Multiple Birth Rates Research Articles

Effects of ewe live weight and age on reproductive performance, lamb growth, and survival in Central Anatolian Merino sheep

<p><strong>Abstract.</strong> The aim of this study was to evaluate the effects of premating ewe weight and age on ewe reproductive performance, lamb growth and survival in Central Anatolian Merino (CAM) sheep. <br><br> The trial included 4935 ewes and 5548 lambs from 23 breeder flocks in Eskişehir Province. The live weights (LWs) and ages of the ewes were recorded 1 week before the mating season. The number of lambs born, fertility rate, multiple birth rate (MBR), and lamb survival rate (SR) at days 75 and 120 were determined. The effects of the LW and age of the ewe were found to be important for the reproductive performance of ewes and for the lamb's growth rate (<i>P</i> < 0.05–0.001). Ewe MBRs and the birth weight (BW) and LW of the lambs at days 75 and 120 increased proportionally with the increase in LW in ewes prior to mating. The fertility rate and MBR were lower (<i>P</i> < 0.05–0.001) in 1.5-year-old ewes than in older ewes. However, lambs' SR at days 75 and 120 were not affected by the premating LW and age of the ewe. In summary, a better reproductive performance and lamb growth rate in CAM flocks may be achieved by the selection of breeding ewes from ewes weighing more than 60 kg.</p>

Assisted Reproductive Technology Surveillance - United States, 2013.

Assisted Reproductive Technology Surveillance - United States, 2013.

Therapy: Unexplained infertility - ongoing transatlantic debate.

A recent US study comparing different drugs for ovarian stimulation in women with unexplained infertility demonstrates that letrozole is less effective than gonadotropins or clomiphene; however, the primary end point for the study was not efficacy but, rather, multiple pregnancy rates. This study confirms, yet again, that gonadotropins are associated with unacceptably high rates of multiple births.

Prólogo al Simposio sobre Embarazo Múltiple

El Hospital Nacional Daniel Alcides Carrión del Callao, Perú, organizó recientemente bajo la conducción del Dr. Rommel Lacunza un simposio sobre Embarazo Múltiple, un tema poco revisado, pero cuya ocurrencia ha existido a través de los tiempos, algo más en las 3 a 4 últimas décadas(1). Hace algunos años, Hellin postuló que el embarazo gemelar ocurría en la proporción de 1 en 89 nacimientos, y que los embarazos triples, cuádruples y de mayor orden aparecían en la relación 1 en 892, 1:893, 1:89n(2). En Inglaterra y Gales, la incidencia de embarazos múltiples aumentó de 10 por 1 000 en 1980 a 16 por 1 000 en 2009, señalándose como causa importante el éxito de las técnicas de reproducción asistida y la ocurrencia de embarazos múltiples hasta en 24% de los casos en que se empleó la fertilización in vitro(1). En un estudio peruano, la incidencia de embarazo múltiple fue 1,1% en 314 078 recién nacidos, aumentando a 2,7% cuando se asoció a la preeclampsia(3). En la Red Latinoamericana de Reproducción Asistida, en su reporte de 2012, la frecuencia de parto múltiple fue 30,2% (27,8% dobles y 2,4% triples y mayores) en 47 326 procedimientos(4).

Assisted reproductive technology use, embryo transfer practices, and birth outcomes after infertility insurance mandates: New Jersey and Connecticut

To explore whether recently enacted infertility mandates including coverage for assisted reproductive technology (ART) treatment in New Jersey (2001) and Connecticut (2005) increased ART use, improved embryo transfer practices, and decreased multiple birth rates. Retrospective cohort study using data from the National ART Surveillance System. We explored trends in ART use, embryo transfer practices and birth outcomes, and compared changes in practices and outcomes during a 2-year period before and after passing the mandate between mandate and non-mandate states. Not applicable. Cycles of ART performed in the United States between 1996 and2013. Infertility insurance mandates including coverage for ART treatment passed in New Jersey (2001) and Connecticut (2005). Number of ART cycles performed, number of embryos transferred, multiple live birth rates. Both New Jersey and Connecticut experienced an increase in ART use greater than the non-mandate states. The mean number of embryos transferred decreased significantly in New Jersey and Connecticut; however, the magnitudes were not significantly different from non-mandate states. There was no significant change in ART birth outcomes in either mandate state except for an increase in live births in Connecticut; the magnitude was not different from non-mandate states. The infertility insurance mandates passed in New Jersey and Connecticut were associated with increased ART treatment use but not a decrease in the number of embryos transferred or the rate of multiples; however, applicability of the mandates was limited.

Prognostic indicators of assisted reproduction technology outcomes of cycles with ultralow serum antimüllerian hormone: a multivariate analysis of over 5,000 autologous cycles from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System database for 2012–2013

To assess cycle outcomes when antimüllerian hormone (AMH) is ultralow (≤0.16ng/mL) and to determine which parameters contribute to the probability of cycle cancellation and/or outcome. Retrospective analysis. Not applicable. 5,087 (7.3%) fresh and 243 (1.5%) thawed cycles with ultralow AMH values. Linear and logistic regression, comparison with age-matched cycles with normal AMH concentrations. Cancellation rate; number of retrieved oocytes, embryos, transferred embryos, and cryopreserved embryos; clinical pregnancy, live-birth, and multiple birth rates. The total cancellation rate per cycle start for fresh cycles was 54%. Of these, 38.6% of the cycles were canceled before retrieval, and 3.3% of cycles obtained no oocytes at time of retrieval. Of all retrieval attempts, 50.7% had three oocytes or fewer retrieved, and 25.1% had no embryo transfer. The live-birth rates were 9.5% per cycle start. Cycles with ultralow AMH levels compared with age-matched normal AMH cycles demonstrated more than a fivefold greater pre-retrieval cancellation rate, a twofold less live-birth rate per cycle and a 4.5-fold less embryo cryopreservation rate. Refusing treatment solely on the basis of ultralow AMH levels is not advisable, but patients should be counseled appropriately about the prognostic factors for cancellation and outcomes.

Elective single-embryo transfer improves cumulative pregnancy outcome in young patients but not in women of advanced reproductive age.

The purpose of the present study is to assess the significance of elective single-embryo transfer (eSET) in older women. The outcomes of assisted reproductive technology between 2001 and 2013 at single institution were retrospectively evaluated. Cumulative live birth rates (CLBRs) in one oocyte retrieval cycle were compared between those who underwent eSET and multiple embryo transfer (MET) in fresh cycles. The outcomes of 429 eSET cycles and 965 MET cycles were compared. CLBRs in eSET were higher than those of MET in women under 37 and were comparable in women aged 37 and over. The analysis of the outcomes separately in three age subgroups showed a significantly higher CLBR in young eSET (aged under 37) than that in young MET and similar CLBR between older (aged 37-40 and over 40) eSET and MET. Multiple birth rates were lower in eSET in all age groups. Multivariate logistic regression analyses showed that, in women aged under 37, number of frozen embryos, presence of good-quality embryos, and eSET were significantly related to cumulative live birth. In women aged between 37 and 40, age and number of frozen embryos were significantly related, while eSET was not. eSET in women under 37 resulted in increased CLBR compared with MET. In women aged between 37 and 40, CLBR in eSET group was similar with that in MET group. In both age groups, eSET reduced multiple birth rates. The significance of eSET in older women is limited presently, and further research on the strategy to improve cumulative outcomes is necessary.

The impact of insurance mandates on multiple birth rates following in vitro fertilization

The impact of insurance mandates on multiple birth rates following in vitro fertilization

Influence of embryo transfer practices on multiple birth rates among states with mandated insurance coverage for in vitro fertilization

Influence of embryo transfer practices on multiple birth rates among states with mandated insurance coverage for in vitro fertilization

Embryo transfer practices and multiple birth rates following in vitro fertilization: has insurance mandate status influenced practice patterns over time?

Embryo transfer practices and multiple birth rates following in vitro fertilization: has insurance mandate status influenced practice patterns over time?

Improved neonatal prognosis following restriction in the number of transferred embryos in assisted reproduction – single center yearly comparison from Turkey

To evaluate the impact of new legislation for assisted reproductive technology (ART) restricting the number of transferred embryos on neonatal prognosis of infants born after infertility treatments. Neonatal records of all live born infants in Ege University Maternity Ward were reviewed for 2006 and 2012. Neonatal outcome measures such as birth weight (BW), gestational age (GA), preterm birth (PTB), very low birth weight (VLBW), and neonatal intensive care unit (NICU) admission were evaluated. Compared to 2006 percentage of newborns conceived by medically assisted reproduction (MAR) decreased from 14.6% to 5% in all live births, from 23.8% to 8.2% in NICU patients in 2012. The number of fetuses in the last pregnancy, frequency of intrauterine reductions, spontaneous pregnancy losses, antenatal bleeding, and premature delivery decreased. Percentage of multiples among MAR newborns (31.7% vs. 55.7%), twins from 51.4% to 30.9%, triplets from 4.3% to 0.8% all decreased significantly. Mean BW and gestational age increased resulting in decreased frequency of PTB and VLBW. Consequently Level 3 NICU admission rate significantly decreased from 44.3% to 22%. The new ART legislation in Turkey resulted in decreased rate of multiple births, prematurity and related complications, and NICU admissions in MAR newborns. However the twin rates are still high. Since uncontrolled ovulation stimulation and intrauterine insemination techniques are also associated with multiple births and unfavorable neonatal outcomes, these procedures deserve close monitorization.

Public health implications of a North American publicly funded in vitro fertilization program; lessons to learn.

A retrospective study was conducted to determine trends in practice and outcomes that occurred since the implementation of the publicly funded in vitro fertilization (IVF) and single embryo transfer (SET) program in Quebec, in August, 2010. Data presented was extracted from an advisory report by the Health and Welfare Commissioner, and from a report by the Ministry of Health and Social Services published in June 2014 and October 2013, respectively. This data is publicly available, and was collected from all six private and three public-assisted reproduction centers in Quebec providing IVF services. Data pertains to all IVF cycles performed from the 2009-2010 to 2012-2013 fiscal years. SET was performed in 71% of cycles in 2012. The number of children born from IVF was 1057 in 2009-2010 and 1723 in 2012-2013 (p < 0.0001). Multiple birth rates from IVF were 24% in 2009-2010 (before the program began) and 9.45% in 2012-2013 (p < 0.0001). The proportions of IVF babies that were premature, that were the result of multiple births, or that required neonatal intensive care unit admission (NICU) all decreased by 35.5% (p < 0.0001), 55% (p < 0.0001), and 37% (p < 0.0001), respectively, from 2009-2010 to 2012-2013. The cost per NICU admission for an IVF baby increased from $19,990 to $28,418 from 2009-2010 to 2011-2012. This first North American publicly funded IVF program with a SET policy shows that such a program contributes substantially to number of births. It has also succeeded in increasing access to treatment and decreasing perinatal morbidity by decreasing multiple birth rates from IVF. A substantial increase in global public health care costs occurred as well.

The success rate of IVF has significantly improved over the last decade.

To demonstrate that success rates with in vitro fertilisation (IVF) have been improving despite decreasing the number of embryos transferred. This was a retrospective cohort study comparing live birth outcomes for women who started IVF between 2001 and 2005 with women who started between 2006 and 2010, using life table analysis to allow for the fact that women had differing number of cycles of treatment. The data were obtained from a single IVF centre, Monash IVF Geelong, Victoria. The 2001-2005 cohort consisted of 233 women, and the 2006-2010 cohort consisted of 453 women who started IVF between the specified dates. The main outcome measure was a live birth. Life table analysis was used to estimate the cumulative probability of a live birth after each cycle. The estimate of cumulative live birth probability demonstrated that the chance of a live birth by cycle five was 75.8% in the 2001-2005 cohort, which significantly increased to 80.1% by cycle five in the 2006-2010 cohort (P=<0.05). There was a mean of 1.8 embryos transferred per embryo transfer in the 2001-2005 cohort, which decreased to a mean of 1.3 embryos transferred per embryo transfer in the 2006-2010 cohort. This was associated with a significant decrease in the multiple birth rate from 24.7% in the 2001-2005 cohort to 7.5% in the 2006-2010 cohort. The IVF success rate has significantly improved despite the number of embryos transferred being reduced. This study provides further support for elective single embryo transfers.

How to maximize the pregnancy rate with no increase in multiple pregnancy rates following blastocyst embryo transfer? Is blastocyst transfer time the missing ingredient?

Abstract Background Multiple births after assisted reproduction techniques are associated with adverse outcome. Transferring one blastocyst is the best way to reduce the rate of multiple births but it may also decrease the clinical pregnancy rate if not used wisely. Methods In this study we reviewed the records of 170 women who undergone transfer of 1–3 blastocysts on day 5 or day 6 after in vitro fertilization from 2008 to 2010 to explore the outcome of elective single blastocyst transfer (SBT) compared with multiple blastocyst embryo transfer (MBT) and determine how this affects multiple pregnancy rates. Results The result suggested increasing the number of blastocysts transferred based on advanced age or poor blastocyst quality did not result in any significant increase in CPR while there was significant increase in multiple pregnancy rate (MPR). On the other hand, using the time of transfer as main criteria to decide the number of blastocysts transferred increased the CPR significantly, without significant increase in MPR. Conclusion Our study identified blastocyst transfer time (in hours) could be the best criteria to transfer single blastocyst (SBT) versus double blastocyst (DBT), as that showed to maximize the clinical pregnancy rate with no increase in multiple pregnancy rate. The likelihood of pregnancy is significantly higher in the group of women who had 2 blastocysts transferred after 140 h compared to SBT, with no increase in the multiple pregnancy rate.

Trends in Use of and Reproductive Outcomes Associated With Intracytoplasmic Sperm Injection

Since its introduction in 1992, intracytoplasmic sperm injection (ICSI) has been increasingly used in patients without severe male factor infertility despite the lack of clear evidence of a benefit over conventional in vitro fertilization (IVF). Compared with pregnancies resulting from conventional IVF, pregnancies resulting from the use of ICSI are associated with 1.5 to 4 times increased risk of chromosomal abnormalities, birth defects, intellectual disabilities, imprinting disorders, and autism. Intracytoplasmic sperm injection is considerably more expensive than conventional IVF. The aim of this retrospective observational study was to assess national trends and reproductive outcomes of fresh IVF cycles associated with the use of ICSI compared with conventional IVF with respect to clinical indications for ICSI use. Although only fresh embryos were transferred, it is unlikely that outcomes for frozen-thawed embryos would differ. Data were obtained from the US National Assisted Reproductive Technology Surveillance System for all fresh and ICSI cycles performed during 1996 to 2012. The primary study outcomes were (1) trends in use of ICSI during 1996 to 2012 with respect to male factor infertility, unexplained infertility, maternal age 38 years or older, low oocyte yield (<5 oocytes retrieved), and 2 or more prior assisted reproductive technology cycles and no prior live birth, and (2) reproductive outcomes during 2008 to 2012 for conventional IVF and ICSI cycles, stratified by the presence or absence of male factor infertility. A total of 1,395,634 fresh IVF cycles were identified between1996 and 2012; 908,767 (65.1%) used ICSI, and 486,867 cycles (34.9%) used conventional IVF. Male factor infertility was identified in 499,135 (35.8%) of fresh cycles. During 2006 to 2012, ICSI use among cycles with male factor infertility increased from 76.3% (10,876/14,259) to 93.3% (32,191/34,506) (P < 0.001), whereas its use for those without male factor infertility increased from 15.4% (4,197/27,191) to 66.9% (42,321/63,250) (P < 0.001). During 2008 to 2012, 494,907 fresh IVF cycles were identified, 74.6% of which used ICSI. Male factor infertility was reported in 35.7% (176,911/494,907) of fresh cycles. The risk for multiple births among these cycles was significantly lower in those undergoing ICSI compared with conventional IVF (30.9% vs 34.2%); the adjusted relative risk (RR) was 0.87, with a 95% confidence interval (CI) of 0.83 to 0.91. Compared with conventional IVF, ICSI use among cycles without male factor infertility (n = 317,996) was associated with lower rates of implantation (23.0% vs 25.2%; adjusted RR, 0.93; 95% CI, 0.91–0.95), live birth (36.5% vs 39.2%; adjusted RR, 0.95; 95% CI, 0.93–0.97), and multiple live births (30.1% vs 31.0%; adjusted RR, 0.93; 95% CI, 0.91–0.95). These findings show that ICSI use among fresh IVF cycles in the United States increased from 36.4% to 76.2% between 1996 and 2012. The largest relative increase occurred in cycles without male factor infertility. The data show no improvement in postfertilization reproductive outcomes with use of ICSI over conventional IVF in the absence of male factor infertility, irrespective of male factor infertility diagnosis.

Endocrinology in pregnancy: management of the pregnant patient with a prolactinoma.

A woman with a prolactinoma is usually infertile. Dopamine agonists usually restore ovulation and fertility and such treatment generally is preferred over transsphenoidal surgery because of higher efficacy and safety. Cabergoline is usually preferred over bromocriptine because of its better efficacy with fewer adverse effects. Either drug increases the rates of spontaneous abortions, preterm deliveries, multiple births, or congenital malformations over what may be expected. However, the number of pregnancies reporting such experience is about sevenfold greater for bromocriptine. Tumor growth causing significant symptoms and requiring intervention has been reported to occur in 2.4% of those with microadenomas, 21% in those with macroadenomas without prior surgery or irradiation, and 4.7% of those with macroadenomas with prior surgery or irradiation. Visual fields should be assessed periodically during gestation in women with macroadenomas. If significant tumor growth occurs, most patients respond well to reinstitution of the dopamine agonist. Delivery of the baby and placenta can also be considered if the pregnancy is sufficiently advanced. Transsphenoidal debulking of the tumor is rarely necessary.

Application of a validated prediction model for in vitro fertilization: comparison of live birth rates and multiple birth rates with 1 embryo transferred over 2 cycles vs 2 embryos in 1 cycle

The purpose of this study was to use a validated prediction model to examine whether single embryo transfer (SET) over 2 cycles results in live birth rates (LBR) comparable with 2 embryos transferred (DET) in 1 cycle and reduces the probability of a multiple birth (ie, multiple birth rate [MBR]). Prediction models of LBR and MBR for a woman considering assisted reproductive technology developed from linked cycles from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System for 2006-2012 were used to compare SET over 2 cycles with DET in 1 cycle. The prediction model was based on a woman's age, body mass index (BMI), gravidity, previous full-term births, infertility diagnoses, embryo state, number of embryos transferred, and number of cycles. To demonstrate the effect of the number of embryos transferred (1 or 2), the LBRs and MBRs were estimated for women with a single infertility diagnosis (male factor, ovulation disorders, diminished ovarian reserve, and unexplained); nulligravid; BMI of 20, 25, 30, and 35 kg/m2; and ages 25, 35, and 40 years old by cycle (first or second). The cumulative LBR over 2 cycles with SET was similar to or better than the LBR with DET in a single cycle (for example, for women with the diagnosis of ovulation disorders: 35 years old; BMI, 30 kg/m2; 54.4% vs 46.5%; and for women who are 40 years old: BMI, 30 kg/m(2); 31.3% vs 28.9%). The MBR with DET in 1 cycle was 32.8% for women 35 years old and 20.9% for women 40 years old; with SET, the cumulative MBR was 2.7% and 1.6%, respectively. The application of this validated predictive model demonstrated that the cumulative LBR is as good as or better with SET over 2 cycles than with DET in 1 cycle, while greatly reducing the probability of a multiple birth.

Multiple births in sub-saharan Africa: epidemiology, postnatal survival, and growth pattern.

The study endeavored to assess the epidemiology, postnatal survival, and growth pattern of multiple births in Sub-Saharan Africa (SSA). It was based on the data of 25 demographic health surveys conducted in the subcontinent since 2008. The records of 213,889 children born in the preceding 59 months of the surveys were included. The multiple birth rate was computed as the number of multiple confinements per 1,000 births. Factors associated with multiple births were identified using logistic regression and their survival pattern was assessed using the Kaplan-Meier method. The multiple birth rate was 17.1 (95% confidence interval: 17.7-16.6) and showed considerable variation across the 25 countries included in the study. Odds of multiple births were significantly increased with advanced maternal age, parity, and maternal height but not with wealth index, age at first birth, and month of birth. At the end of the fourth year of age, the cumulative survival probability was as low as 0.77 in multiple births as compared to 0.93 in their counterparts. The odds of neonatal, infant and under-five mortality were 5.55, 4.39, and 3.72 times increased in multiple births, respectively. Multiple births tend to be malnourished than singletons and the odds of wasting, stunting, and underweight were 1.31, 1.83, and 1.73 times raised, consecutively. Nevertheless, multiple births regain their weight-for-age (WFA) and height-for-age (HFA) deficits by the end of the fourth year of age. Counseling pregnant mothers with multiple gestation to give birth at a health institution and providing close medical follow-up during and after the neonatal period can improve the survival of multiple births.

The experience of parents who lose a baby of a multiple birth during the neonatal period – A literature review

This literature review investigates the experience of parents who return to the NICU, following the death of a twin or higher order multiple (HOM), in order to care for a surviving infant. Infants of multiple births are considered at greater risk of prematurity and therefore of death. Bereaved multiple birth parents were identified to grieve similarly to bereaved singleton parents; however, it was acknowledged that they may have difficulty coping with such grief in the presence of a surviving co-multiple and, potentially unacknowledged, disenfranchised grief. ‘Hurtful’ and ‘helpful’ interactions with Healthcare Professionals (HCP) as well as the general public were a frequently recorded theme. As multiple birth rates continue to increase, HCP will be greater exposed to the unique needs of bereaved multiple birth parents. As Nurses, we work closely with parents on a regular basis, and are therefore best positioned to provide compassionate, un-discriminative, holistic care, to bereaved parents in line with the Nursing & Midwifery Council's (NMC) (2008) Code of Conduct. From reviewing the available literature it is evident that there is need for greater training, education and acknowledgement of multiple birth bereavement, within Neonatal End of Life (EoL) care.

International Committee for Monitoring Assisted Reproductive Technologies: World Report on Assisted Reproductive Technologies, 2007

To analyze information on assisted reproductive technology (ART) performed worldwide, and trends in outcomes over successive years. Cross-sectional survey on access, efficiency, and safety of ART procedures performed in 55 countries during 2007. Not applicable. Infertile women and men undergoing ART globally. Collection and analysis of international ART data. Number of cycles performed, by country and region, including pregnancies, single and multiple birth rates, and perinatal mortality. Overall, >1,251,881 procedures with ART were reported, and resulted in 229,442 reported babies born. The availability of ART varied by country, from 12 to 4,140 treatments per million population. Of all aspiration cycles, 65.2% (400,617 of 614,540) were intracytoplasmic sperm injection. The overall delivery rate per fresh aspiration was 20.3%, and for frozen-embryo transfer (FET), 18.4%, with a cumulative delivery rate of 25.8%. With wide regional variations, single-embryo transfer represented 23.4% of fresh transfers, and the proportion of deliveries with twins and triplets from fresh transfers was 22.3% and 1.2%, respectively. The perinatal mortality rate was 19.9 per 1,000 births for fresh in vitro fertilization using intracytoplasmic sperm injection, and 9.6 per 1,000 for FET. The proportion of women aged ≥40 years increased to 19.8% from 15.5% in 2006. The international trend toward <3 transferred embryos continued, as did the wider uptake of FET. This was achieved without compromising delivery rates. The application of ART for women aged >40 years was a major component of ART services in some regions and countries.