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Reproductive Biology and Endocrinology
Published in: Reproductive Biology and Endocrinology 1/2017

Open Access 01-12-2017 | Research

Differences in utilization of Intracytoplasmic sperm injection (ICSI) within human services (HHS) regions and metropolitan megaregions in the U.S.

Authors: Pavel Zagadailov, Albert Hsu, David B. Seifer, Judy E. Stern

Published in: Reproductive Biology and Endocrinology | Issue 1/2017

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Abstract

Background

Anecdotal evidence suggests that US practice patterns for ART differ by geographical region. The purpose of this study was to determine whether use of ICSI differs by region and to evaluate whether these rates are correlated with differences in live birth rates.

Methods

Public data for 2012 were obtained from the Centers for Disease Control and Prevention. Clinics with ≥100 fresh, non-donor cycles were grouped by 10 nationally recognized Department of Health & Human Services regions and 11 metropolitan Megaregions and were compared for use of ICSI, frequency of male factor infertility, and live birth rate in women <35 years.

Results

There were 274 clinics in the Health & Human Services regions and 247 in the Megaregions. ICSI utilization rates in Health & Human Services groups ranged between 52.5–78.2% (P < 0.0001). Live birth rates per cycle in women <35 years differed (34.1–47.6%; P < 0.0001) but did not correlate with rates of ICSI (R2 = 0.2096; P = 0.18) per cycle. For Megaregions, rates of ICSI per cycle differed (63.4%–93.5%, P < 0.0001) as did live birth rates per cycle for women <35 (36.0%–59.0%, P = 0.001) but there was only minimal correlation between them (R2 = 0.5347; P = 0.01). Highest rates of ICSI occurred in Front Range (93.5%) and Gulf Coast (83.1%) Megaregions. Lowest rates occurred in the Northeast (63.4%) and Florida (64.8%) Megaregions. Male factor infertility rates did not differ across regions.

Conclusions

ICSI utilization and live birth rates per cycle for each clinic group were significantly different across geographical regions of the U.S. However, higher ICSI utilization rate was not associated with higher rates of male factor infertility nor were they strongly correlated with higher live birth rates per cycle. Studies are needed to understand factors that may influence ICSI overutilization in the U.S.
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Metadata
Title
Differences in utilization of Intracytoplasmic sperm injection (ICSI) within human services (HHS) regions and metropolitan megaregions in the U.S.
Authors
Pavel Zagadailov
Albert Hsu
David B. Seifer
Judy E. Stern
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Reproductive Biology and Endocrinology / Issue 1/2017
Electronic ISSN: 1477-7827
DOI
https://doi.org/10.1186/s12958-017-0263-4

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