title: Assisted hatching and intracytoplasmic sperm injection are not associated with improved outcomes in assisted reproduction cycles for diminished ovarian reserve: an analysis of cycles in the United States from 2004 to 2011.
abstract: OBJECTIVE
  To investigate the impact of intracytoplasmic sperm injection (ICSI) and assisted hatching (AH) on assisted reproductive technology (ART) outcomes in initial cycles with diminished ovarian reserve (DOR) as the primary diagnosis.
  
  
  METHODS
  Retrospective cohort study of cycles from the Society for Assisted Reproductive Technology (SART) Clinic Outcome Reporting System database.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  A total of 422,949 fresh, nondonor, initial ART cycles of which 8,597 were diagnosed with only elevated FSH and 38,926 were diagnosed with only DOR according to the SART DOR categorization.
  
  
  METHODS
  None.
  
  
  METHODS
  Live birth and clinical pregnancy rates.
  
  
  RESULTS
  ICSI and AH were associated with diminished odds of live birth in SART DOR-only cycles (adjusted odds ratio [AOR] 0.88, 95% confidence interval [CI] 0.81-0.96 for ICSI; AOR 0.77, 95% CI 0.71-0.84 for AH). No association between odds of live birth and either ICSI or AH in elevated FSH-only cycles was observed. The combination of ICSI and AH was associated with significantly lower odds of live birth in SART DOR-only cycles but not in elevated FSH-only cycles.
  
  
  CONCLUSIONS
  In initial ART cycles for which the only indication relates to a diagnosis of DOR, AH and ICSI are not associated with improved live birth rates.
authors.affiliation: Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: sbutts@obgyn.upenn.edu.
authors.forename: Samantha F
authors.initials: SF
authors.lastname: Butts
authors.affiliation: Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Carter
authors.initials: C
authors.lastname: Owen
authors.affiliation: Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Monica
authors.initials: M
authors.lastname: Mainigi
authors.affiliation: Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Suneeta
authors.initials: S
authors.lastname: Senapati
authors.affiliation: Genesis Fertility and Reproductive Medicine, Maimonides Medical Center, Brooklyn, New York; New York University School of Medicine, New York, New York.
authors.forename: David B
authors.initials: DB
authors.lastname: Seifer
authors.affiliation: Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Anuja
authors.initials: A
authors.lastname: Dokras
mesh_terms: D016009:Chi-Square Distribution; D046149:Embryo Culture Techniques; D004624:Embryo Transfer; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D050498:Live Birth; D016015:Logistic Models; D016017:Odds Ratio; D065851:Ovarian Reserve; D011247:Pregnancy; D018873:Pregnancy Rate; D016649:Primary Ovarian Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D020554:Sperm Injections, Intracytoplasmic / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: ART; Diminished ovarian reserve; ICSI; assisted hatching
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