 2019. Live birth rates demonstrate almost steady improvements until 2002, a decline between 2003 and 2007, reaching a new peak similar to that in 2002 between 2008 and 2010, only to again decline by 2016 to rates not seen since 1998.