Skip to main content
Log in

Factors affecting assisted reproductive technology (ART) pregnancy rates: a multivariate analysis

  • Published:
Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Purpose : To determine factors instrumental in achieving a clinical pregnancy in assisted reproductive technology (ART) patients.

Methods : This study included 205 women undergoing their first ART cycle. Univariate and multivariate analyses were performed for patient demographics, in vitro production data, and factors associated with embryo transfer. Odds ratios (OR) were performed where appropriate.

Results : Our analyses indicated that age (OR: 0.879), specific year in which the cycle was performed (OR: 2.959), and use of intracytoplasmic sperm injection (OR: 2.867) altered potential pregnancy rate. In addition, percent fertilization (OR: 1.028), number of embryos transferred (OR: 1.842), type of catheter used to transfer the embryos (OR: 0.377), presence of blood on the catheter (OR .414), and embryologist (OR: 2.338) also altered pregnancy rate.

Conclusions : Our data indicate patients' age, use of the Cook catheter, and presence of blood on the catheter reduce pregnancy rates. Performing ART in 1999, using ICSI, increasing fertilization rate, increasing number of embryos transferred (albeit less desirable when the chance of multiple gestation may occur), and transferring embryos via a particular embryologist, improve pregnancy rates.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Hearns-Stokes RM, Miller BT, Scott L, Creuss D, Chakraborty PK, Segars JH: Pregnancy rates after embryo transfer depend on provider at embryo transfer. Fertil Steril 2000;74:80–86

    Article  PubMed  Google Scholar 

  2. Pope CS, Cook EKD, Arny M, Novak A, Grow DR: Influence of embryo transfer depth on in vitro fertilization and embryo transfer outcomes. Fertil Steril 2004;81:51–58

    Article  PubMed  Google Scholar 

  3. Meriano J, Weissman A, Greenblatt EM, Ward S, Casper RF: The choice of embryo transfer catheter affects embryo implantation after IVF. Fertil Steril 2000;74:678–682

    Article  PubMed  Google Scholar 

  4. Urman B, Askoy S, Alatas C, Mercan R, Nuhoglu A, Isiklar A, Balaban B: Comparing two embryo transfer catheters: Use of trial transfer to determine the catheter applied. J Reprod Med 2000;45:135–138

    PubMed  Google Scholar 

  5. Rosenlund B, Sjöblom P, Hillensjö T: Pregnancy outcome related to the site of embryo deposition in uterus. J Assist Reprod Genet 1996;13:511–513

    Article  PubMed  Google Scholar 

  6. Wood EG, Batzer FR, Go KJ, Gutmann JN, Corson SL: Ultrasound-guided soft catheter embryo transfers will improve pregnancy rates in in-vitro fertilization. Hum Reprod 2000;15:107–112

    Article  PubMed  Google Scholar 

  7. Burke LM, Davenport AT, Russell GB, Deaton JL: Predictors of success after embryo transfer: Experience from a single provider. Am J Obstet Gynecol 2000;182:1001–1004

    Article  PubMed  Google Scholar 

  8. De Placido G, Wilding M, Strina I, Mollo A, Alviggi E, Tolino E, et al.: The effect of ease of transfer and type of catheter used on pregnancy and implantation rates in an IVF program. J Assist Reprod Genet 2002;19:14–18

    Article  PubMed  Google Scholar 

  9. Goudas VT, Hammitt DG, Damario MA, Session DR, Singh AP, Dumesic DA: Blood on the embryo transfer catheter is associated with decreased rates of embryo implantation and clinical pregnancy with the use of in vitro fertilization-embryo transfer. Fertil Steril 1998;70:878–882

    Article  PubMed  Google Scholar 

  10. Barber D, Egan D, Ross C, Evans B, Barlow D: Nurses performing embryo transfer: Successful outcome of in-vitro fertilization. Hum Reprod 1996;11:105–108

    PubMed  Google Scholar 

  11. Cheung WM, Ng EHY, Lau EYL, Yeung WSB, So WWK, Ho PC: Is there any difference in pregnancy and implantation rates when nurses perform embryo transfer in an IVF-ET program? Gynecol Obstet Invest 2003;56:1–5

    Article  PubMed  Google Scholar 

  12. Sinclair L, Morgan C, Lashen H, Afnan M, Sharif K: Nurses performing embryo transfer: The development and results of the Birmingham experience. Hum Reprod 1998;13:699–702

    Article  PubMed  Google Scholar 

  13. Van de Pas MMC, Weima S, Looman CWN, Broekmans FJM: The use of fixed distance embryo transfer after IVF/ICSI equalizes the success rates among physicians. Hum Reprod 2003;18:774–780

    Article  PubMed  Google Scholar 

  14. Coroleu B, Barri PN, Carreras O, Martínez F, Parriego M, Hereter L, et al.: The influence of the depth of embryo replacement into the uterine cavity on implantation rates after IVF: A controlled, ultrasound-guided study. Hum Reprod 2002; 17:341–346

    Article  PubMed  Google Scholar 

  15. Coulam CB, Bustillo M, Soenksen DM, Britten S: Ultrasonographic predictors of implantation after assisted reproduction. Fertil and Steril 1994;62:1004–1010

    Google Scholar 

  16. Dickey RP, Olar TT, Taylor SN, Curole DN, Harrigill K: Relationship of biochemical pregnancy to pre-ovulatory endometrial thickness and pattern in patients undergoing ovulation induction. Hum Reprod 1993;8:327–330

    PubMed  Google Scholar 

  17. Schwartz LB, Chiu AS, Courtney M, Krey L, Schmidt-Sarosi C: The embryo versus endometrium controversy revisited as it relates to predicting pregnancy outcome in in-vitro fertilization-embryo transfer cycles. Hum Reprod 1997;12:45–50

    Article  PubMed  Google Scholar 

  18. Lesny P, Killick SR, Tetlow RL, Manton DJ, Robinson J, Maguiness SD: Ultrasound evaluation of the uterine zonal anatomy during in-vitro fertilization and embryo transfer. Hum Reprod 1999;14:1593–1598

    Article  PubMed  Google Scholar 

  19. Schild RL, Knobloch C, Dorn C, Fimmers R, van der Ven H, Hansmann M: Endometrial receptivity in an in vitro fertilization program as assessed by spiral artery blood flow, endometrial thickness, endometrial volume, and uterine artery blood flow. Fertil Steril 2001;75:361–366

    Article  PubMed  Google Scholar 

  20. Baruffi RLR, Contart P, Mauri AL, Petersen C, Felipe V, Garbellini E, et al.: A uterine ultrasonographic scoring system as a method for the prognosis of embryo implantation. J Assist Reprod Gen 2002;19:99–102

    Article  Google Scholar 

  21. Yuval Y, Lipitz S, Dor J, Achiron R: The relationships between endometrial thickness, and blood flow and pregnancy rates in in-vitro fertilization. Hum Reprod 1999;14:1067–1071

    Article  PubMed  Google Scholar 

  22. Franco JG, Jr: The risk of multifetal pregnancy. Hum Reprod 1994;9:185–186

    Google Scholar 

  23. Nijs M: Factors involved in replacing two or more embryos. Hum Reprod 1994;9:185

    Google Scholar 

  24. Walters DE: Can Pregnancy rates be maintained when two embryos are replaced in in-vitro fertilization? Hum Reprod 1994;9:184

    Google Scholar 

  25. Centers for Disease Control and Prevention: 2002 Assisted reproductive technology success rates: National summary and fertility clinic reports. Atlanta, Georgia. http://www.cdc.gov/reproductivehealth/ART02/PDF/ART2002.pdf

  26. Minaretzis D, Harris D, Alper MM, Mortola JF, Berger MJ, Power D: Multivariate analysis of factors predictive of successful live births in in vitro fertilization (IVF) suggests strategies to improve IVF outcome. J Assist Reprod Genet 1998;15:365–371

    Article  PubMed  Google Scholar 

  27. Hu Y, Maxson WS, Hoffman DI, Ory SJ, Eager S, Dupre J, et al.: Maximizing pregnancy rates and limiting higher-order multiple conceptions by determining the optimal number of embryos to transfer based on quality. Fertil Steril 1998;69:650–657

    Article  PubMed  Google Scholar 

  28. American Society for Reproductive Medicine: A Practice Committee Report. Guidelines on number of embryos transferred. Fertil Steril 2004;82(Suppl. 1):S1–S2

    Google Scholar 

  29. Wang W-H, Meng L, Hackett RJ, Odenbourg R, Keefe DL: Limited recovery of meiotic spindles in living human oocytes after cooling-rewarming observed using polarized light microscopy. Hum Reprod 2001;16:2374–2378

    PubMed  Google Scholar 

  30. Fanchin R, Righini C, Olivennes F, Taylor S, de Ziegler D, Frydman R: Uterine contractions at the time of embryo transfer alter pregnancy rates after in-vitro fertilization. Hum Reprod 1998;13:1968–1974

    Article  PubMed  Google Scholar 

  31. Nichols JE, Higdon HL III, Crane MM, Boone WR: Comparison of implantation and pregnancy rates in African American and white women in an assisted reproductive technology practice. Fertil Steril 2001;76:80–84

    Article  PubMed  Google Scholar 

  32. Boone WR, Johnson JE, Locke A-J, Crane IV MM, Price TM: Control of air quality in an assisted reproductive technology laboratory. Fertil Steril 1999;71:150–154

    Article  PubMed  Google Scholar 

  33. Johnson JE, Boone WR. Can varying the number of spermatozoa used for insemination improve in vitro fertilization rates? J Asst Reprod Gen 2000;17:397–399

    Article  Google Scholar 

  34. Johnson JE, Higdon HL III, Blackhurst DW, Boone WR: Expectations for oocyte fertilization and embryo cleavage after whole sperm versus sperm head intracytoplasmic sperm injection. Fertil Steril 2004;82:1412–1417

    Article  PubMed  Google Scholar 

  35. Obruca A, Strohmer H, Sakkas D, Menezo Y, Kogosowki A, Barak Y, Feichtinger W: Use of lasers in assisted fertilization and hatching. Hum Reprod 1994;9:1723–1726

    PubMed  Google Scholar 

  36. Chao, KH, Chen SU, Chen HF, Wu MY, Yang YS, Ho HN: Assisted hatching increases the implantation and pregnancy rate of in vitro fertilization (IVF)-embryo transfer (ET), but not that of IVF-tubal ET in patients with repeated IVF failures. Fertil Steril 1997;67:904–908

    Article  PubMed  Google Scholar 

  37. Magli MC, Gianaroli L, Ferraretti AP, Fortini D, Aicardi G, Montanaro N: Rescue of implantation potential in embryos with poor prognosis by assisted zona hatching. Hum Reprod 1998;13:1331–1335

    Article  PubMed  Google Scholar 

  38. Edwards RG, Fishel SB, Cohen J, Fehilly CB, Purdy JM, Salter JM, et al.: Factors influencing the success of in vitro fertilization for alleviating human infertility. J In vitro Fert Embryo Transf. 1984;1: 3–23

    Article  PubMed  Google Scholar 

  39. Cohen J, Inge KL, Suzman M, Wiker S, Wright G: Videocinematography of fresh and cryopreserved embryos: A retrospective analysis of embryonic morphology and implantation, Fertil Steril 1989;51:820–827

    PubMed  Google Scholar 

  40. Wright G, Wiker S, Elsner C, Kort H, Massey J, Mitchell D, et al.: Observations on the morphology of human zygotes, pronuclei and implications for cryopreservation. Hum Reprod 1990;5:109–115

    PubMed  Google Scholar 

  41. Cohen J: Assisted hatching of human embryos. J In Vitro Fert Embryo Transf 1991;8:179–190

    Article  PubMed  Google Scholar 

  42. Cohen J, Alikani M, Trowbridge J, Rosenwaks Z: Implantation enhancement by selective assisted hatching using zona drilling of human embryos with poor prognosis. Hum Reprod 1992;7:685–691

    PubMed  Google Scholar 

  43. Schoolcraft WB, Schlenker T, Jones GS, Jones Jr HW: In vitro fertilization in women age 40 and older: The impact of assisted hatching. J Assist Reprod Genet 1995;12:581–584

    Article  PubMed  Google Scholar 

  44. Stein A, Rufias O, Amit S, et al.: Assisted hatching by partial zona dissection of human pre-embryos in patients with recurrent implantation failure after in vitro fertilization. Fertil Steril 1995;63:838–841

    PubMed  Google Scholar 

  45. Nakayama t, Fujiwara H, Yamada S, Tastumi K, Honda T, Fujii S: Clinical application of a new assisted hatching method using a piezo-micromanipulator for morphologically low-quality embryos I poor-prognosis infertile patients. Fertil Steril 1999;71:1014–1018

    Article  PubMed  Google Scholar 

  46. Cohen J, Elsner C, Kort H, Malter H, Massey J, Mayer MP, et al:. Impairment of the hatching process following IVF in the human and improvement of implantation by assisting hatching using micromanipulation. Hum Reprod 1990;5:7–13

    PubMed  Google Scholar 

  47. Zang X, Rutledge J, Armstrong DT: Studies on zona hardening in rat oocytes that are matured in vitro in a serum-free medium. Mol Reprod Dev.1991;28:292–296

    Article  PubMed  Google Scholar 

  48. Veeck LL: Atlas of the Human Oocyte and Early Conceptus. Vol. 2, Baltimore, Williams & Wilkins, 1991

    Google Scholar 

  49. Karande V, Gleicher N: IVF in humans: Technologies for oocyte retrieval, in vitro insemination and embryo transfer. In Biotechnology of Human Reproduction. A Revelli, I Tur-Kaspa, JG Holte, M Massobrio (eds), Boca Raton: The Parthenon Publishing Group, 2003, pp 161–171

    Google Scholar 

  50. Boone WR, Johnson JE, Blackhurst DM, Crane MM IV: Cook versus Edwards-Wallace: Are there differences in flexible catheters. J Assist Reprod Genet 2001;18:15–17

    Article  PubMed  Google Scholar 

  51. American Society for Reproductive Medicine: A Practice Committee Report. A committee opinion. Guidelines on number of embryos transferred. Birmingham, Alabama. 1999.

  52. Grunert GM, Dunn RC, Valdes CT, Wun CC, Wun WSA. Comparison of Wallace, Frydman DT, and Cook embryo transfer catheter for IVF: A prospective randomized study. Fertil Steril 1998;70(Suppl 1):S120

    Google Scholar 

  53. Mayer JF, Nehchiri F, Jones EL, Weedon VM, Kalin HL, Lanzendorf SE, et al.: Prospective randomized analysis of the impact of two different transfer catheters on clinical pregnancy rates. Fertil Steril 1999;72(Suppl 1):S144

    Google Scholar 

  54. Wisanto A, Janssens R, Deschacht J, Camus M, Devroey P, Van Steirteghem AC: Performance of different embryo transfer catheters in a human in vitro fertilization program. Fertil Steril 1989;52:79–84

    PubMed  Google Scholar 

  55. Van Weering HGI, Schats R, McDonnell J, Vink JM, Vermeiden JPW, Hompes PGA: The impact of the embryo transfer catheter on the pregnancy rate in IVF. Hum Reprod 2002;17:666–670

    Article  PubMed  Google Scholar 

  56. Gonen Y, Dirnfeld M, Goldman S, Koifman M, Abramovici H: Does the choice of catheter for embryo transfer influence the success rate of in-vitro fertilization? Hum Reprod 1991;6:1092–1094

    PubMed  Google Scholar 

  57. Karande VC, Morris R, Chapman C, Rinehart J, Gleicher N: Impact of the physician factor on pregnancy rates in a large assisted reproductive technology program: Do too many cooks spoil the broth? Fertil Steril 1999;71:1001–1009

    Article  PubMed  Google Scholar 

  58. Roseboom TJ, Vermeiden JPW, Schoute E, Lens JW, Schats R: The probability of pregnancy after embryo transfer is affected by the age of the patient, cause of infertility, number of embryos transferred and the average morphology score, as revealed by multiple logistic regression analysis. Hum Reprod 1995;10:3035–3041

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to William R. Boone.

Additional information

58th Annual Meeting of the South Carolina Obstetrics and Gynecology Society, Hilton Head, South Carolina, September 9–12, 2004.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rhodes, T.L., McCoy, T.P., Higdon, H.L. et al. Factors affecting assisted reproductive technology (ART) pregnancy rates: a multivariate analysis. J Assist Reprod Genet 22, 335–346 (2005). https://doi.org/10.1007/s10815-005-6794-1

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10815-005-6794-1

Key Words

Navigation