We read with interest the article from Kawwass et al. in which they report that tubal factor infertility prevalence is decreasing in the United States and that it is associated with an increased risk of adverse perinatal outcomes. Because these conclusions derive from the analysis of almost 1.5 million assisted reproductive technology (ART) cycles, and their affect may be very important in clinical practice, extreme caution in their interpretation would be desirable. Data from the National ART Surveillance System show a decrease of 43% in tubal infertility patients between 2000 and 2010. This dramatic decline is explained by the authors as the result of an increasing number of alternative indications for use of ART. However, no significant increase in other ART indication was observed over the past 11 years except for an increase of patients with diminished ovarian reserve. Furthermore, an absolute decline in number of the couples with tubal factor infertility also was observed. The authors suggest that this decline may result from the decrease in the rates of pelvic inflammatory disease in the United States that started in the 1980s. However, by analyzing data from the National ART Surveillance System, it emerges that the decline in the number of couples with tubal factor infertility is restricted to past 5 years.
