IVF by the Numbers: What the 2024 SART Report Reveals and Why It Matters Legally and Practically

The 2024 Clinic Summary Report published by the Society for Assisted Reproductive Technology (SART) provides one of the most comprehensive datasets available on in vitro fertilization (IVF), egg freezing, and related fertility treatments.  For patients, intended parents, and legal practitioners alike, the data offers both reassurance and a necessary dose of realism: IVF is more effective and safer than ever before, but it remains complex, individualized, and deeply shaped by medical research, law, and policy.  This article distills the most important insights from the 2024 report and examines their practical and legal implications, particularly for those pursuing IVF, fertility preservation, and LGBTQ+ family building.

IVF Is Mainstream and Growing Rapidly

The SART data confirms what reproductive endocrinologists and lawyers already know: demand for fertility care continues to rise at a remarkable rate.  IVF now accounts for a meaningful percentage of all births in the United States, with tens of thousands of babies born each year through assisted reproductive technology (ART).

This growth is driven by multiple factors including delayed parenthood, expanded insurance coverage (in some states), advances in reproductive technology, and increased reliance on ART among LGBTQ+ individuals and single parents by choice.

Legal implication:
As IVF becomes more common, it will increasingly intersecting with areas of law that have not traditionally been associated with reproductive medicine including: insurance law (coverage for reproductive care and insurance mandates), constitutional law (reproductive rights), family law (securing legal parentage through ART), and even contract law (IVF Clinic forms, cryopreservation agreements, egg donation agreements, embryo disposition agreements, and gestational surrogacy agreements).

Success Is a Process, Not a Single Event

One of the most important clarifications in the SART report is how success is measured by those collecting and reporting data. Rather than focusing the definition of “success” on a single IVF cycle, SART emphasizes cumulative live birth rates per egg retrieval, reflecting the reality that one retrieval may lead to multiple embryo transfers over time, and that not every embryo transfer results in a pregnancy.

For patients, this means:

• A single “failed” cycle is not the end of the IVF journey
• Achieving a successful pregnancy sometimes takes multiple embryo transfers
• Time, cost, and emotional investment must be viewed longitudinally

Legal implication:
This cumulative model has direct relevance for:

• Insurance disputes, where coverage may be limited to a fixed number of IVF cycles or embryo transfer procedures
• Informed consent, where providers must accurately communicate realistic timelines and probabilities for patients undergoing fertility treatment, egg donors undergoing egg retrievals, and gestational surrogates undergoing embryo transfer procedures
• Contract drafting, for gestational surrogacy arrangements addressing the number of embryo transfers the gestational surrogate will agree to undergo, and the timing of any embryo transfer procedure

Age Remains the Dominant Variable

Despite technological advances, age continues to be the most significant predictor of IVF success. Outcomes are strongest for patients under 35 and decline steadily thereafter, with a more pronounced drop after age 40.  This reality is driven primarily by increased rates of chromosomal abnormalities in embryos over time.

Practical implications:

• Egg freezing is most effective when undertaken earlier
• Delayed family building carries measurable biological risk
• Patients should be counseled with age-specific expectations

Legal and policy implications:

• Employers offering fertility benefits must consider whether age-based limitations are discriminatory or actuarially justified
• Public policy debates around fertility coverage increasingly hinge on whether ART is treated as elective or as medically necessary care
• Age-related decline underscores the importance of access and timing, raising equity concerns for patients who cannot afford early intervention

A Shift Toward Safer Outcomes: The End of the DET

Modern IVF practice has moved decisively toward transferring a single embryo during any embryo transfer procedure, as opposed to the historic approach that a double embryo transfer (DET) was associated with a higher success rate.  This shift toward single embryo transfers has dramatically reduced the incidence of twins and multiple pregnancies.  The vast majority of ART births are now singletons, reflecting improved laboratory techniques and embryo selection.

Why this matters:

• Reduced maternal and neonatal health risks
• Lower long-term healthcare costs
• Greater alignment with ethical standards in reproductive medicine

Legal implication:
This shift reduces malpractice exposure related to high-risk multiple pregnancies and strengthens the argument that IVF, when properly practiced, is a risk-managed and evidence-based medical treatment.

Frozen Embryos Are Now the Norm

The SART data reflects a clear trend: most IVF cycles now involve frozen embryo transfers (FET) rather than fresh transfers.  This approach allows for preimplantation genetic testing (PGT-A), improved uterine preparation, and greater flexibility in timing, which is especially important for gestational surrogacy arrangements.

Legal implications:
The increased use of cryopreservation raises complex and evolving legal questions, including disputes over the disposition of remaining embryos, enforceability of IVF Clinic forms in the event of a later dispute, cryopreservation agreements, and regulatory uncertainty regarding the legal status of cryopreserved embryos in jurisdictions adopting personhood legislation and policies.

In the wake of Dobbs v. Jackson Women’s Health Organization, these questions have taken on heightened urgency, as states reconsider the legal status of embryos both inside and outside the body.

Egg Freezing: Opportunity, Not Insurance

Egg freezing has also increased at substantial rates.  It is now a common form of fertility preservation and family planning for individuals delaying parenthood, patients facing medical treatments that impact fertility, and LGBTQ+ family building.  However, the SART data reinforces a critical point: while egg freezing offers a form of fertility insurance, egg freezing does not guarantee a future live birth.

Legal and policy implications:

IVF Clinics must be careful when marketing egg freezing options and avoid overstating success probabilities so patients can be sure they are providing informed consent. For individuals electing to freeze their eggs to delay parenthood, cryopreservation agreements for oocytes generally create long-term contractual relationships that may persist for decades with any number of legal implications.

Not Every IVF Cycle Reaches Embryo Transfer

A frequently overlooked aspect of IVF is attrition: not all cycles result in viable embryos, and not all embryos result in transfer.  Patients may experience poor ovarian response, failure of eggs to fertilize, and arrested embryo development.  Patients should review their IVF Clinic forms carefully, understand cycle attrition rates, and that reported success rates often reflect a number of IVF cycles.

The Limits of Data: Why Clinic Comparisons Can Mislead

SART itself cautions against simplistic comparisons between clinics. Success rates vary greatly based on patient demographics, case complexity, prevalence of gamete donation, and fertility treatment philosophy of individual physicians and practices.  For example, a clinic treating older patients or more complex cases may report lower success rates despite providing high-quality care.

IVF and the Law: A Rapidly Evolving Landscape

The legal environment surrounding IVF is in flux. Several key developments shape the current landscape:

1. The Post-Dobbs Environment

The decision in Dobbs v. Jackson Women’s Health Organization has shifted reproductive regulatory authority to the states, creating variability in how reproductive care is governed from one state to another.  Proposed legislation and active litigation in some states may serve to further restrict access to reproductive care for many individuals throughout the United States.

2. Federal Protections for Marriage and Family Recognition

The Respect for Marriage Act provides important but limited protections for marital recognition, which can impact parentage determinations for anyone growing their family through ART, and especially LGBTQ+ couples.

3. Emerging Personhood Theories

Legislative and judicial efforts to define embryos as legal persons could have profound consequences for IVF Clinic practices, gestational surrogacy arrangements, and embryo storage and disposition.

LGBTQ+ Family Building

LGBTQ+ individuals and couples seek IVF, sperm donation, egg donation, and gestational surrogacy at higher rates on their path to parenthood.  We know that many LGBTQ+ individuals and couples rely on donor sperm, donor eggs, and/or gestational surrogates in order to grow their families.  Additionally, LGBTQ+ couples are also forced to navigate limited or inconsistent insurance coverage, and coordinated legal planning to ensure they are recognized as the legal parents of their child.  The SART data includes LGBTQ+ individuals and couples in their report, but does not report data on the rates LGBTQ+ individuals are accessing IVF and ART.

Conclusion: Data as a Tool for Informed Decision-Making

The 2024 SART report tells a story of progress: IVF is more effective, safer, and more widely used than ever before. But the report also underscores enduring truths including the fact that success is not guaranteed, outcomes vary significantly, and equitable access remains an issue.

For patients, the lesson is clear: approach fertility treatment with informed expectations and a long-term perspective.  For legal practitioners, the SART data serves as a reminder that reproductive technology is outpacing the law, requiring careful, forward-looking counsel.  And for policymakers, the data presents a challenge: to ensure that access to family building is not determined solely by geography, income, or identity.

IVF is not only a medical process.  It is a legal, ethical, and deeply human undertaking.  Understanding IVF by the numbers is only the beginning.