**Warning:**	The NCBI web site requires JavaScript to function. 	more...

An official website of the United States government

**The .gov means it's official.**							Federal government websites often end in .gov or .mil. Before							sharing sensitive information, make sure you're on a federal							government site.						

**The site is secure.**							The **https://** ensures that you are connecting to the							official website and that any information you provide is encrypted							and transmitted securely.						

Log in

#### Account

                          - Dashboard
                          - Publications
                          - Account settings
                          - Log out

Access keysNCBI HomepageMyNCBI HomepageMain ContentMain Navigation

# Bookshelf

## 

                -  Browse Titles 
                -  Advanced 
                -  Help 
                -  Disclaimer 

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

                        - This publication is provided for historical reference only and the information may be out of date.

**This publication is provided for historical reference only and the information may be out of date.**

< PrevNext >

# Effectiveness of Assisted Reproductive Technology

*Evidence Reports/Technology Assessments, No. 167*

Investigators: Evan R Myers, MD, MPH, Douglas C McCrory, MD, MHS, Alyssa A Mills, MD, Thomas M Price, MD, Geeta K Swamy, MD, Julierut Tantibhedhyangkul, MD, Jennifer M Wu, MD, and David B Matchar, MD, MHSA.

Agency for Healthcare Research and Quality (US)2008 May

                            - Copyright and        Permissions

Bookshelf Copyright Notice

## Structured Abstract

#### Objectives:

We reviewed the evidence regarding the outcomes of interventions used in ovulation induction, superovulation, and in vitro fertilization (IVF) for the treatment of infertility. Short-term outcomes included pregnancy, live birth, multiple gestation, and complications. Long-term outcomes included pregnancy and post-pregnancy complications for both mothers and infants.

#### Data Sources:

MEDLINE® and Cochrane Collaboration resources.

#### Review Methods:

We included studies published in English from January 2000 through January 2008. For short-term outcomes, we excluded non-randomized studies and studies where a pregnancy or live birth rate per subject could not be calculated. For long-term outcomes, we excluded studies with fewer than 100 subjects and those without a control group. Articles were abstracted for relevant details, and relative risks or odds ratios, with 95 percent confidence intervals, were calculated for outcomes of interest for each study.

#### Results:

We identified 5294 abstracts and (for the three questions discussed in this draft report) reviewed 1210 full-text articles and included 478 articles for abstraction. Approximately 80 percent of the included studies were performed outside the United States.

The majority of randomized trials were not designed to detect differences in pregnancy and live birth rates; reporting of delivery rates and obstetric outcomes was unusual. Most did not have sufficient power to detect clinically meaningful differences in live birth rates, and had still lower power to detect differences in less frequent outcomes such as multiple births and complications.

Interventions for which there was sufficient evidence to demonstrate improved pregnancy or live birth rates included: (a) administration of clomiphene citrate in women with polycystic ovarian syndrome, (b) metformin plus clomiphene in women who fail to respond to clomiphene alone; (c) ultrasound-guided embryo transfer, and transfer on day 5 post-fertilization, in couples with a good prognosis; and (d) assisted hatching in couples with previous IVF failure. There was insufficient evidence regarding other interventions.

Infertility itself is associated with most of the adverse longer-term outcomes. Consistently, infants born after infertility treatments are at risk for complications associated with abnormal implantation or placentation; the degree to which this is due to the underlying infertility, treatment, or both is unclear. Infertility, but not infertility treatment, is associated with an increased risk of breast and ovarian cancer.

#### Conclusions:

Despite the large emotional and economic burden resulting from infertility, there is relatively little high-quality evidence to support the choice of specific interventions. Removing barriers to conducting appropriately designed studies should be a major policy goal.

## Contents

                          - Expand All
                          - Collapse All

                        - Preface
                        - Acknowledgments
                        - Executive Summary
                        - 1. Introduction                           - Normal Reproduction
                          - Infertility
                          - Assisted Reproductive Technologies
                          - Prevalence and Burden of Disease
                          - Evidence and Practice
                          - Uses of This Report
                        - 2. Methods                           - Topic Assessment and Refinement
                          - Analytic Framework
                          - Literature Search and Review
                          - Data Abstraction and Development of Evidence Tables
                          - Quality Assessment Criteria
                          - Peer Review Process
                        - 3. Results                           - Ovulation Induction without Assisted Conception (Question 2)
                          - Assisted Conception: IVF and ICSI (Question 3)
                          - Longer Term Outcomes (Question 4)
                        - 4. Discussion
                        - 5. Future Research                           - Study Design and Data Collection
                          - Barriers to High-Quality Research
                          - Areas for Prioritizing Research
                        - 6. Conclusions                           - Ovulation Induction without Assisted Conception (Question 2)
                          - Assisted Conception: IVF and ICSI (Question 3)
                          - Longer Term Outcomes (Question 4)
                        - Acronyms and Abbreviations
                        - Appendix A: Exact Search String
                        - Appendix B: List of Excluded Studies
                        - Appendix C: Data Abstraction Forms (Questions 2–4)
                        - Appendix D: Evidence Tables
                        - Appendix E: Peer Reviewers
                        - References Cited in the Evidence Report
                        - List of Included Studies (Questions 2–4, in Alphabetical Order)

                          - Expand All
                          - Collapse All

Prepared for: Agency for Healthcare Research and                            Quality, U.S. Department of Health and Human Services.1             Contract No. 290-02-0025. Prepared by: Duke University Evidence-based Practice Center, Durham, NC.

#### Suggested citation:

Myers ER, McCrory DC, Mills AA, Price TM, Swamy GK, Tantibhedhyangkul J, Wu JM, Matchar DB. Effectiveness of Assisted Reproductive Technology. Evidence Report/Technology Assessment No. 167 (Prepared by the Duke University Evidence-based Practice Center under Contract No. 290-02-0025.) AHRQ Publication No. 08-E012. Rockville, MD: Agency for Healthcare Research and Quality. May 2008.

This report is based on research conducted by the Duke University Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0025). The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

The information in this report is intended to help clinicians, employers, policymakers, and others make informed decisions about the provision of health care services. This report is intended as a reference and not as a substitute for clinical judgment.

This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

**No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in this report.**

                        - 1
                        - 
540 Gaither Road, Rockville, MD 20850. www​.ahrq.gov

Copyright Notice

Bookshelf ID: NBK38549

< PrevNext >

Share

### Views

                    - PubReader
                    - Print View
                    - Cite this Page Myers ER, McCrory DC, Mills AA, et al. Effectiveness of Assisted Reproductive Technology. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 May. (Evidence Reports/Technology Assessments, No. 167.)

### Other titles in these collections

                    - AHRQ Evidence Reports
                    - Health Services/Technology Assessment Text                            (HSTAT)

### Similar articles in PubMed

                    - Pregnancy outcomes after assisted human reproduction. [J Obstet Gynaecol Can. 2014] Pregnancy outcomes after assisted human reproduction.*Okun N, Sierra S, GENETICS COMMITTEE, SPECIAL CONTRIBUTORS.**J Obstet Gynaecol Can. 2014 Jan; 36(1):64-83.*
                    - Review In vitro fertilisation for unexplained subfertility. [Cochrane Database Syst Rev. 2005] Review In vitro fertilisation for unexplained subfertility.*Pandian Z, Bhattacharya S, Vale L, Templeton A.**Cochrane Database Syst Rev. 2005 Apr 18; (2):CD003357. Epub 2005 Apr 18.*
                    - Temperature of embryo culture for assisted reproduction. [Cochrane Database Syst Rev. 2019] Temperature of embryo culture for assisted reproduction.*Baak NA, Cantineau AE, Farquhar C, Brison DR.**Cochrane Database Syst Rev. 2019 Sep 17; 9(9):CD012192. Epub 2019 Sep 17.*
                    - Review Pregnancy and birth outcomes in couples with infertility with and without assisted reproductive technology: with an emphasis on US population-based studies. [Am J Obstet Gynecol. 2017] Review Pregnancy and birth outcomes in couples with infertility with and without assisted reproductive technology: with an emphasis on US population-based studies.*Luke B.**Am J Obstet Gynecol. 2017 Sep; 217(3):270-281. Epub 2017 Mar 18.*
                    - Assisted Reproductive Technology Surveillance — United States, 2012. [MMWR Surveill Summ. 2015] Assisted Reproductive Technology Surveillance — United States, 2012.*Sunderam S, Kissin DM, Crawford SB, Folger SG, Jamieson DJ, Warner L, Barfield WD, Centers for Disease Control and Prevention (CDC).**MMWR Surveill Summ. 2015 Aug 14; 64(6):1-29.*
See reviews...See all...

### Recent Activity

ClearTurn OffTurn On
                      - Effectiveness of Assisted Reproductive Technology Effectiveness of Assisted Reproductive Technology 
                      - Impact of Gene Expression Profiling Tests on Breast Cancer Outcomes Impact of Gene Expression Profiling Tests on Breast Cancer Outcomes 
                      - Collection and Use of Cancer Family History in Primary Care Collection and Use of Cancer Family History in Primary Care 
                      - Effectiveness and Safety of Vitamin D in Relation to Bone Health Effectiveness and Safety of Vitamin D in Relation to Bone Health 
                      - Management of Uterine Fibroids Management of Uterine Fibroids 

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on
See more...

TwitterFacebookLinkedInGitHubNCBI Insights Blog

Connect with NLM
                      - Twitter
                      - Facebook
                      - Youtube

National Library of Medicine8600 Rockville Pike							Bethesda, MD 20894

Web PoliciesFOIAHHS Vulnerability Disclosure

HelpAccessibilityCareers

-  NLM 
-  NIH 
-  HHS 
-  USA.gov