Common practices among consistently high-performing in vitro fertilization programs in the United States: 10-year update

Abstract

Objective: To evaluate similarities and differences in clinical and laboratory practices among high-performing fertility clinics.

Design: Cross-sectional questionnaire study of selected programs.

Setting: Academic and private fertility practices performing in vitro fertilization (IVF).

Patient(s): Not applicable.

Intervention(s): A comprehensive survey was conducted of 13 IVF programs performing at least 100 cycles a year and having high cumulative singleton delivery rates for 2 years.

Main outcome measure(s): Clinical and laboratory IVF practices.

Result(s): Although many areas of clinical practice varied among top programs, some commonalities were observed. All programs used a combination of follicle-stimulating hormone and luteinizing hormone for IVF stimulation, intramuscular progesterone in frozen embryo transfer cycles, ultrasound-guided embryo transfers, and a required semen analysis before starting the IVF cycle. Common laboratory practices included vitrification of embryos at the blastocyst stage, air quality control with positive air pressure and high-efficiency particulate air filtration, use of incubator gas filters, working on heated microscope stages, and incubating embryos in a low-oxygen environment, most often in benchtop incubators.

Conclusion(s): Some areas of consistency in clinical and laboratory practices were noted among high-performing IVF programs that are likely contributing to their success. High-performing programs focused on singleton deliveries. As the field of IVF is rapidly evolving, it is imperative that we share best practices in an effort to improve outcomes from all clinics for the good of our patients.

Keywords: Assisted reproductive technology; IVF; best practices; infertility.