Progress we can be proud of: US trends in assisted reproduction over the first 20 years

Objective: Documentation of the significant progress of assisted reproductive technology (ART) therapy in the United States. Design: Tabulation of data from the annual published reports of ART activity in the United States for the years 1985 through 1999. Setting: ART centers in the United States that report their results to the Centers for Disease Control and Prevention (CDC) via the Society for Assisted Reproductive Technology (SART). Patient(s): The annual reports included 647,208 cycles of treatment. Intervention(s): None. Main Outcome Measure(s): The number of clinics and cycles, and the rates of pregnancy, delivery, miscarriage, and multiple pregnancy were examined. Practice trends were also examined. Result(s): The number of clinics and cycles has grown steadily. The 155,661 clinical pregnancies led to 128,608 births and 177,745 babies born. The advent of intracytoplasmic sperm injection (ICSI) and the fall of GIFT and zygote intrafallopian transfer (ZIFT) are noted. Pregnancy rates have risen steadily in all therapies, and the number of deliveries of triplets or more has declined dramatically in the most recent reporting years. Conclusion(s): Over the years, ART therapies have steadily become more effective, with notable reductions in multiple pregnancies, the ability to avoid laparoscopy (for egg retrieval and in some cases tubal transfers), and effective therapy for serious sperm, egg, and uterine problems, none of which was true in the early years. This has occurred owing to the dedication and ingenuity of practitioners, and, notably, without federal regulation of clinical practice. (C) 2002 by American Society for Reproductive Medicine.