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This study used national surveillance data from the Society for Assisted Reproductive Technology to describe trends and outcomes in assisted reproductive technology cycles using a gestational carrier vs those not using a gestational carrier. [ABSTRACT FROM AUTHOR]

Insurance coverage for fertility services may reduce the financial burden of high-cost fertility care such as assisted reproductive technology and improve its utilization. Patients who exit care after failing to reach their reproductive goals report higher rates of mental health problems and a lower sense of well-being. It is important to understand the relationship between state-mandated insurance coverage for fertility services and assisted reproductive technology care discontinuation. This study aimed to assess whether state-mandated insurance coverage for fertility services is associated with lower rates of care discontinuation after an initial assisted reproductive technology cycle that did not result in a live birth. This is a retrospective, population-based cohort study using data from United States fertility clinics reporting to the National Assisted Reproductive Technology Surveillance System during 2016 and 2018. Patients who began their first autologous assisted reproductive technology cycle during 2016 and 2017 and did not have a live birth were included. We describe the rate of assisted reproductive technology care discontinuation (no additional cycle within 12 months of the previous cycle's date of failure). Multivariable analyses were conducted to evaluate factors independently associated with care discontinuation, including the scope of fertility services included in state coverage mandate at assisted reproductive technology cycle initiation that were as follows: comprehensive (≥3 assisted reproductive technology cycles), limited (1, 2, or an unspecified number of assisted reproductive technology cycles), mandate not including assisted reproductive technology, and no mandate. Among 91,324 patients who underwent their first autologous assisted reproductive technology cycle that did not result in live birth, 24,072 (26.4%) discontinued care. Compared with patients who lived in states with mandates for comprehensive assisted reproductive technology coverage, those in states with mandates for fertility services coverage that did not include assisted reproductive technology or states with no mandate were 46% (adjusted relative risk, 1.46; 95% confidence interval, 1.31–1.63) and 26% (adjusted relative risk, 1.26; 95% confidence interval, 1.15–1.39) more likely to discontinue care, respectively, after controlling for patient and cycle characteristics. Increasing patient age, distance from clinic ≥50 miles, previous live birth, fewer oocytes retrieved, and not having embryos cryopreserved were also associated with higher rates of discontinuation. Non-Hispanic Black, non-Hispanic Asian, and Hispanic patients had higher rates of care discontinuation than non-Hispanic White patients regardless of the existence or scope of state-mandated assisted reproductive technology coverage. Comprehensive state-mandated insurance coverage for assisted reproductive technology is associated with lower rates of assisted reproductive technology care discontinuation. [ABSTRACT FROM AUTHOR]

Background: In 2016, the Food and Drug Administration amended existing regulations to increase access to donated embryos for reproductive use. Current information regarding characteristics and outcomes of embryo donation cycles could benefit patients and providers during counseling and decision making.Objective(s): To examine trends in utilization of embryo donation, pregnancy rates and live birth rates per transfer between 2004-2019; to describe recipients of donated embryos and outcomes of frozen donated embryo transfer cycles during the most recent time period: 2016-2019 STUDY DESIGN: We conducted a retrospective population-based cohort study of frozen donated embryo transfer cycles in United States fertility clinics reporting to the National Assisted Reproductive Technology Surveillance System during 2004-2019. Trends in the annual number and proportion of frozen donated embryo transfers, pregnancy rates and live birth rates from 2004-2019 were described. During 2016-2019, rate of cycle cancellation, pregnancy, miscarriage, live birth, singleton birth, and good perinatal outcome (delivery ≥37 weeks, birthweight ≥2500 grams) of frozen donated embryo transfers were also calculated. Transfer and pregnancy outcomes stratified by oocyte source age at the time of oocyte retrieval were also described.Result(s): From 2004-2019, there were 21,060 frozen donated embryo transfers in the United States resulting in 8,457 live births. During this period, the annual number and proportion of frozen donated embryo transfers of all transfers increased, as did the pregnancy rate and live birth rate. Among all initiated cycles during 2016-2019, the cancellation rate was 8.2%. Among 8,773 transfers with known outcomes, 4,685 (53.4%) resulted in pregnancy and 3,820 (43.5%) in live birth. Among all pregnancies, 814 (17.4%) resulted in miscarriage. Among all live births, 3,223 (84.4%) delivered a singleton of which 2,474 (76.8%) had a good perinatal outcome. The clinical pregnancy rate and live birth rate per frozen donated embryo transfer decreased with increasing age of oocyte source.Conclusions: The outcomes of embryo donation cycles reported in this national cohort may aid patients and providers when considering use of donated embryos. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Given the high cost of assisted reproductive technology (ART) in the United States, we assessed the association between state-mandated insurance coverage for fertility services with rates of care discontinuation after an initial ART cycle that did not result in a live birth. METHODS: This retrospective cohort study using data from the National ART Surveillance System included patients who began their first autologous ART cycle between 2016-2017 and did not have a live birth. Patients were divided into those that continued and discontinued ART care within 12 months. Multivariable analyses were conducted to evaluate factors associated with discontinuation, including categories of state-mandated insurance coverage. Institutional review board approval was obtained. RESULTS: Among 91,234 patients who underwent their first autologous ART cycle that did not result in live birth, 24,072 (26%) discontinued care. Compared to patients who lived in states with comprehensive mandated insurance coverage (≥3 ART cycles), states with mandated insurance coverage excluding ART, or states with no mandated insurance coverage, were 46% (adjusted relative risk [aRR] 1.46; 95% CI, 1.31–1.63) and 26% (aRR 1.26; 95% CI, 1.15–1.39) more likely to discontinue care, respectively, after controlling for patient and cycle characteristics. Increasing patient age, distance from clinic >50 miles, prior live birth, fewer oocytes retrieved, and not having embryos cryopreserved were also associated with higher rates of discontinuation. Non-Hispanic Black, non-Hispanic Asian, and Hispanic patients had higher rates of care discontinuation compared to non-Hispanic White patients for any insurance coverage level. CONCLUSION: Comprehensive mandated insurance coverage for ART is associated with lower rates of ART care discontinuation. [ABSTRACT FROM AUTHOR]