Guidance on the limits to the number of embryos to transfer: a committee opinion (2021)
On the basis of American Society for Reproductive Medicine and Society for Assisted Reproductive Technology data, the American Society for Reproductive Medicine's guidelines for the limits on the number of embryos to be transferred during in vitro fertilization cycles have been further refined in continuing efforts to promote singleton gestation and reduce the number of multiple pregnancies.
Respect for a patient's autonomy to consider placement of more than one embryo requires a full discussion of the ethical and medical considerations, ensuring that a patient is able to make a fully informed decision. Elective placement of multiple embryos is often influenced by financial considerations. Studies showed that insurance coverage for IVF was associated with the transfer of fewer embryos and with significantly lower rates of high-order multiple births (9). Financial pressures may be a coercive tipping point in favor of multiple embryo transfer. In contrast, if patients are informed of the risks inherent in twin or high-order pregnancy and these financial pressures are removed or at least alleviated, most patients would opt to maximize their chance of a singleton, safe pregnancy and birth (10).
Although multifetal pregnancy reduction can be performed to reduce the fetal number, the procedure may result in the loss of all fetuses, it does not completely eliminate the risks associated with multiple pregnancies, and it may have adverse psychological consequences (11). Moreover, multifetal pregnancy reduction is not an acceptable option for many women.
Individual programs are encouraged to generate and use their own data regarding patient characteristics and the number of embryos to be transferred with the goal of maintaining pregnancy rates and minimizing multiple gestations. For example, if a program notes a particularly high implantation rate for cleavage-stage embryos among their patients aged 41–42 years, they should adjust their clinic-specific range for the number of embryos to transfer downward. Accordingly, programs should monitor their results continually and consider decreasing the number of embryos transferred to minimize undesirable outcomes. Conversely, use of a clinic's own data cannot be used to routinely exceed the recommended limits. Programs that have a multiple pregnancy rate that is well above average for all SART-reporting clinics may be audited by SART, and persistent noncompliance may result in expulsion from SART.
Apart from young age, characteristics like the expectation of one or more high-quality embryos available for cryopreservation; euploid embryos; and previous live birth after an IVF cycle have been associated with a favorable prognosis for pregnancy. Additional favorable criteria for frozen embryo transfer (FET) cycles include the availability of vitrified, high-quality blastocysts for transfer (14). The number of embryos transferred should be determined by the physician and the patient(s), informed consents completed, and the information recorded in the clinical record. In the absence of data generated by the individual program, and on the basis of data generated by all clinics providing ART services, the following guidelines are recommended for upper limits (Table 1):
BACKGROUND
The American Society for Reproductive Medicine’s (formerly The American Fertility Society) guidance for the limits to the number of embryos to be transferred during in vitro fertilization (IVF) cycles aims to promote singleton gestation and reduce the number of multiple pregnancies while maximizing the cumulative live birth rates. Although the incidence of high-order multiple pregnancies (three or more fetuses in one pregnancy) have diminished in recent years, twin gestations are still a relatively common occurrence with assisted reproductive technology (ART). Multiple gestation leads to an increased risk of complications in both the woman carrying the pregnancy and the fetuses (1–3). Even twin gestations have significant additional morbidity compared with that of singletons (3). Ideally, the goal of ART is to achieve a healthy singleton gestation (4–6). Among cycles reported to the Society for Assisted Reproductive Technology (SART) in 2017, 12.4% of women <38 years of age who had a successful IVF cycle had a twin gestation (7), down from 23% in 2014 but still significantly more than baseline. Almost half of all ART multiple gestations in the United States occurred in women <35 years old when 2 fresh or frozen blastocysts were transferred (8).Respect for a patient's autonomy to consider placement of more than one embryo requires a full discussion of the ethical and medical considerations, ensuring that a patient is able to make a fully informed decision. Elective placement of multiple embryos is often influenced by financial considerations. Studies showed that insurance coverage for IVF was associated with the transfer of fewer embryos and with significantly lower rates of high-order multiple births (9). Financial pressures may be a coercive tipping point in favor of multiple embryo transfer. In contrast, if patients are informed of the risks inherent in twin or high-order pregnancy and these financial pressures are removed or at least alleviated, most patients would opt to maximize their chance of a singleton, safe pregnancy and birth (10).
Although multifetal pregnancy reduction can be performed to reduce the fetal number, the procedure may result in the loss of all fetuses, it does not completely eliminate the risks associated with multiple pregnancies, and it may have adverse psychological consequences (11). Moreover, multifetal pregnancy reduction is not an acceptable option for many women.
RECOMMENDATIONS
In an effort to promote singleton gestations, reduce twin gestations, and eliminate high-order multiple gestations, the American Society for Reproductive Medicine and SART have developed the following guidance to assist ART programs and patients in determining the appropriate number of cleavage-stage embryos or blastocysts to transfer. National data from 2013 demonstrated that clinics that performed higher rates of elective single-embryo transfer in women aged <38 years had decreased rates of multiple gestations with no significant impact on clinic-level live birth rates (12). In addition, preimplantation genetic testing for aneuploidy maybe a tool to reduce the rate of multiple gestations, especially in women >37 years of age. In women %42 years, transferring a single euploid blastocyst resulted in pregnancy rates similar to those of transferring 2 untested blastocysts while dramatically reducing the risk of twins (13). Strict limitations on the number of embryos transferred, which may be required by law in some countries, do not allow treatment plans to be individualized after careful consideration of each patient's own unique circumstances. Therefore, on rare occasions, transferring more or fewer embryos than recommended by this document may be justified; documentation of justification for transferring a greater number of embryos should be recorded in the medical record, noting the individual clinical conditions, including patient age, parity, medical conditions, embryo quality, the opportunity for cryopreservation, and the patient prognosis.Individual programs are encouraged to generate and use their own data regarding patient characteristics and the number of embryos to be transferred with the goal of maintaining pregnancy rates and minimizing multiple gestations. For example, if a program notes a particularly high implantation rate for cleavage-stage embryos among their patients aged 41–42 years, they should adjust their clinic-specific range for the number of embryos to transfer downward. Accordingly, programs should monitor their results continually and consider decreasing the number of embryos transferred to minimize undesirable outcomes. Conversely, use of a clinic's own data cannot be used to routinely exceed the recommended limits. Programs that have a multiple pregnancy rate that is well above average for all SART-reporting clinics may be audited by SART, and persistent noncompliance may result in expulsion from SART.
Apart from young age, characteristics like the expectation of one or more high-quality embryos available for cryopreservation; euploid embryos; and previous live birth after an IVF cycle have been associated with a favorable prognosis for pregnancy. Additional favorable criteria for frozen embryo transfer (FET) cycles include the availability of vitrified, high-quality blastocysts for transfer (14). The number of embryos transferred should be determined by the physician and the patient(s), informed consents completed, and the information recorded in the clinical record. In the absence of data generated by the individual program, and on the basis of data generated by all clinics providing ART services, the following guidelines are recommended for upper limits (Table 1):
Table 1
| Recommendations for the limit to the number of embryos to transfer | ||||
| Age | ||||
| Prognosis | <35 | 35-37 | 38-40 | 41-42 |
| Cleavage stage embryos | ||||
| Euploid (a) | 1 | 1 | 1 | 1 |
| Other Favorable (b) | 1 | 1 | ≤3 | ≤4 |
| Embryos not Euploid (a) or Favorable (b) | ≤2 | ≤3 | ≤4 | ≤5 |
| Blastocysts | ||||
| Euploiad (a) | 1 | 1 | 1 | 1 |
| Other Favorable (b) | 1 | 1 | ≤2 | ≤3 |
| Embryos not Euploid (a) or Favorable (b) | ≤2 | ≤2 | ≤3 | ≤3 |
| (a) Demonstrated euploid embryos, best prognosis (b) Other Favorable = Any ONE of these criteria: Fresh cycle: expectation of 1 or more high-quality embryos available for cryopreservation or previous live birth after a prior transfer with sibling embryo(s); FET cycle: availability of vitrified day-5 or day-6 blastocysts, euploid embryos, 1st FET cycle, or previous live birth after an IVF cycle. **Please note that justification for transferring additional embryos beyond recommended limits should be clearly documented in the patient’s medical record. |
||||
- Patients with a favorable prognosis:
- Transfer of a euploid embryo should be limited to one, regardless of patient age.
- Patients <35 years of age should be strongly encouraged to receive a single-embryo transfer, regardless of the embryo stage.
- For patients between 35 and 37 years of age, strong consideration should be made for a single-embryo transfer.
- For patients between 38 and 40 years of age, no more than 3 untested cleavage-stage embryos or 2 blastocysts should be transferred.
- Patients 41–42 years of age should plan to receive no more than 4 untested cleavage-stage embryos or 3 blastocysts.
- Other scenarios:
- In each of the preceding age groups, patients who do not meet the criteria for a favorable prognosis may have an additional embryo transferred according to their individual circumstances (Table 1). The patient must be counseled regarding the additional risk of twin or higher-order multiple pregnancy.
- If otherwise favorable patients fail to conceive after multiple cycles with high-quality embryo(s) transferred, the physicians and patients may consider proceeding with an additional embryo to be transferred.
- Patients with a coexisting medical condition for which a multiple pregnancy may increase the risk of significant morbidity should not have more than one embryo transferred.
- In the rare cases in which the number of embryos or blastocysts transferred exceeds the recommended limits, both the counseling and the justification must be documented in the patient's permanent medical record.
- In women R43 years of age, there are insufficient data to recommend a limit on the number of embryos to transfer when the patient uses her own oocytes. Caution should be exercised as the risk associated with multiple pregnancy increases dramatically with advancing maternal age.
- In donor-oocyte cycles, the age of the donor should be used to determine the appropriate number of embryos to transfer. For example, when the donor is <38 years of age and other favorable criteria exist, single-embryo transfer should be planned.
- Single-embryo transfer should be strongly recommended in all gestational carrier (GC) cycles, given the health risks associated with multiple gestations for the GC. At a minimum, it is recommended to follow age-related limits on the number of embryos to transfer in GC cycles, on the basis of the age of the woman who produced the oocytes (either the intended parent or oocyte donor).
- In FET cycles, favorable characteristics should be on the basis of the age of the woman when the embryos were cryopreserved and include the presence of high-quality vitrified embryos, euploid embryos, first FET cycle, or previous live birth after a prior transfer with sibling embryo(s). Embryo transfer numbers should not exceed the recommended limit on the number of fresh embryos transferred for each age group.
Acknowledgments: This report was developed under the direction of the Practice Committees of the American Society for Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART) as a service to its members and other practicing clinicians. Although this document reflects appropriate management of a problem encountered in the practice of reproductive medicine, it is not intended to be the only approved standard of practice or to dictate an exclusive course of treatment. Other plans of management may be appropriate, taking into account the needs of the individual patient, available resources, and institutional or clinical practice limitations. The Practice Committees and the Boards of Directors of the ASRM and SART have approved this report.
This document was reviewed by ASRM members and their input was considered in the preparation of the final document. The following members of the ASRM Practice Committee participated in the development of this document: Alan Penzias, M.D.; Ricardo Azziz, M.D., M.P.H., M.B.A.; Kristin Bendikson, M.D.; Marcelle I. Cedars, MD; Tommaso Falcone, M.D.; Karl Hansen, M.D., Ph.D.; Micah Hill, D.O.; Sangita Jindal, Ph.D.; Suleena Kalra, M.D., M.S.C.E.; Jennifer Mersereau, M.D.; Richard Reindollar, M.D.; Chevis N. Shannon, Dr.P.H., M.P.H., M.B.A.; Anne Steiner, M.D., M.P.H.: Cigdem Tanrikut, M.D.; Hugh Taylor, M.D.; and Belinda Yauger, M.D. All Committee members disclosed commercial and financial relationships with manufacturers or distributors of goods or services used to treat patients. Members of the Committees who were found to have conflicts of interest on the basis of the relationships disclosed did not participate in the discussion or development of this document.
REFERENCES
- Rao A, Sairam S, Shehata H. Obstetric complications of twin pregnancies. Best Pract Res Clin Obstet Gynaecol 2004;18:557–76.
- The ESHRE Capri workshop group. Multiple gestation pregnancy. Hum Reprod 2000;15:1856–64.
- Santana DS, Cecatti JG, Surita FG, Silveira C, Costa ML, Souza JP, et al. Twin pregnancy and severe maternal outcomes: the World Health Organization multicountry survey on maternal and newborn health. Obstet Gynecol 2016;127:631–41.
- Practice Committee of the American Society for Reproductive Medicine. Multiple gestation associated with infertility therapy: an American Society for Reproductive Medicine Practice Committee opinion. Fertil Steril 2012; 97:825–34.
- Practice Committee of Society for Assisted Reproductive Technology, Practice Committee of the American Society for Reproductive Medicine. Elective single-embryo transfer. Fertil Steril 2012;97:835–42.
- ESHRE Guideline Group on Good Practice in IVF Labs, De los Santos MJ, Apter S, Coticchio G, Debrock S, Lundin K, Plancha CE, et al. Revised guidelines for good practice in IVF laboratories (2015). Hum Reprod 2016;31: 685–6.
- Society for Assisted Reproductive Technology. National summary report. Available at: https://www.sartcorsonline.com/rptCSR_PublicMultYear. aspx?reportingYear¼2019. Accessed June 18, 2021.
- Kissin DM, Kulkarni AD, Mneimneh A, Warner L, Boulet SL, Crawford S, et al. Embryo transfer practices and multiple births resulting from assisted reproductive technology: an opportunity for prevention. Fertil Steril 2015; 103:954–61.
- Jain T, Harlow BL, Hornstein MD. Insurance coverage and outcomes of in vitro fertilization. N Engl J Med 2002;347:661–6.
- Johnston J, Gusmano MK, Patrizio P. In search of real autonomy for fertility patients. Health Econ Policy Law 2015;10:243–50.
- Stone J, Eddleman K, Lynch L, Berkowitz RL. A single center experience with 1000 consecutive cases of multifetal pregnancy reduction. Am J Obstet Gynecol 2002;187:1163–7.
- Mancuso AC, Boulet SL, Duran E, Munch E, Kissin DM, Van Voorhis BJ. Elective single embryo transfer in women less than age 38 years reduces multiple birth rates, but not live birth rates, in United States fertility clinics. Fertil Steril 2016;106:1107–14.
- Forman EJ, Hong KH, Ferry KM, Tao X, Taylor D, Levy B, et al. In vitro fertilization with single euploid blastocyst transfer: a randomized controlled trial. Fertil Steril 2013;100:100–7.e1.
- Richter KS, Ginsburg DK, Shipley SK, Lim J, Tucker MJ, Graham JR, et al. Factors associated with birth outcomes from cryopreserved blastocysts: experience from 4,597 autologous transfers of 7,597 cryopreserved blastocysts. Fertil Steril 2016;106:354–62.e2.
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Do you know if both assisted hatching (89253) and embryo biopsy for PGS/PGD/CCS (89290/89291) can be billed during the same cycle? View the Answer
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The International Glossary on Infertility and Fertility Care, 2017†‡§ (2017)
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Do you know if both assisted hatching (89253) and embryo biopsy for PGS/PGD/CCS (89290/89291) can be billed during the same cycle? View the Answer
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This Fertility and Sterility Journal Club Global discusses February’s seminal article, “Common practices among consistently high-performing in vitro fertilization programs in the United States: a 10 year update.” View the Video
Journal Club Global - Fertilization rate as a novel indicator in ART results
This Journal Club Global discusses a provocative article recently published in Fertility and Sterility, discussing the results of a multicenter retrospective cohort study with the objective to appraise the fertilization rate as a predictive factor for cumulative live birth rate (CLBR). View the Video
Journal Club Global - Are We Approaching Automation in ART?
Some ART diagnostic devices are already available and offer objective tools of evaluation. View the Video
Guidance on the limits to the number of embryos to transfer: a committee opinion (2021)
ASRM's guidelines for the limits on the number of embryos to be transferred during IVF cycles have been further refined ... View the Committee Opinion
Minimum standards for practices offering assisted reproductive technologies: a committee opinion (2021)
A framework for assisted reproductive technology (ART) programs that meet or exceed the requirements suggested by the Centers for Disease Control View the Committee Opinion
Role of tubal surgery in the era of assisted reproductive technology: a committee opinion (2021)
This document reviews surgical options for reparative tubal surgery and the factors that must be considered when deciding between surgical repair and IVF.View the Committee Opinion
Journal Club Global - Recurrent Implantation Failures in ART: Myth or Reality?
Classically, implantation failures in ART were believed to result from alterations in embryo or endometrium quality.
View the Video
The role of immunotherapy in in vitro fertilization: a guideline (2018)
Adjuvant immunotherapy treatments in in vitro fertilization (IVF) aim to improve the outcome of assisted reproductive technology (ART) in both the general ART population as well as subgroups such as patients with recurrent miscarriage or implantation failure. View the Committee Opinion
Correct coding for laboratory procedures during assisted reproductive technology cycles
This document provides updated coding information for services related to assisted reproductive technology procedures. View the Coding Committee Document
Recommended practices for the management of embryology, andrology, and endocrinology laboratories: a committee opinion (2014)
A general overview for good management practices within the endocrinology, andrology, and embryology laboratories in the United States. View the Recommendation
Best practices of ASRM and ESHRE: a journey through reproductive medicine (2012)
ASRM and ESHRE are the two largest societies in the world whose members comprise the major experts and professionals working in reproductive medicine. View the Committee Joint GuidelineTopic Resources
View more on the topic of in vitro fertilization (IVF)
Fertility and Sterility On Air - Unplugged: October 2024
Topics include: mechanical contractions and fibroid progression, endometriosis classification and risk of infertility, fertility coverage for military personnel and more. Listen to the Episode
ASRM Releases Congressional Scorecard
Discover ASRM's first Congressional scorecard, detailing positions of the 118th Congress on key reproductive legislation to guide ASRM members in elections.
View the Press Release
Fertility Care Gets Important Win in California
ASRM celebrates California's SB 729, expanding IVF coverage for same-sex couples and singles, advancing equitable fertility care access.
View the Press Release
ASRM Today: Equity, Access, and Innovation, Episode Five: Policy Matters
This episode covers ballot measures on reproductive rights, ASRM advocacy efforts, and Vot-ER’s push for civic engagement among healthcare workers ahead of elections. Listen to the Episode
Nation’s Leading Professional Group for Fertility Care Professionals Calls for Passage of Right to IVF Act
ASRM applauds Majority Leader Schumer’s decision to seek reconsideration of the Right to IVF Act.
View the Press Release
ASRM Today: Equity, Access, and Innovation, Episode Three: Innovation
Explore innovation in reproductive health with ASRM Today. Discover how AI, robotics, and new technologies are transforming fertility care and improving patient outcomes. Listen to the Episode
Fertility and Sterility On Air - Live from ESHRE 2024: Part 1
Discover the impact of embryo expansion post-biopsy and freezing time standardization on live births in this episode from ESHRE 2024. Listen to the Episode
Fertility and Sterility On Air - Live from ESHRE 2024: Part 2
Explore fresh embryo transfers, progesterone elevation, and day-seven embryo utility from experts at ESHRE 2024. Cutting-edge fertility insights await! Listen to the Episode
Fertility and Sterility On Air - ANZSREI 2024 Journal Club Global: "Should Unexplained infertility Go Straight to IVF?"
Join "Fertility and Sterility On Air" for insights from the ANXSREI conference on unexplained infertility, IVF, and expert debates. Listen now at ASRM.org. Listen to the Episode
The use of preimplantation genetic testing for aneuploidy: a committee opinion (2024)
PGT-A use in the U.S. is rising, but its value as a routine IVF screening test is unclear, with mixed results from various studies. View the Committee Opinion
Trump Calls for IVF Coverage, California Legislature Sends IVF Mandate Bill to Governor
The California General Assembly approved a bill mandating most private health insurance plans to provide coverage for In Vitro Fertilization (IVF).
View the Press Release
Journal Club Global from ANZSREI 2024: Debate Unexplained infertility; Straight to IVF?
ANZSREI 2024 debate: Should unexplained infertility go straight to IVF? Experts discuss pros, cons, and alternative treatments. No clear consensus reached. View the Video
Get Vot-ER Ready This National Patient Advocacy Day!
Celebrate National Patient Advocacy Day by boosting civic engagement! Order your free Vot-ER badge to help patients register to vote and promote healthy communities.
View the Press Release
Who to bill for gestational carrier services if intended parents have insurance?
I wanted to inquire about guidelines for billing services to a surrogate’s insurance company if intended parents purchased the insurance coverage. View the Answer
Performing MD is not the Doctor of Record
Currently we are billing the performing provider as the service provider and the Doctor of Record as the billing provider. View the Answer
ASRM marks World IVF Day by doing what we do best – advocating for access to reproductive health care by calling for a House floor vote on the Right to IVF Act
ASRM observed World IVF Day, the day marking the birth of the world’s first IVF baby in 1978, by continuing its advocacy for improvements in IVF policy.
View the Press Release
Journal Club Global: Oral Progestin For Ovulation Suppression During IVF
Live broadcast from the 2024 Midwest Reproductive SymposiumInternational in Chicago, IL View the Video
Order your FREE Vot-ER badge to encourage patients and colleagues to vote!
ASRM) is pleased to announce our partnership with Vot-ER, a grassroots organization dedicated to driving civic engagement among healthcare professionals.
View the Press Release
Fertility and Sterility On Air - Seminal Article: Ernest Ng and Zhi Chen
June issue Seminal Contribution: a randomized controlled trial studying the use of progestins for ovulation supression in predicted high responders. Listen to the Episode
ASRM Responds to Senate Vote on IVF Bill
ASRM is disappointed that a filibuster prevented the passage of the Right to IVF Act.
View the Press Release
ASRM Calls for Passage of Family Building Bill
It would increase access to IVF treatments for all Americans, including active-duty service members, veterans, and federal employees.
View the Press Release
Fertility and Sterility On Air - TOC: May 2024
Topics this month include Iatrogenic and demographic determinants of the national plural birth increase, outcomes between ICSI and IVF with PGT-A. Listen to the Episode
ASRM publishes IVF one-pagers for media use
The documents lay out the clinical IVF process, summarize oversight of IVF in the U.S., and explain how lawmakers can support access to IVF.
View the Press Release
Billing for assisted hatching at biopsy and transfer
We would also like to know if you can bill assisted hatching with biopsy and then assisted hatching again during the transfer cycle. View the Answer
ASRM Reacts to Cruz/Britt OPED
We are pleased to see Senators Cruz and Britt express their interest in protecting access to IVF.
View the Press Release
Fertility and Sterility On Air - Unplugged: April 2024
Topics include: IVF in film, a rat model of fallopian tube torsion, comparing letrozole regimens for PCOS, and a review of chronic endometritis. Listen to the Episode
ASRM Files Amicus Brief in Texas Embryo Case
ASRM has filed an amicus curiae (friend of the court) brief in the case of Antoun v Antoun, which is pending before the Texas Supreme Court.
View the Press Release
Financial ‘‘risk-sharing’’ or refund programs in assisted reproduction: an Ethics Committee opinion (2023)
Financial ‘‘risk-sharing’’ fee structures in programs charge patients a higher initial fee but provide reduced fees for subsequent cycles. View the Committee Document
Alabama Supreme Court Rules Frozen Embryos are “Unborn Children” and admonishes IVF’s “Wild West” treatment
Legally Speaking™ on presenting facts and reflecting on the impact and potential implications of legal developments in ART. View the Column
Prevention of moderate and severe ovarian hyperstimulation syndrome: a guideline (2023)
Ovarian hyperstimulation syndrome is a serious complication associated with assisted reproductive technology. View the guideline
Billing IVF lab work
We typically bill our IVF Lab work under the rendering provider who performs the VOR. Who should be the supervising provider for embryology billing? View the Answer
Journal Club Global: IVM in Clinical Practice: An Idea Whose Time Has Come?
In vitro maturation (IVM) has the potential to make IVF cheaper, safer, and more widely accessible to patients with infertility. View the Video
Comparison of pregnancy rates for poor responders using IVF with mild ovarian stimulation versus conventional IVF: a guideline (2018)
Mild-stimulation protocols with in vitro fertilization (IVF) generally aim to use less medication than conventional IVF. View the Guideline
IVF cycle management and facility fees, an overview
How should IVF Cycle Management be coded? View the Answer
Limited ultrasound performed by RN
Would it be appropriate to bill a 99211 when an RN is doing a limited ultrasound and documenting findings during an IUI or IVF treatment cycle? View the Answer
CPT 89253 and 89254 for Assisted hatching
Can I bill CPT codes 89253 and 89254 together? If yes, do I need a modifier on any of the codes? View the Answer
Journal Club Global - What is the optimal number of oocytes to reach a live-birth following IVF?
The optimal number of oocytes necessary to expect a live birth following in vitro fertilization remains unclear. View the Video
Patient Education
What is the correct way to bill for the patient education sessions performed by registered nurses to individual patients prior to their IVF cycle? View the Answer
Pregnancy Ultrasound
Our practice does routine ultrasounds (sac check- 76817) at the end of an IVF cycle and bill with a diagnosis code O09.081, pregnancy resulting from ART. View the Answer
IVF Consent Counseling
When a patient is scheduled to undergo IVF and the provider schedules the patient for a 30-minute consultation is this visit billable? View the Answer
Lab Case Rates
What ICD-10 codes apply to case rates? View the Answer
In Vitro Maturation
Have CPT codes been established for maturation in vitro? View the Answer
IV Fluids During Egg Retrieval
Is it appropriate to bill the insurance company for CPT 96360, Under Hydration Infusion when being used in conjunction with IVF retrieval? View the Answer
IVF Billing Forms
I am seeking information on IVF insurance billing guidelines. View the Answer
IVF Billing Globally
Am I correct in assuming that it is duplicate billing for both the ambulatory center and embryology laboratory to bill globally? View the Answer
IVF Billing of Professional Charges
Are we allowed to bill professional charges under the physician for the embryologist who performs the IVF laboratory services? View the Answer
IVF Case Rates
What ICD-10 codes apply to case rates? View the Answer
Oocyte Denudation
Is there is a separate code for denudation of oocytes? View the Answer
Ovulation Induction Monitoring for IUI
We would like to clarify the correct ICD 10 diagnosis code for monitoring of an IUI cycle. View the Answer
Endometrial Biopsy/Scratch
What CPT code should be used for a “scratch test”? View the Answer
Endometriosis and Infertility
For treatment like IVF would we bill with N97.x first or an endometriosis diagnosis? View the Answer
Follicle Monitoring For Diminished Ovarian Reserve
If a patient has decreased ovarian reserve (ICD-10 E28.8) and patient is undergoing follicle tracking to undergo either an IUI cycle or IVF cycle... View the Answer
Global Billing Vs Billing Under Provider
For an IVF cycle (that is not being billed global to an insurance plan) is it appropriate to bill the charges under one “global” provider? View the Answer
Diagnosis of Infertility for IVF Procedure
How important is it to have accurate documentation of the type of infertility diagnosis for IVF procedures? View the Answer
Donor Embryos
Could you give guidance for the correct ICD-10 code(s) to use when a patient is doing an Anonymous Donor Embryo Transfer cycle? View the Answer
Egg Culture and Fertilization
We are billing for the technical component of 89250 and would like to also bill a professional component of the 89250. View the Answer
Egg Culture and Fertilization: Same Gender
A same-sex male couple requested half their donor eggs be fertilized with sperm from male #1 and the other half fertilized from male #2. View the Answer
Journal Club Global: Natural versus Programmed FET Cycles
A significant portion of IVF cycles now utilize frozen embryo transfer.
View the Video
Role of assisted hatching in in vitro fertilization: a guideline (2022)
There is moderate evidence that assisted hatching does not significantly improve live birth rates in fresh assisted reproductive technology cycles View the Committee Opinion
Journal Club Global - Best Practices of High Performing ART Clinics
This Fertility and Sterility Journal Club Global discusses February’s seminal article, “Common practices among consistently high-performing in vitro fertilization programs in the United States: a 10 year update.” View the Video
Guidance on the limits to the number of embryos to transfer: a committee opinion (2021)
ASRM's guidelines for the limits on the number of embryos to be transferred during IVF cycles have been further refined ... View the Committee Opinion
Journal Club Global Live from India - Adjuvants in IVF and IVF Add-Ons for the Endometrium
Many adjuvants have been utilized by IVF centers to improve their success rates. View the Video
Evidence-based outcomes after oocyte cryopreservation for donor oocyte in vitro fertilization and planned oocyte cryopreservation: a guideline (2021)
A review of success rates, factors that may impact success rates, and outcomes. View the Committee Opinion
Development of an emergency plan for in vitro fertilization programs: a committee opinion (2021)
All IVF programs and clinics should have a plan to protect fresh and cryopreserved human specimens (embryos, oocytes, sperm). View the Committee Opinion
In vitro maturation: a committee opinion (2021)
The results of in vitro maturation (IVM) investigations suggest the potential for wider clinical application. View the Committee Opinion
Fertility treatment when the prognosis is very poor or futile: an Ethics Committee opinion (2019)
The Ethics Committee recommends that in vitro fertilization (IVF) centers develop patient-centered policies regarding requests for futile treatment. View the Committee Opinion
Blastocyst culture and transfer in clinically assisted reproduction: a committee opinion (2018)
The purposes of this document is to review the literature regarding the clinical application of blastocyst transfer. View the Committee Opinion
The role of immunotherapy in in vitro fertilization: a guideline (2018)
Adjuvant immunotherapy treatments in in vitro fertilization (IVF) aim to improve the outcome of assisted reproductive technology (ART) in both the general ART population as well as subgroups such as patients with recurrent miscarriage or implantation failure. View the Committee Opinion
Performing the embryo transfer: a guideline (2017)
A systematic review of the literature was conducted which examined each of the major steps of embryo transfer. Recommendations made for improving pregnancy rates are based on interventions demonstrated to be either beneficial or not beneficial. (Fertil Steril® 2017;107:882–96. ©2017 by American Society for Reproductive Medicine.) View the Committee Guideline
Best practices of ASRM and ESHRE: a journey through reproductive medicine (2012)
ASRM and ESHRE are the two largest societies in the world whose members comprise the major experts and professionals working in reproductive medicine. View the Committee Joint Guideline
What support for IVF looks like
Bipartisan support for IVF, that is responsible for the birth of over 2% of all babies born in the USA each year, will ensure that families continue to grow. View the advocacy resource
It takes more than one
Why IVF patients often need multiple embryos to have a baby View the advocacy resource
Oversight of IVF in the US
In the US, medical care is regulated by a complex and comprehensive network of federal and state regulations and professional oversight. View the advocacy resource
In Vitro Maturation Special Interest Group (IVMSIG)
IVMSIG strives to define the best strategies to optimize IVM outcomes. Learn more about IVMSIG
