Assessing the use of assisted reproductive technology in the United States by non–United States residents

Non-U.S. residents accounted for a growing share of all assisted reproductive technology cycles in the U.S. from 2006 to 2013 and made higher user of donated oocytes, gestational carriers, and preimplantation genetic diagnosis.

Volume 108, Issue 5, Pages 815–821


Aaron D. Levine, Ph.D., Sheree L. Boulet, Dr.P.H., Roberta M. Berry, J.D., Ph.D., Denise J. Jamieson, M.D., Hillary B. Alberta-Sherer, Ph.D., Dmitry M. Kissin, M.D.



To study cross-border reproductive care (CBRC) by assessing the frequency and nature of assisted reproductive technology (ART) care that non-U.S. residents receive in the United States.


Retrospective study of ART cycles reported to the Centers for Disease Control and Prevention's National ART Surveillance System (NASS) from 2006 to 2013.


Private and academic ART clinics.


Patients who participated in ART cycles in the United States from 2006 to 2013.



Main Outcome Measure(s)

Frequency and trend of ART use in the U.S. by non-U.S. residents, countries of residence for non-U.S. residents, differences by residence status for specific ART treatments received, and the outcomes of these ART cycles.


A total of 1,271,775 ART cycles were reported to NASS from 2006 to 2013. The percentage of ART cycles performed for non-U.S. residents increased from 1.2% (n = 1,683) in 2006 to 2.8% (n = 5,381) in 2013 (P<.001), with treatment delivered to residents of 147 countries. Compared with resident cycles, non-U.S. resident cycles had higher use of oocyte donation (10.6% vs. 42.6%), gestational carriers (1.6% vs. 12.4%), and preimplantation genetic diagnosis or screening (5.3% vs. 19.1%). U.S. resident and non-U.S. resident cycles had similar embryo transfer and multiple birth rates.


This analysis showed that non-U.S. resident cycles accounted for a growing share of all U.S. ART cycles and made higher use of specialized treatment techniques. This study provides important baseline data on CBRC in the U.S. and may also prove to be useful to organizations interested in improving access to fertility treatments.

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