Claffey Andrew, Ngo Anh, McIntire Donald, Doody Kathleen, Doody Kevin
Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
Reproductive Endocrinology and Infertility, Care Fertility, Bedford, TX, USA.
J Assist Reprod Genet. 2025 Mar;42(3):799-807. doi: 10.1007/s10815-025-03413-9. Epub 2025 Feb 5.
Many national recommendations have been made regarding practice patterns of assisted reproductive technology utilization (intracytoplasmic sperm injection (ICSI), preimplantation genetic testing (PGT), and blastocyst stage embryo transfer). This study seeks to assess individual clinic changes in practice behaviors from 2014 to 2020 in response to national guidelines.
This retrospective cohort study examined data from individual clinics using the Society of Assisted Reproductive Technology Clinical Outcome Reporting System (SART-CORS) database. Each clinic was weighed individually and equally regardless of clinic volume to avoid skewing national data with larger-volume clinics. The trends of ICSI, PGT, and blastocyst stage embryo transfer were examined across five age groups (< 35, 35-37, 38-40, 40-42, and > 42).
ICSI usage from 2014 to 2020 increased in all age groups (p < 0.001). In 2020, more than half the clinics in this study utilized ICSI in ≥ 90% of IVF cycles (per oocyte retrieval). Utilization of prolonged embryo culture increased in all age groups across the seven years of this study, with a more extensive adoption of this practice in patients ≤ 40 years (p < 0.001). Between 2014 and 2020, PGT usage increased by 3-4 times across all age groups (p < 0.001). By 2020, PGT was performed after egg retrievals in approximately 40 to 50% (mean) of patients < 42 years old.
Nationally, the application of all three reproductive technologies (ICSI, PGT, and blastocyst stage transfer) has drastically increased. The authors suspect that these technology expansions are interrelated and may be associated with the rise of rates of PGT.
关于辅助生殖技术应用（卵胞浆内单精子注射（ICSI）、植入前基因检测（PGT）和囊胚期胚胎移植）的实践模式，已经有许多国家层面的建议出台。本研究旨在评估各诊所从2014年到2020年因应国家指南而在实践行为上的个体变化。
这项回顾性队列研究使用辅助生殖技术协会临床结果报告系统（SART-CORS）数据库检查了各诊所的数据。每个诊所不论规模大小都被单独且平等地加权，以避免规模较大的诊所扭曲全国数据。在五个年龄组（<35岁、35 - 37岁、38 - 40岁、40 - 42岁和>42岁）中研究了ICSI、PGT和囊胚期胚胎移植的趋势。
2014年至2020年，所有年龄组的ICSI使用率均有所上升（p<0.001）。2020年，本研究中超过一半的诊所在≥90%的体外受精周期（每次取卵）中使用了ICSI。在本研究的七年中，所有年龄组的延长胚胎培养使用率均有所上升，40岁及以下患者对这种做法的采用更为广泛（p<0.001）。2014年至2020年，所有年龄组的PGT使用率增长了3至4倍（p<0.001）。到2020年，在42岁以下的患者中，约40%至50%（平均）在取卵后进行了PGT。
在全国范围内，所有三种生殖技术（ICSI、PGT和囊胚期移植）的应用都大幅增加。作者怀疑这些技术的扩展是相互关联的，并且可能与PGT率的上升有关。
