Unveiling clinic variation in utilization of ICSI, PGT, and blastocyst transfer: a comprehensive study using the SART...

Many national recommendations have been made regarding practice patterns of assisted reproductive technology utilization (intracytoplasmic sperm injection (ICSI), preimplantation genetic testing (PGT), and blastocyst stage embryo transfer). This study seeks to assess individual clinic changes in practice behaviors from 2014 to 2020 in response to national guidelines.

This retrospective cohort study examined data from individual clinics using the Society of Assisted Reproductive Technology Clinical Outcome Reporting System (SART-CORS) database. Each clinic was weighed individually and equally regardless of clinic volume to avoid skewing national data with larger-volume clinics. The trends of ICSI, PGT, and blastocyst stage embryo transfer were examined across five age groups (< 35, 35-37, 38-40, 40-42, and > 42).

ICSI usage from 2014 to 2020 increased in all age groups (p < 0.001). In 2020, more than half the clinics in this study utilized ICSI in ≥ 90% of IVF cycles (per oocyte retrieval). Utilization of prolonged embryo culture increased in all age groups across the seven years of this study, with a more extensive adoption of this practice in patients ≤ 40 years (p < 0.001). Between 2014 and 2020, PGT usage increased by 3-4 times across all age groups (p < 0.001). By 2020, PGT was performed after egg retrievals in approximately 40 to 50% (mean) of patients < 42 years old.

Nationally, the application of all three reproductive technologies (ICSI, PGT, and blastocyst stage transfer) has drastically increased. The authors suspect that these technology expansions are interrelated and may be associated with the rise of rates of PGT.