The declining efficiency of IVF in the USA

STUDY QUESTION: Has the efficiency of IVF cycles in the USA declined between 2012 and 2021? SUMMARY ANSWER: National U.S. data show a continuous linear decline in IVF cycle efficiency between 2012 and 2021. WHAT IS KNOWN ALREADY: Previous studies reported that live birth rates after IVF increased until 2010 but subsequently declined, potentially due to the introduction of IVF ‘add-ons’ and changes in clinical practice. STUDY DESIGN, SIZE, DURATION: Retrospective cohort study, using publicly available national U.S. IVF outcome data reported annually to the Centers for Disease Control and Prevention (CDC) for the period 2012–2021. PARTICIPANTS/MATERIALS, SETTING, METHODS: CDC annual reports were used as a data source. Extracted variables included a number of IVF cycle starts, embryo transfers, embryo banking cycles, and live births. IVF ‘treatment efficiency’ was calculated as the proportion of live births per initiated cycle (intent-to-treat analysis). MAIN RESULTS AND THE ROLE OF CHANCE: Over the study period, IVF cycle starts increased by 234.7% (176 274 to 413 776), embryo transfers by 150.3% (134 471 to 202 121), and embryo banking cycles by 902.3% (18 585 to 167 689). Live births increased by 179.2% (51 286 to 91 906). However, cycle efficiency declined from 29.1% in 2012 to 22.2% in 2021, a relative reduction of 23.4%, with an approximately linear decline across the decade. LIMITATIONS, REASONS FOR CAUTION: The study is based on aggregate CDC data without patient-level granularity. Therefore, analyses could not control for confounding factors such as parity, infertility diagnosis, or detailed age subgroups. Embryo banking practices also complicate year-to-year comparisons of live birth rates. WIDER IMPLICATIONS OF THE FINDINGS: These findings suggest that despite substantial growth in IVF cycle numbers, treatment efficiency has progressively declined in the USA over the last decade. This decline coincided with a rapid increase in the use of embryo banking and other IVF ‘add-ons’. The results raise concern about current clinical practices and highlight the need for critical reevaluation of routine interventions in IVF. STUDY FUNDING/COMPETING INTEREST(S): No external funding was received for this study. NG and DHB hold patents related to androgen treatment in females (DHEA) with numbers US8067400B2, US8501718B2, and US9375436B2 (listed in USPTO/public records and assigned to American Infertility of New York). They also receive royalties from Nutraceuticals LLC, which has helped commercialize DHEA as a nutritional supplement.