title: In Vitro fertilization (IVF) treatments in Maccabi Healthcare Services 2007-2014.
abstract: BACKGROUND
  Israel reports the world's highest IVF cycles per capita. However, clinical outcome data of these treatments are scarce. In a previous publication, we summarized IVF results among Maccabi Healthcare Services members for the years 2007-2010. The main findings included an increase in mean patients' age over the period studied, a 50 % increase in cycle numbers during this time, and a decrease in success rate (live birth) from 18.8 % in 2007 to 14.8 % in 2010. The purpose of the current publication is to summarize IVF outcome for the years 2011-2014, and to explore possible changes in the trends we reported previously.
  
  
  METHODS
  IVF and live births data were collected from Maccabi Healthcare Services' fertility treatments registry. Analyses were conducted by treatment year and patients' age at the initiation of treatment cycles. Autologous cycles, were included (ovum donation cycles and frozen-thaw cycles were excluded). A successful cycle was defined if a live birth was recorded within 10 months of its initiation.
  
  
  RESULTS
  In accordance with previous data for the years 2007-2010, mean patients' age continued to rise (from 36.2 in 2011 to 37.1 in 2014). In contrast to previous years, during which a continued increase in treatment cycles was recorded, we found that treatment number decreased from a peak of 9,751 in 2011 to 8,623 in 2014. Contrary to that trend, the number of patients over 40 years of age increased from 3,204 in 2011 to 3,648 in 2014. Success rate fluctuated between 14.4 % in 2014 to 16.4 % in 2013. The majority (78 %) of treatment cycles were conducted in four private medical centers.
  
  
  CONCLUSIONS
  The decrease in treatment cycles in recent years notwithstanding, Israel is still leading the world with IVF treatments relative to population. Success rate is relatively low compared to international data. Given the steady increase in patients' mean age, and particularly, the increase in patients over 40 years of age, we maintain that the low success rate reflects a growing number of treatments that a priori have a low chance of success.
authors.affiliation: Maccabi Healthcare Services, Tel Aviv, Israel.
authors.forename: Shahar
authors.initials: S
authors.lastname: Kol
authors.affiliation: Department of Health Services Research at Chief Physician Office of Maccabi Healthcare Services, Tel Aviv, Israel.
authors.forename: Lucia Bergovoy
authors.initials: LB
authors.lastname: Yellin
authors.affiliation: Maccabi Healthcare Services, Tel Aviv, Israel.
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Segal
authors.affiliation: Maccabi Healthcare Services, Tel Aviv, Israel.
authors.forename: Avi
authors.initials: A
authors.lastname: Porath
keywords: Assisted reproductive technology; In-vitro fertilization; Infertility registry; Israel; Maccabi Healthcare Services