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Lee Warner - One of the best experts on this subject based on the ideXlab platform.
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embryo transfer practices and Multiple Births resulting from assisted reproductive technology an opportunity for prevention
Fertility and Sterility, 2015Co-Authors: Dmitry M. Kissin, Aniket D. Kulkarni, Sara Crawford, Lee Warner, Allison S Mneimneh, Sheree L Boulet, Denise J. JamiesonAbstract:Objective To evaluate assisted reproductive technology (ART) ET practices in the United States and assess the impact of these practices on Multiple Births, which pose health risks for both mothers and infants. Design Retrospective cohort analysis using the National ART Surveillance System data. Setting US fertility centers reporting to the National ART Surveillance System. Patient(s) Noncanceled ART cycles conducted in the United States in 2012. Intervention(s) None. Main Outcome Measure(s) Multiple birth (birth of two or more infants, at least one of whom was live-born). Result(s) Of 134,381 ART transfer cycles performed in 2012, 51,262 resulted in live Births, of which 13,563 (26.5%) were Multiple Births: 13,123 twin and 440 triplet and higher order Births. Almost half (46.1%) of these Multiple Births resulted from the following four cycle types: two fresh blastocyst transfers among favorable or average prognosis patients less than 35 years (1,931 and 1,341 Multiple Births, respectively), two fresh blastocyst transfers among donor-oocyte recipients (1,532 Multiple Births), and two frozen/thawed ETs among patients less than 35 years (1,452 Multiple Births). More than half of triplet or higher order Births resulted from the transfer of two embryos (52.5% of Births among fresh autologous transfers, 67.2% of Births among donor-oocyte recipient transfers, and 42.9% among frozen/thawed autologous transfers). Conclusion(s) A substantial reduction of ART-related Multiple (both twin and triplet or higher order) Births in the United States could be achieved by single blastocyst transfers among favorable and average prognosis patients less than 35 years of age and donor-oocyte recipients.
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estimation of the contribution of nonassisted reproductive technology ovulation stimulation fertility treatments to us singleton and Multiple Births
Obstetrical & Gynecological Survey, 2010Co-Authors: Laura A Schieve, Owen Devine, Coleen A Boyle, Joann Petrini, Lee WarnerAbstract:Infertility treatment with ovulation stimulation, either as part of assisted reproductive technologies (ARTs) or for non-ART infertility treatment, has been primarily responsible for the marked increase in Multiple Births in the United States in recent decades. The Multiple-gestations resulting from both ART and non-ART treatments are associated with adverse sequelae, including markedly higher risks of pregnancy complications, premature delivery, infant death, and neurodevelopmental impairment in survivors. A number of studies have reported that ART-conceived singletons are also at higher risk of these outcomes than naturally conceived singletons. Although there is an ongoing, population-based surveillance system in the United States for ART-induced Births, there is no comparable system to monitor non-ART infertility treatments, thus the contribution of each to Multiple Births in the United States is not known. The investigators present data from a multistep modeling process that was developed to estimate the proportions of Multiple and singleton liveBirths conceived in 2005 by use of non-ART ovulation stimulation. Published surveillance data provided an estimate of the proportion of US Multiple Births conceived naturally and by ART; it was assumed that the remainder was conceived with non-ART treatments. A meta-analysis of peer-reviewed literature published from 1997 to 2007 was used to estimate the contribution of non-ART ovulation treatment to the risk of Multiple-gestation in the annual US birth cohort. A non-ART fetal survival factor was applied to obtain Multiple-birth risk estimates. This estimate and the investigator's previous estimate of the proportion of US Multiple Births attributable to non-ART ovulation stimulation provided an estimate of the total and singleton (derived through subtraction of Multiple Births) proportion of infants conceived using non-ART induction. Based on the model data, the investigators estimated that the mean percentage of all US Births in 2005 conceived with non-ART ovulation stimulation was 4.62% (95% uncertainty range, 2.8%-7.8%), which is 4 times more that the number contributed by ART treatment and equates to more than 190,000 liveBirths. Of all singleton pregnancies, 3.98% were conceived with non-ART ovulation stimulation, and 22.8% of all multifetal pregnancies resulted from non-ART ovulation stimulation. These findings demonstrate that non-ART ovulation induction treatment in the United States is associated with a higher Multiple-birth-attributable risk than ART. The estimated percentage contribution to US Births is 2 to 6 times higher than the contribution of ART.
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estimation of the contribution of non assisted reproductive technology ovulation stimulation fertility treatments to us singleton and Multiple Births
American Journal of Epidemiology, 2009Co-Authors: Owen Devine, Coleen A Boyle, Joann Petrini, Lee WarnerAbstract:: Infertility treatments that include ovulation stimulation, both assisted reproductive technologies (ARTs) and non-ART ovulation stimulation, are associated with increased risks of Multiple birth and concomitant sequelae and adverse outcomes, even among singletons. While a US surveillance system for ART-induced Births is ongoing, no population-based tracking system exists for Births resulting from non-ART treatments. The authors developed a multistage model to estimate the uncertain proportion of US infants born in 2005 who were conceived by using non-ART ovulation treatments. Using published surveillance data, they estimated proportions of US Multiple Births conceived naturally and by ART and assumed that the remainder were conceived with non-ART treatments. They used Bayesian meta-analyses to summarize published clinical studies on the Multiple-gestation risk associated with non-ART ovulation treatments, applied a fetal survival factor, and used this Multiple-birth risk estimate and their own estimate of the proportion of US Multiple Births attributable to non-ART ovulation stimulation to estimate the total (and, through subtraction, singleton) proportion of infants conceived with such treatments. On the basis of the model, the authors estimate that 4.6% of US infants born in 2005 (95% uncertainty range: 2.8%-7.1%) resulted from non-ART ovulation treatments. Notably, this figure is 4 times greater than the ART contribution.
Howard W Jones - One of the best experts on this subject based on the ideXlab platform.
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fertility treatments and Multiple Births in the united states
The New England Journal of Medicine, 2013Co-Authors: Aniket Kulkarni, Dmitry M. Kissin, Denise J. Jamieson, Howard W Jones, Maria F Gallo, Maurizio Macaluso, Eli Y. AdashiAbstract:Background The advent of fertility treatments has led to an increase in the rate of Multiple Births in the United States. However, the trends in and magnitude of the contribution of fertility treatments to the increase are uncertain. Methods We derived the rates of Multiple Births after natural conception from data on distributions of all Births from 1962 through 1966 (before fertility treatments were available). Publicly available data on Births from 1971 through 2011 were used to determine national Multiple birth rates, and data on in vitro fertilization (IVF) from 1997 through 2011 were used to estimate the annual proportion of Multiple Births that were attributable to IVF and to non-IVF fertility treatments, after adjustment for maternal age. Trends in Multiple Births were examined starting from 1998, the year when clinical practice guidelines for IVF were developed with an aim toward reducing the incidence of Multiple Births. Results We estimated that by 2011, a total of 36% of twin Births and 77% of triplet and higher-order Births resulted from conception assisted by fertility treatments. The observed incidence of twin Births increased by a factor of 1.9 from 1971 to 2009. The incidence of triplet and higher-order Births increased by a factor of 6.7 from 1971 to 1998 and decreased by 29% from 1998 to 2011. This decrease coincided with a 70% reduction in the transfer of three or more embryos during IVF (P<0.001) and a 33% decrease in the proportion of triplet and higher-order Births attributable to IVF (P<0.001). Conclusions Over the past four decades, the increased use of fertility treatments in the United States has been associated with a substantial rise in the rate of Multiple Births. The rate of triplet and higher-order Births has declined over the past decade in the context of a reduction in the transfer of three or more embryos during IVF. (Funded by the Centers for Disease Control and Prevention.)
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ovarian stimulation and intrauterine insemination at the quarter centennial implications for the Multiple Births epidemic
Fertility and Sterility, 2012Co-Authors: Howard D Mcclamrock, Howard W Jones, Eli Y. AdashiAbstract:Ovarian stimulation and intrauterine insemination (OS/IUI), a mainstay of current infertility therapy and a common antecedent to IVF, is a significant driver of the Multiple Births epidemic. Redress of this challenge, now marking its quarter centennial, will require a rethinking of current practice patterns. Herein we explore prospects for prevention, mitigation, and eventual resolution. We conclude that the Multiple Births attributable to OS/IUI may not be entirely preventable but that the outlook for their mitigation is promising, if in need of solidification. Specifically, we observe that low-dose (≤75 IU) gondotropin, clomiphene, and especially off-label letrozole regimens outperform high-dose (≥150 IU) gonadotropin counterparts in the gestational plurality category while maintaining comparable per-cycle pregnancy rates. Accordingly we recommend that, subject to appropriate exceptions, high-dose gonadotropin regimens be used sparingly and that whenever possible they be replaced with emerging alternatives. Finally, we posit that OS/IUI is not likely to be superseded by IVF absent further commoditization and thus greater affordability.
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iatrogenic Multiple Births a 2003 checkup
Fertility and Sterility, 2007Co-Authors: Howard W JonesAbstract:If further progress is to be made in reducing the problem of Multiple pregnancies, guidelines and their enforcement for the use of induction of ovulation and enhancement of ovulation are required. Collecting information on fetal reduction will also be necessary.
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Multiple Births: how are we doing?
Fertility and sterility, 2003Co-Authors: Howard W JonesAbstract:On a national basis, the ratio of Multiple Births to total Births tended to lessen in 1999 and 2000 compared to previous years (the good news), although in each of these years, the ratio of all Multiple Births compared to total Births continued to increase (the bad news) (Fig. 1). However, values appear to vary considerably from state to state. For example, in Virginia, the increase in the ratio of Multiple Births to total Births was smaller in 1999 than in previous years, but the steep upward trend continued for the year 2000 (Fig. 2).
Laura A Schieve - One of the best experts on this subject based on the ideXlab platform.
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estimation of the contribution of nonassisted reproductive technology ovulation stimulation fertility treatments to us singleton and Multiple Births
Obstetrical & Gynecological Survey, 2010Co-Authors: Laura A Schieve, Owen Devine, Coleen A Boyle, Joann Petrini, Lee WarnerAbstract:Infertility treatment with ovulation stimulation, either as part of assisted reproductive technologies (ARTs) or for non-ART infertility treatment, has been primarily responsible for the marked increase in Multiple Births in the United States in recent decades. The Multiple-gestations resulting from both ART and non-ART treatments are associated with adverse sequelae, including markedly higher risks of pregnancy complications, premature delivery, infant death, and neurodevelopmental impairment in survivors. A number of studies have reported that ART-conceived singletons are also at higher risk of these outcomes than naturally conceived singletons. Although there is an ongoing, population-based surveillance system in the United States for ART-induced Births, there is no comparable system to monitor non-ART infertility treatments, thus the contribution of each to Multiple Births in the United States is not known. The investigators present data from a multistep modeling process that was developed to estimate the proportions of Multiple and singleton liveBirths conceived in 2005 by use of non-ART ovulation stimulation. Published surveillance data provided an estimate of the proportion of US Multiple Births conceived naturally and by ART; it was assumed that the remainder was conceived with non-ART treatments. A meta-analysis of peer-reviewed literature published from 1997 to 2007 was used to estimate the contribution of non-ART ovulation treatment to the risk of Multiple-gestation in the annual US birth cohort. A non-ART fetal survival factor was applied to obtain Multiple-birth risk estimates. This estimate and the investigator's previous estimate of the proportion of US Multiple Births attributable to non-ART ovulation stimulation provided an estimate of the total and singleton (derived through subtraction of Multiple Births) proportion of infants conceived using non-ART induction. Based on the model data, the investigators estimated that the mean percentage of all US Births in 2005 conceived with non-ART ovulation stimulation was 4.62% (95% uncertainty range, 2.8%-7.8%), which is 4 times more that the number contributed by ART treatment and equates to more than 190,000 liveBirths. Of all singleton pregnancies, 3.98% were conceived with non-ART ovulation stimulation, and 22.8% of all multifetal pregnancies resulted from non-ART ovulation stimulation. These findings demonstrate that non-ART ovulation induction treatment in the United States is associated with a higher Multiple-birth-attributable risk than ART. The estimated percentage contribution to US Births is 2 to 6 times higher than the contribution of ART.
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relationships between Multiple Births and autism spectrum disorders cerebral palsy and intellectual disabilities autism and developmental disabilities monitoring addm network 2002 surveillance year
Autism Research, 2008Co-Authors: Kim Van Naarden Braun, Russell S. Kirby, Laura A Schieve, Li Ching Lee, Craig J Newschaffer, Julie L Daniels, Maureen S Durkin, Ellen Giarelli, Joyce S Nicholas, Jennifer PintomartinAbstract:Since the 1970s, the prevalence of Multiple Births (MBs) in the United States has increased significantly. This has been attributed, in large part, to iatrogenic MBs resulting from infertility treatments that include ovulation stimulation. A past study has indicated that children from MBs have an increased prevalence of cerebral palsy (CP). Other studies also have suggested an association between MBs and intellectual disabilities (ID) and autism spectrum disorders (ASDs); however, results have been inconsistent. From the Autism and Developmental Disabilities Monitoring (ADDM) Network, a surveillance project among several US populations, we obtained MB estimates among children born in 1994 and classified by 8 years of age as having: an ASD (n=1,626 total children from 11 sites; 50 born as part of an MB); CP (n=302 total children from 3 sites; 25 born as part of an MB); or ID (n=1,195 total children from 3 sites; 45 born as part of an MB). All three MB estimates were notably higher than age-adjusted expected estimates of naturally conceived MBs derived from 1971 US natality data. However, when MB estimates from the ADDM Network were compared with expected MB estimates derived from 1994 natality data for the states corresponding to the relevant ADDM Network sites, we observed no association with ASDs (observed/expected=1.08 [0.78-1.38]), a moderate, but not statistically significant association with ID (observed/expected=1.34 [0.95-1.73]), and a strong association with CP (observed/expected=2.96 [1.80-4.12]). Further investigation of specific types of MBs (natural vs. iatrogenic) is warranted.
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does insurance coverage decrease the risk for Multiple Births associated with assisted reproductive technology
Fertility and Sterility, 2003Co-Authors: Meredith A Reynolds, Laura A Schieve, Gary Jeng, Herbert B PetersonAbstract:Abstract Objective To determine whether insurance coverage for ART is associated with transfer of fewer embryos and decreased risk of Multiple Births. Design Retrospective cohort study of a population-based sample of IVF procedures performed in six U.S. states during 1998. Setting Three states with mandated insurance coverage (Illinois, Massachusetts, and Rhode Island) and three states without coverage (Indiana, Michigan, and New Jersey). Participant(s) Seven thousand, five hundred sixty-one IVF transfer procedures in patients ≤ 35 years of age. Main outcome measure(s) Number of embryos transferred, Multiple-birth rate, triplet or higher order birth rate, and triplet or higher order gestation rate. Result(s) A smaller proportion of procedures included transfer of three or more embryos in Massachusetts (64%) and Rhode Island (74%) than in the noninsurance states (82%). The Multiple-birth rate in Massachusetts (38%) was less than in the noninsurance states (43%). The insurance states all had protective odds ratios for triplet or higher order Births, but only the odds ratio (0.2) for Massachusetts was significant. This decreased risk in Massachusetts resulted from several factors, including a smaller proportion of patients with three or more embryos transferred, lower implantation rates when three or more embryos were transferred, and greater rates of fetal loss among triplet or higher order gestations. Conclusion(s) Insurance appears to affect embryo transfer practices. Whether this translates into decreased Multiple birth risk is less clear.
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trends in Multiple Births conceived using assisted reproductive technology united states 1997 2000
Pediatrics, 2003Co-Authors: Meredith A Reynolds, Laura A Schieve, Joyce A Martin, Gary Jeng, Maurizio MacalusoAbstract:Objective. To examine trends in Multiple Births conceived using assisted reproductive technology (ART) in the United States between 1997 and 2000 and to estimate the proportion of all US Multiple Births attributable to ART use. Methods. We analyzed population-based data of 109 519 live-born infants who were conceived in the United States using ART and born between 1997 and 2000 and population-based data of 15 856 809 live-born infants who were delivered in the United States between 1997 and 2000. Multiple birth rates (the number of live-born infants delivered in Multiple gestation pregnancies per 1000 live Births) and the proportion of all US Multiple Births attributable to ART were evaluated. Results. The twin rate for ART patients increased between 1997 and 2000, reaching 444.7 per 1000 live Births in 2000, whereas the triplet/+ rate declined substantially from 134.3 to 98.7 per 1000 live Births from 1997–2000. From 1997–2000, the proportion of Multiple Births in the United States attributable to ART increased from 11.2% to 13.6%, whereas the proportion attributable to natural conception decreased from 69.9% to 64.5%. In 2000, the proportion of triplet/+ Births attributable to ART and to natural conception was 42.5% and 17.7%, respectively. The contribution of ART to Multiple Births increased substantially with maternal age, from 11.6% for triplet/+ infants born to women aged 20 to 24 to 92.8% for women aged 45 to 49 years. Conclusions. The contribution of ART to twin birth rates continues to increase, but the contribution of ART to triplet/+ birth rates has declined.
Joann Petrini - One of the best experts on this subject based on the ideXlab platform.
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estimation of the contribution of nonassisted reproductive technology ovulation stimulation fertility treatments to us singleton and Multiple Births
Obstetrical & Gynecological Survey, 2010Co-Authors: Laura A Schieve, Owen Devine, Coleen A Boyle, Joann Petrini, Lee WarnerAbstract:Infertility treatment with ovulation stimulation, either as part of assisted reproductive technologies (ARTs) or for non-ART infertility treatment, has been primarily responsible for the marked increase in Multiple Births in the United States in recent decades. The Multiple-gestations resulting from both ART and non-ART treatments are associated with adverse sequelae, including markedly higher risks of pregnancy complications, premature delivery, infant death, and neurodevelopmental impairment in survivors. A number of studies have reported that ART-conceived singletons are also at higher risk of these outcomes than naturally conceived singletons. Although there is an ongoing, population-based surveillance system in the United States for ART-induced Births, there is no comparable system to monitor non-ART infertility treatments, thus the contribution of each to Multiple Births in the United States is not known. The investigators present data from a multistep modeling process that was developed to estimate the proportions of Multiple and singleton liveBirths conceived in 2005 by use of non-ART ovulation stimulation. Published surveillance data provided an estimate of the proportion of US Multiple Births conceived naturally and by ART; it was assumed that the remainder was conceived with non-ART treatments. A meta-analysis of peer-reviewed literature published from 1997 to 2007 was used to estimate the contribution of non-ART ovulation treatment to the risk of Multiple-gestation in the annual US birth cohort. A non-ART fetal survival factor was applied to obtain Multiple-birth risk estimates. This estimate and the investigator's previous estimate of the proportion of US Multiple Births attributable to non-ART ovulation stimulation provided an estimate of the total and singleton (derived through subtraction of Multiple Births) proportion of infants conceived using non-ART induction. Based on the model data, the investigators estimated that the mean percentage of all US Births in 2005 conceived with non-ART ovulation stimulation was 4.62% (95% uncertainty range, 2.8%-7.8%), which is 4 times more that the number contributed by ART treatment and equates to more than 190,000 liveBirths. Of all singleton pregnancies, 3.98% were conceived with non-ART ovulation stimulation, and 22.8% of all multifetal pregnancies resulted from non-ART ovulation stimulation. These findings demonstrate that non-ART ovulation induction treatment in the United States is associated with a higher Multiple-birth-attributable risk than ART. The estimated percentage contribution to US Births is 2 to 6 times higher than the contribution of ART.
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estimation of the contribution of non assisted reproductive technology ovulation stimulation fertility treatments to us singleton and Multiple Births
American Journal of Epidemiology, 2009Co-Authors: Owen Devine, Coleen A Boyle, Joann Petrini, Lee WarnerAbstract:: Infertility treatments that include ovulation stimulation, both assisted reproductive technologies (ARTs) and non-ART ovulation stimulation, are associated with increased risks of Multiple birth and concomitant sequelae and adverse outcomes, even among singletons. While a US surveillance system for ART-induced Births is ongoing, no population-based tracking system exists for Births resulting from non-ART treatments. The authors developed a multistage model to estimate the uncertain proportion of US infants born in 2005 who were conceived by using non-ART ovulation treatments. Using published surveillance data, they estimated proportions of US Multiple Births conceived naturally and by ART and assumed that the remainder were conceived with non-ART treatments. They used Bayesian meta-analyses to summarize published clinical studies on the Multiple-gestation risk associated with non-ART ovulation treatments, applied a fetal survival factor, and used this Multiple-birth risk estimate and their own estimate of the proportion of US Multiple Births attributable to non-ART ovulation stimulation to estimate the total (and, through subtraction, singleton) proportion of infants conceived with such treatments. On the basis of the model, the authors estimate that 4.6% of US infants born in 2005 (95% uncertainty range: 2.8%-7.1%) resulted from non-ART ovulation treatments. Notably, this figure is 4 times greater than the ART contribution.
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The changing epidemiology of Multiple Births in the United States.
Obstetrics and gynecology, 2003Co-Authors: Rebecca B. Russell, Joann Petrini, Karla Damus, Donald R. Mattison, Richard H. SchwarzAbstract:Abstract OBJECTIVE: To describe changes in the epidemiology of Multiple Births in the United States from 1980 to 1999 by race, maternal age, and region; and to examine the impact of these changes on birth weight-specific infant mortality rates for singleton and Multiple Births. METHODS: Retrospective univariate and multivariable analyses were conducted using vital statistics data from the National Center for Health Statistics. RESULTS: Between 1980 and 1999, the overall Multiple birth ratio increased 59% (from 19.3 to 30.7 Multiple Births per 1000 live Births, P CONCLUSION: It is important to understand the changing epidemiology of Multiple Births, especially for women at highest risk (advanced maternal age, white race, Northeast residents). The attribution of infertility management requires further study. The differential birth weight-specific infant mortality for singletons and Multiples demonstrates the importance of stratifying by plurality when assessing perinatal outcomes.
Eli Y. Adashi - One of the best experts on this subject based on the ideXlab platform.
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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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fertility treatments and Multiple Births in the united states
The New England Journal of Medicine, 2013Co-Authors: Aniket Kulkarni, Dmitry M. Kissin, Denise J. Jamieson, Howard W Jones, Maria F Gallo, Maurizio Macaluso, Eli Y. AdashiAbstract:Background The advent of fertility treatments has led to an increase in the rate of Multiple Births in the United States. However, the trends in and magnitude of the contribution of fertility treatments to the increase are uncertain. Methods We derived the rates of Multiple Births after natural conception from data on distributions of all Births from 1962 through 1966 (before fertility treatments were available). Publicly available data on Births from 1971 through 2011 were used to determine national Multiple birth rates, and data on in vitro fertilization (IVF) from 1997 through 2011 were used to estimate the annual proportion of Multiple Births that were attributable to IVF and to non-IVF fertility treatments, after adjustment for maternal age. Trends in Multiple Births were examined starting from 1998, the year when clinical practice guidelines for IVF were developed with an aim toward reducing the incidence of Multiple Births. Results We estimated that by 2011, a total of 36% of twin Births and 77% of triplet and higher-order Births resulted from conception assisted by fertility treatments. The observed incidence of twin Births increased by a factor of 1.9 from 1971 to 2009. The incidence of triplet and higher-order Births increased by a factor of 6.7 from 1971 to 1998 and decreased by 29% from 1998 to 2011. This decrease coincided with a 70% reduction in the transfer of three or more embryos during IVF (P<0.001) and a 33% decrease in the proportion of triplet and higher-order Births attributable to IVF (P<0.001). Conclusions Over the past four decades, the increased use of fertility treatments in the United States has been associated with a substantial rise in the rate of Multiple Births. The rate of triplet and higher-order Births has declined over the past decade in the context of a reduction in the transfer of three or more embryos during IVF. (Funded by the Centers for Disease Control and Prevention.)
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ovarian stimulation and intrauterine insemination at the quarter centennial implications for the Multiple Births epidemic
Fertility and Sterility, 2012Co-Authors: Howard D Mcclamrock, Howard W Jones, Eli Y. AdashiAbstract:Ovarian stimulation and intrauterine insemination (OS/IUI), a mainstay of current infertility therapy and a common antecedent to IVF, is a significant driver of the Multiple Births epidemic. Redress of this challenge, now marking its quarter centennial, will require a rethinking of current practice patterns. Herein we explore prospects for prevention, mitigation, and eventual resolution. We conclude that the Multiple Births attributable to OS/IUI may not be entirely preventable but that the outlook for their mitigation is promising, if in need of solidification. Specifically, we observe that low-dose (≤75 IU) gondotropin, clomiphene, and especially off-label letrozole regimens outperform high-dose (≥150 IU) gonadotropin counterparts in the gestational plurality category while maintaining comparable per-cycle pregnancy rates. Accordingly we recommend that, subject to appropriate exceptions, high-dose gonadotropin regimens be used sparingly and that whenever possible they be replaced with emerging alternatives. Finally, we posit that OS/IUI is not likely to be superseded by IVF absent further commoditization and thus greater affordability.
