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Dmitry M. Kissin - One of the best experts on this subject based on the ideXlab platform.
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live Birth and Multiple Birth rates in us in vitro fertilization treatment using donor oocytes a comparison of single embryo transfer and double embryo transfer
Journal of Assisted Reproduction and Genetics, 2018Co-Authors: V E Klenov, Abigail C. Mancuso, Sheree L. Boulet, Erika M. Munch, Dmitry M. Kissin, Rachel B Mejia, Bradley J Van VoorhisAbstract:To compare live Birth rates (LBRs) and Multiple Birth rates (MBRs) between elective single-embryo transfer (eSET) and double-embryo transfer (DET) in donor oocyte in vitro fertilization (IVF) treatments in both a cycle-level and clinic-level analysis. Donor oocyte IVF treatments performed by US IVF clinics reporting to the Centers for Disease Control and Prevention in 2013–2014 were included in the analysis. Primary outcomes included LBR and MBR. Secondary outcomes included gestational age at delivery (GA) and Birth weight (BW) of offspring. These outcomes were evaluated on an individual cycle level as well as on the clinic level. In multivariable models, LBR did not change significantly as clinics utilized eSET more frequently. MBR decreased significantly as utilization of eSET increased, from 39% MBR in clinics that utilized eSET 0–9% of the time to 7% MBR in clinics that used eSET 70% of the time (P < .0001). Mean BW and GA of IVF-conceived offspring both increased as clinics utilized eSET more frequently (2778 to 3185 g [P < .0001] and 37.5 to 38.5 weeks [P = .02] for clinics with the lowest and highest eSET utilization, respectively). US IVF clinics utilizing eSET with higher frequencies have clinically comparable LBRs and significantly lower MBRs than clinics with lower-frequency eSET utilization. Mean offspring BW and GA increased with higher eSET utilization, further confirming the improved safety of this practice.
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assisted reproductive technology surveillance united states 2015
Morbidity and mortality weekly report. Surveillance summaries (Washington D.C. : 2002), 2018Co-Authors: Saswati Sunderam, Sheree L. Boulet, Dmitry M. Kissin, Sara Crawford, Lee Warner, Suzanne G Folger, Wanda D BarfieldAbstract:PROBLEM/CONDITION Since the first U.S. infant conceived with assisted reproductive technology (ART) was born in 1981, both the use of ART and the number of fertility clinics providing ART services have increased steadily in the United States. ART includes fertility treatments in which eggs or embryos are handled in the laboratory (i.e., in vitro fertilization [IVF] and related procedures). Although the majority of infants conceived through ART are singletons, women who undergo ART procedures are more likely than women who conceive naturally to deliver Multiple-Birth infants. Multiple Births pose substantial risks for both mothers and infants, including obstetric complications, preterm delivery ( 37 years). Among women aged <35 years, the national elective single-embryo transfer (eSET) rate was 34.7% (range: 11.3% in Puerto Rico to 88.1% in Delaware). In 2015, ART contributed to 1.7% of all infants born in the United States (range: 0.3% in Puerto Rico to 4.5% in Massachusetts). ART also contributed to 17.0% of all Multiple-Birth infants, 16.8% of all twin infants, and 22.2% of all triplets and higher-order infants. The percentage of Multiple-Birth infants was higher among infants conceived with ART (35.3%) than among all infants born in the total Birth population (3.4%). Approximately 34.0% of ART-conceived infants were twins and 1.0% were triplets and higher-order infants. Nationally, infants conceived with ART contributed to 5.1% of all low Birthweight infants. Among ART-conceived infants, 25.5% had low Birthweight, compared with 8.1% among all infants. ART-conceived infants contributed to 5.3% of all preterm (gestational age <37 weeks) infants. The percentage of preterm Births was higher among infants conceived with ART (31.2%) than among all infants born in the total Birth population (9.7%). Among singletons, the percentage of ART-conceived infants who had low Birthweight was 8.7% compared with 6.4% among all infants born. The percentage of ART-conceived infants who were born preterm was 13.4% among singletons compared with 7.9% among all infants. INTERPRETATION Multiple Births from ART contributed to a substantial proportion of all twins, triplets, and higher-order infants born in the United States. For women aged <35 years, who are typically considered good candidates for eSET, the national average of 1.6 embryos was transferred per ART procedure. Of the four states (Illinois, Massachusetts, New Jersey, and Rhode Island) with comprehensive mandated health insurance coverage for ART procedures (i.e., coverage for at least four cycles of IVF), three (Illinois, Massachusetts, and New Jersey) had rates of ART use exceeding 1.5 times the national rate. This type of mandated insurance coverage has been associated with greater use of ART and likely accounts for some of the difference in per capita ART use observed among states. PUBLIC HEALTH ACTION Twins account for the majority of ART-conceived Multiple Births. Reducing the number of embryos transferred and increasing use of eSET when clinically appropriate could help reduce Multiple Births and related adverse health consequences for both mothers and infants. State-based surveillance of ART might be useful for monitoring and evaluating maternal and infant health outcomes of ART in states with high ART use.
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Affordability of Fertility Treatments and Multiple Births in the United States
Paediatric and perinatal epidemiology, 2017Co-Authors: Aniket D. Kulkarni, Eli Y. Adashi, Denise J. Jamieson, Sara Crawford, Saswati Sunderam, Dmitry M. KissinAbstract:Background Affordability plays an important role in the utilisation of in vitro fertilisation (IVF) and non-IVF fertility treatments. Fertility treatments are associated with increased risk of Multiple Births. The objective of this study was to investigate the association between the affordability of fertility treatments across US states and the percentage of Multiple Births due to natural conception, non-IVF treatments, and IVF, and the association between these percentages and state-specific Multiple Birth rates. Methods State-specific per capita disposable personal income and state-specific infertility insurance mandates were used as measures of affordability. Maternal age-adjusted percentages of Multiple Births due to natural conception, non-IVF treatments, and IVF were estimated for each state using Birth certificate and IVF data. Scatter plots and regression analysis were used to explore associations between state-level measures of affordability, the percentage of Multiple Births due to natural conception and fertility treatments, and state-specific Multiple Birth rates. Results In 2013, age-adjusted contributions of natural conception, non-IVF fertility treatments, and IVF to Multiple Births in US were 58.2, 22.8, and 19.0% respectively. States with greater affordability of fertility treatments had higher percentages of Multiples due to IVF and lower percentages due to natural conception. Higher percentages of Multiples due to IVF and lower percentages due to natural conception were associated with higher state-specific Multiple Birth rates. Conclusion Increasing affordability of fertility treatments may increase state-specific Multiple Birth rates. Policies and treatment practices encouraging single-gestation pregnancies may help reduce Multiple Births resulting from these treatments.
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trends and outcomes of gestational surrogacy in the united states
Fertility and Sterility, 2016Co-Authors: Kiran M Perkins, Sheree L. Boulet, Denise J. Jamieson, Dmitry M. KissinAbstract:Objective To evaluate trends and reproductive outcomes of gestational surrogacy in the United States. Design Retrospective cohort study. Setting Infertility clinics. Patient(s) IVF cycles transferring at least one embryo. Intervention(s) Use of a gestational carrier. Main Outcome Measure(s) Trends in gestational carrier cycles during 1999–2013, overall and for non-U.S. residents; reproductive outcomes for gestational carrier and nongestational carrier cycles during 2009–2013, stratified by the use of donor or nondonor oocytes. Result(s) Of 2,071,984 assisted reproductive technology (ART) cycles performed during 1999–2013, 30,927 (1.9%) used a gestational carrier. The number of gestational carrier cycles increased from 727 (1.0%) in 1999 to 3,432 (2.5%) in 2013. Among gestational carrier cycles, the proportion with non-U.S. residents declined during 1999–2005 (9.5% to 3.0%) but increased during 2006–2013 (6.3% to 18.5%). Gestational carrier cycles using nondonor oocytes had higher rates of implantation (adjusted risk ratio [aRR], 1.22; 95% confidence interval [CI], 1.17–1.26), clinical pregnancy (aRR, 1.14; 95% CI, 1.10–1.19), live Birth (aRR, 1.17; 95% CI, 1.12–1.21), and preterm delivery (aRR, 1.14; 95% CI, 1.05–1.23) compared with nongestational carrier cycles. When using donor oocytes, Multiple Birth rates were higher among gestational carrier compared with nongestational carrier cycles (aRR, 1.13; 95% CI, 1.08–1.19). Conclusion(s) Use of gestational carriers increased during 1999–2013. Gestational carrier cycles had higher rates of ART success than nongestational carrier cycles, but Multiple Birth and preterm delivery rates were also higher. These risks may be mitigated by transferring fewer embryos given the higher success rates among gestational carrier cycles.
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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.
Fertility and Sterility, 2016Co-Authors: Abigail C. Mancuso, Sheree L. Boulet, Eyup Hakan Duran, Erika M. Munch, Dmitry M. Kissin, Bradley J. Van VoorhisAbstract:Objective To determine the effect of elective single ET (eSET) on live Birth and Multiple Birth rates by a cycle-level and clinic-level analysis. Design Retrospective cohort study. Setting Not applicable. Patient(s) Patient ages Intervention(s) None. Main Outcome Measure(s) Clinics were divided into groups based on eSET rate for each age group and aggregate rates of live Birth per ET and Multiple Birth per delivery were calculated. A cycle-level analysis comparing eSET and double ET (DET) live Birth and Multiple Birth rates was also performed, stratified based on total number (2, 3, or 4+) of embryos available, embryo stage, and patient age. Result(s) There was a linear decrease in Multiple Birth rate with increasing eSET rate and no significant difference in clinic-level live Birth rates for each age group. Cycle-level analysis found slightly higher live Birth rates with double ET, but this was mainly observed in women aged 35–37 years or with four or more embryos available for transfer, and confirmed the marked reduction in Multiple Births with eSET. Conclusion(s) Our study showed a marked and linear reduction in Multiple Birth rates, and important, little to no effect on clinic-level live Birth rates with increasing rates of eSET supporting the growing evidence that eSET is effective in decreasing the high Multiple Birth rates associated with IVF and suggests that eSET should be used more frequently than is currently practiced.
Christina Bergh - One of the best experts on this subject based on the ideXlab platform.
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cumulative live Birth rates in a trial of single embryo or double embryo transfer
The New England Journal of Medicine, 2009Co-Authors: Ann Thurinkjellberg, Catharina Olivius, Christina BerghAbstract:The cumulative live-Birth rates were 43.9% in the single-embryo-transfer group and 51.1% in the double-embryo-transfer group. The Multiple-Birth rate was significantly lower in the single-embryo-tr...
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reducing the number of embryos transferred in sweden impact on delivery and Multiple Birth rates
Human Reproduction, 2007Co-Authors: P O Karlstrom, Christina BerghAbstract:BACKGROUND: Reduction of the number of embryos transferred has been introduced to decrease the Multiple Birth rates (MBRs) after IVF and the associated risks for the children. The aim of this report is to present the effect of two steps in reduction of the number of embryos transferred, when applied in the majority of the patients, on national data for delivery and MBR after IVF in Sweden. METHODS: This observational study is based on annual reports from all IVF clinics in Sweden to the National Board of Health and Welfare for the time period 1991–2004. RESULTS: The main finding is that despite a successive reduction in the number of embryos transferred, delivery rates were maintained at around 26% while MBR decreased dramatically, from about 35% to around 5%. The same pattern was noticed, independent of age, for all women below 40. In comparison with the USA, lower delivery and MBR were noted for Sweden whereas a higher ‘Birth per embryo transferred’ was found. CONCLUSIONS: Single embryo transfer (SET) results in satisfactory delivery rates and a dramatic decrease in the MBRs, also when applied on a broad scale. The experience from Sweden ought to encourage other countries to introduce SET more widely.
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randomized single versus double embryo transfer obstetric and paediatric outcome and a cost effectiveness analysis
Human Reproduction, 2006Co-Authors: Ann Thurin Kjellberg, Per Carlsson, Christina BerghAbstract:Background: Transfer of several embryos after IVF results in a high Multiple Birth rate associated with increased morbidity and high costs for the neonatal care. In a previous randomized trial we d ...
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selection of patients suitable for one embryo transfer may reduce the rate of Multiple Births by half without impairment of overall Birth rates
Human Reproduction, 2000Co-Authors: Annika Strandell, Christina Bergh, Kersti LundinAbstract:The aim of the present study was to identify a subset of patients at high risk of Multiple Birth after IVF and hence suitable for one-embryo transfer, which undoubtedly would reduce the Multiple Birth rate. This retrospective study included 2107 IVF cycles in which two embryos were transferred. Factors with possible correlation to Multiple Birth were studied in a multivariate analysis. The factors included background data (female age, previous pregnancies and Births, previous IVF cycles, indication for IVF) and IVF cycle characteristics. The following factors were independently predictive of Multiple Birth: female age expressed a negative correlation while number of good quality embryos transferred was positively correlated. A subset of patients was identified as being at high risk of Multiple Birth by including age, cycle number and presence of tubal infertility in a model derived from a logistic regression analysis. The rate of Multiple Births can be reduced from 26% to 13% of all Births if one-embryo transfer is performed in selected cases. The total Birth rate will decrease from 29% to 25% but may be completely restored by performing one additional one-embryo freeze transfer in high risk patients who do not achieve a term pregnancy.
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selection of patients suitable for one embryo transfer may reduce the rate of Multiple Births by half without impairment of overall Birth rates
Human Reproduction, 2000Co-Authors: Annika Strandell, Christina Bergh, Kersti LundinAbstract:The aim of the present study was to identify a subset of be an appropriate definition of IVF success and an incentive patients at high risk of Multiple Birth after IVF and hence to make efforts to reduce the rates of Multiple Births, as suitable for one-embryo transfer, which undoubtedly would previously suggested (Martin and Welch, 1998). reduce the Multiple Birth rate. This retrospective study An alternative to consistent one-embryo transfer would included 2107 IVF cycles in which two embryos were be an individualized embryo transfer policy, as previously transferred. Factors with possible correlation to Multiple discussed (Coetsier and Dhont, 1998). A theoretical model Birth were studied in a multivariate analysis. The factors was developed in which Multiple pregnancies were reduced included background data (female age, previous pregnan- from 28% to 15% and pregnancy rates from 30% to 26% if cies and Births, previous IVF cycles, indication for IVF) one-embryo transfer was applied in selected patients. A Finnish and IVF cycle characteristics. The following factors were study has also demonstrated satisfactory pregnancy rates independently predictive of Multiple Birth: female age (29.7%) after one-embryo transfers in selected groups of expressed a negative correlation while number of good patients (Vilska et al., 1999). quality embryos transferred was positively correlated. A The aim of the present study was to identify cycles at subset of patients was identified as being at high risk of increased risk of Multiple Births and to calculate the effects Multiple Birth by including age, cycle number and presence on the overall Birth and Multiple Birth rates in routine cycles of tubal infertility in a model derived from a logistic if a one-embryo transfer policy was applied to the high regression analysis. The rate of Multiple Births can be risk group. reduced from 26% to 13% of all Births if one-embryo transfer is performed in selected cases. The total Birth rate will decrease from 29% to 25% but may be completely Materials and methods restored by performing one additional one-embryo freeze transfer in high risk patients who do not achieve a term Study population pregnancy.
Xiekai Zhang - One of the best experts on this subject based on the ideXlab platform.
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Weighted linear loss Multiple Birth support vector machine based on information granulation for multi-class classification
Pattern Recognition, 2017Co-Authors: Xiekai Zhang, Yuexuan AnAbstract:This paper presents a weighted linear loss Multiple Birth support vector machine based on information granulation (GWLMBSVM).GWLMBSVM divides the data into several granules and builds a set of classifiers in the mixed granules.By introducing the weighted linear loss, the proposed GWLMBSVM only needs to solve simple linear equations.The overall computational complexity of GWLMBSVM is lower than multi-class WLTSVM classifier. Recently proposed weighted linear loss twin support vector machine (WLTSVM) is an efficient algorithm for binary classification. However, the performance of Multiple WLTSVM classifier needs improvement since it uses the strategy one-versus-rest with high computational complexity. This paper presents a weighted linear loss Multiple Birth support vector machine based on information granulation (WLMSVM) to enhance the performance of Multiple WLTSVM. Inspired by granular computing, WLMSVM divides the data into several granules and builds a set of sub-classifiers in the mixed granules. By introducing the weighted linear loss, the proposed approach only needs to solve simple linear equations. Moreover, since WLMSVM uses the strategy all-versus-one which is the key idea of Multiple Birth support vector machine, the overall computational complexity of WLMSVM is lower than that of Multiple WLTSVM. The effectiveness of the proposed approach is demonstrated by experimental results on artificial datasets and benchmark datasets.
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An improved Multiple Birth support vector machine for pattern classification
Neurocomputing, 2017Co-Authors: Xiekai Zhang, Shifei DingAbstract:Multiple Birth support vector machine is a novel machine learning algorithm for multi-class classification, which is considered as an extension of twin support vector machine. Compared with training speeds of other multi-class classifiers based on twin support vector machine, the training speed of Multiple Birth support vector machine is faster, especially when the number of class is large. However, one of the disadvantages of Multiple Birth support vector machine is that when used to deal with some datasets such as "Cross planes" datasets, Multiple Birth support vector machine is likely to get bad results. In order to deal with this, we propose an improved Multiple Birth support vector machine. We add a modified item into Multiple Birth support vector machine to make the variance of the distances from each samples of a given class to their hyperplanes as small as possible. To predict a new sample, our method first determines an interval for each class depending on the distances between training samples and their hyperplanes, and then classifies the new sample depending on the distances between hyperplanes and the new sample which are in the corresponding intervals. In addition, smoothing technique is applied on our model, the first time it was used in multi-class twin support vector machine. The experimental results on artificial datasets and UCI datasets show that the proposed algorithm is efficient and has good classification performance.
Sugen Chen - One of the best experts on this subject based on the ideXlab platform.
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Multiple Birth least squares support vector machine for multi class classification
International Journal of Machine Learning and Cybernetics, 2017Co-Authors: Sugen ChenAbstract:Least squares twin support vector machine (LSTSVM) was initially designed for binary classification. However, practical problems often require the discrimination more than two categories. To tackle multi-class classification problem, a novel algorithm, called Multiple Birth least squares support vector machine (MBLSSVM), is proposed. Our MBLSSVM solves K quadratic programming problems (QPPs) to obtain K hyperplanes, each problem is similar to binary LSTSVM. Comparison against the Multi-LSTSVM, Multi-TWSVM, MBSVM and our MBLSSVM on both UCI datasets and ORL, YALE face datasets illustrates the effectiveness of the proposed method.
Hannu Martikainen - One of the best experts on this subject based on the ideXlab platform.
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elective single embryo transfer with cryopreservation improves the outcome and diminishes the costs of ivf icsi
Human Reproduction, 2009Co-Authors: Zdravka Veleva, Petri Karinen, Candido Tomas, Juha S Tapanainen, Hannu MartikainenAbstract:BACKGROUND: Although elective single embryo transfer (eSET) minimizes the Multiple Birth rate after in vitro fertilization (IVF)/intra cytoplasmic sperm injection (ICSI), there remain concerns in many countries that it is less effective and more expensive than conventional double embryo transfer (DET). METHODS: We compared the clinical outcome achieved in the years 1995-1999, in which eSET was rarely used (4.2% of women, DET period) with that of the years 2000-2004, in which eSET was more widely used (46.2%, eSET period). In the DET period, 826 women had 1359 fresh embryo cycles followed by 589 frozen-thawed embryo transfer (FET) cycles. In the eSET period, 684 women had 1027 fresh and 683 FET cycles. The cumulative term live Birth rate/woman was the primary clinical outcome measure. An incremental cost-effectiveness ratio of a term live Birth was also calculated based on hospital charges and medication prices of IVF/ICSI treatment. RESULTS: The cumulative pregnancy rate/oocytes pickup (38.2 versus 33.1%, P = 0.01), cumulative live Birth rate/oocytes pickup (28.0 versus 22.5%, P = 0.002) and cumulative live Birth rate/woman (41.7 versus 36.6%, P = 0.04) were all higher in the eSET period than in the DET period. The cumulative Multiple Birth rate was significantly lower in the eSET period than in the DET period (8.9 versus 19.6%, P < 0.0001). A term live Birth in the eSET period was 19 889 euros less expensive than in the DET period. CONCLUSIONS: This study shows that eSET with cryopreservation is more effective and less expensive than DET and should be adopted as a treatment of choice.
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elective single embryo transfer in women aged 36 39 years
Human Reproduction, 2006Co-Authors: Zdravka Veleva, Sirpa Vilska, Aila Tiitinen, Juha S Tapanainen, Hannu Martikainen, Christel HydengranskogAbstract:BACKGROUND: The elective single embryo transfer policy is the only effective strategy known to minimize the risk of Multiple pregnancy. However, little is known about its applicability to women older than 35 years. METHODS: Analysis was carried out on 1224 fresh IVF/ICSI cycles with embryo transfer and 828 frozen embryo transfer (FET) cycles of women aged 36-39 years. In the fresh cycles, 335 elective single top quality embryo (eSET), 110 elective single non top quality embryo (nt-eSET), 194 compulsory single embryo (cSET) and 585 double embryo transfers (DET) were carried out. RESULTS: Pregnancy rate/embryo transfer (33.1 versus 29.9%) and live Birth rate (26.0 versus 21.9%) in fresh cycles did not differ significantly between the eSET and the DET groups. However, women in the eSET group had a higher cumulative pregnancy rate (54.0% versus 35.0%) and a higher cumulative live Birth rate (41.8% versus 26.7%, P < 0.0001) compared with those in the DET group. The cumulative Multiple Birth rate in the eSET group was 1.7%, whereas in the DET group it was 16.6% (P < 0.0001). CONCLUSIONS: The eSET policy can be applied also to patients aged 36-39 years, reducing the risk of Multiple Birth and increasing the safety of assisted reproduction technique (ART) in this age group.