Indications<unk>  may be used to overcome female infertility when it is due to problems with the fallopian tubes, making in vivo<unk>  difficult. It can also assist in male infertility, in those cases where there is a defect in sperm quality; in such situations intracytoplasmic sperm injection (ICSI) may be used, where a sperm cell is injected directly into the egg cell. This is used when sperm has difficulty penetrating the egg. In these cases the partner's or a donor's sperm may be used. ICSI is also used when sperm numbers are very low. When indicated, the use of ICSI has been found to increase the success rates of<unk> . According to UK's guidelines,<unk>  treatment is appropriate in cases of unexplained infertility for women who have not conceived after 2 years of regular unprotected sexual intercourse. In women with anovulation, it may be an alternative after 7–12 attempted cycles of ovulation induction, since the latter is expensive and more easy to control. Success rates<unk>  success rates are the percentage of all<unk>  procedures that result in a favourable outcome. Depending on the type of calculation used, this outcome may represent the number of confirmed pregnancies, called the pregnancy rate, or the number of live births, called the live birth rate. The success rate depends on variable factors such as maternal age, cause of infertility, embryo status, reproductive history, and lifestyle factors. Maternal age: Younger candidates of<unk>  are more likely to get pregnant. Females older than 41 are more likely to get pregnant with a donor egg. Reproductive history: women who have been previously pregnant are in many cases more successful with<unk>  treatments than those who have never been pregnant. Due to advances in reproductive technology, live birth rates by cycle five of<unk>  have increased from 76% in 2005 to 80% in 2010 despite a reduction in the number of embryos being transferred (which decreased the multiple birth rate from 25% to 8%). Live birth rate The live birth rate is the percentage of all<unk>  cycles that lead to a live birth. This rate does not include miscarriage or stillbirth; multiple-order births, such as twins and triplets, are counted as one pregnancy. A 2017 summary compiled by the Society for Assisted Reproductive Technology (SART) which reports the average<unk>  success rates in the United States per age group using non-donor eggs compiled the following data: 42 Pregnancy rate (%) 47.1 40.6 30.9 18.8 7.6 Live birth rate (%) 40.5 30.2 18.7 9.1 2.9 In 2006, Canadian clinics reported a live birth rate of 27%. Birth rates in younger patients were slightly higher, with a success rate of 35.3% for those 21 and younger, the youngest group evaluated. Success rates for older patients were also lower and decrease with age, with 37-year-olds at 27.4% and no live births for those older than 48, the oldest group evaluated. Some clinics exceeded these rates, but it is impossible to determine if that is due to superior technique or patient selection, since it is possible to artificially increase success rates by refusing to accept the most difficult patients or by steering them into oocyte donation cycles (which are compiled separately). Further, pregnancy rates can be increased by the placement of several embryos at the risk of increasing the chance for multiples. The live birth rates using donor eggs are also given by the SART and include all age groups using either fresh or thawed eggs: Fresh donor egg embryos Thawed donor egg embryos Live birth rate (%) 40.3 36.3 Because not each<unk>  cycle that is started will lead to oocyte retrieval or embryo transfer, reports of live birth rates need to specify the denominator, namely<unk>  cycles started,<unk>  retrievals, or embryo transfers. The SART summarised 2008–9 success rates for US clinics for fresh embryo cycles that did not involve donor eggs and gave live birth rates by the age of the prospective mother, with a peak at 41.3% per cycle started and 47.3% per embryo transfer for patients under 35 years of age.<unk>  attempts in multiple cycles result in increased cumulative live birth rates. Depending on the demographic group, one study reported 45% to 53% for three attempts, and 51% to 71% to 80% for six attempts. Effective from 15 February 2021 the majority of Australian<unk>  clinics publish their individual success rate online via YourIVFSuccess.com.au. This site also contains a predictor tool. Pregnancy rate Pregnancy rate may be defined in various ways. In the United States, the pregnancy rate used by the SART and the Centers for Disease Control (and appearing in the table in the Success Rates section above) are based on fetal heart motion observed in ultrasound examinations. The 2017 summary compiled by the SART the following data for the United States: 42 Pregnancy rate (%) 47.1 40.6 30.9 18.8 7.6 In 2006, Canadian clinics reported an average pregnancy rate of 35%. A French study estimated that 66% of patients starting<unk>  treatment finally succeed in having a child (40% during the<unk>  treatment at the centre and 26% after<unk>  discontinuation). Achievement of having a child after<unk>  discontinuation was mainly due to adoption (46%) or spontaneous pregnancy (42%). Miscarriage rate According to a study done by the Mayo Clinic miscarriage rates for<unk>  are somewhere between 15 and 25%. Predictors of success The main potential factors that influence pregnancy (and live birth) rates in<unk>  have been suggested to be maternal age, duration of infertility or subfertility, bFSH and number of oocytes, all reflecting ovarian function. Optimal woman's age is 23–39 years at time of treatment. A triple-line endometrium is associated with better<unk>  outcomes. Biomarkers that affect the pregnancy chances of<unk>  include: * Antral follicle count, with higher count giving higher success rates. * Anti-Müllerian hormone levels, with higher levels indicating higher chances of pregnancy, as well as of live birth after<unk> , even after adjusting for age. * Level of DNA fragmentation as measured, e.g. by Comet assay, advanced maternal age and semen quality. * Women with ovary-specific FMR1 genotypes including het-norm/low have significantly decreased pregnancy chances in<unk> . *Progesterone elevation on the day of induction of final maturation is associated with lower pregnancy rates in<unk>  cycles in women undergoing ovarian stimulation using GnRH analogues and gonadotrophins. At this time, compared to a progesterone level below 0.8 ng/ml, a level between 0.8 and 1.1 ng/ml confers an odds ratio of pregnancy of approximately 0.8, and a level between 1.2 and 3.0 ng/ml confers an odds ratio of pregnancy of between 0.6 and 0.7. On the other hand, progesterone elevation does not seem to confer a decreased chance of pregnancy in frozen–thawed cycles and cycles with egg donation. * Characteristics of cells from the cumulus oophorus and the membrana granulosa, which are easily aspirated during oocyte retrieval. These cells are closely associated with the oocyte and share the same microenvironment, and the rate of expression of certain genes in such cells are associated with higher or lower pregnancy rate. * An endometrial thickness (EMT) of less than 7 mm decreases the pregnancy rate by an odds ratio of approximately 0.4 compared to an EMT of over 7 mm. However, such low thickness rarely occurs, and any routine use of this parameter is regarded as not justified. Other determinants of outcome of<unk>  include: * As the maternal age increases, the likelihood of conception decreases and the chance of miscarriage increases. *With increasing paternal age, especially 50 years and older, the rate of blastocyst formation decreases. * Tobacco smoking reduces the chances of<unk>  producing a live birth by 34% and increases the risk of an<unk>  pregnancy miscarrying by 30%. * A body mass index (BMI) over 27 causes a 33% decrease in likelihood to have a live birth after the first cycle of<unk> , compared to those with a BMI between 20 and 27. Also, pregnant females who are obese have higher rates of miscarriage, gestational diabetes, hypertension, thromboembolism and problems during delivery, as well as leading to an increased risk of fetal congenital abnormality. Ideal body mass index is 19–30. * Salpingectomy or laparoscopic tubal occlusion before<unk>  treatment increases chances for women with hydrosalpinges. * Success with previous pregnancy and/or live birth increases chances * Low alcohol/caffeine intake increases success rate * The number of embryos transferred in the treatment cycle * Embryo quality * Some studies also suggest that autoimmune disease may also play a role in decreasing<unk>  success rates by interfering with proper implantation of the embryo after transfer. Aspirin is sometimes prescribed to women for the purpose of increasing the chances of conception by<unk> , but there was no evidence to show that it is safe and effective. A 2013 review and meta analysis of randomised controlled trials of acupuncture as an adjuvant therapy in<unk>  found no overall benefit, and concluded that an apparent benefit detected in a subset of published trials where the control group (those not using
In vitro fertilisation
Egg donation
Embryo transfer
Fetal surgery
Intracytoplasmic morphologically selected sperm injection
Assisted reproductive technology
Artificial insemination
Partner-assisted reproduction