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CURRENT COMMENTARY |
Rollins School of Public Health, Emory University, Atlanta, Georgia
Address reprint requests to: Carol J. Rowland Hogue, PhD, MPH, Emory University, Rollins School of Public Health, Terry Professor of Maternal and Child Health, Professor of Epidemiology, 1518 Clifton Road, NE, Atlanta, GA 30322; E-mail: chogue{at}sph.emory.edu.
In 1999, the approximately 90,000 in vitro fertilization procedures accounted for 98% of all types of assisted reproductive technologies in the United States. Since 1992, when Congress recognized a public health interest in reporting accurate and timely information about pregnancy success rates for infertility treatments, success has been defined as a live birth after an assisted reproductive technology cycle, regardless of the number of live-born infants per delivery. Because of pressures to achieve success, often more than one pre-embryo is transferred per cycle, frequently resulting in multifetal pregnancy reduction or multiple births. Twin and higher order births associated with assisted reproductive technology have increased significantly since 1980. Although births resulting from assisted reproductive technology amount to less than 1% of all live births, they now account for about a third of all twin births and more than 40% of triplets and higher number births in the United States. Although multiple births fit the current definition of success, they create much higher risks for maternal and infant morbidity and mortality, contributing to more than $640 million in excess initial hospital costs during the year 2000 alone. With recent improvements in assisted reproductive technology procedures that increase the likelihood of delivery after the transfer of just one pre-embryo per cycle, it is time to re-examine how success is measured. Assisted reproductive technology success should be redefined to be the proportion of cycles resulting in a singleton, live birth.
This article has been cited by other articles:
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  S. E. Little, J. Ratcliffe, and A. B. Caughey Cost of transferring one through five embryos per in vitro fertilization cycle from various payor perspectives. Obstet. Gynecol., September 1, 2006; 108(3): 593 - 601. [Abstract] [Full Text] [PDF]
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M.A. Reynolds and L.A. Schieve Trends in embryo transfer practices and multiple gestation for IVF procedures in the USA, 1996-2002 Hum. Reprod., March 1, 2006; 21(3): 694 - 700. [Abstract] [Full Text] [PDF]
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 N. S. Green Risks of Birth Defects and Other Adverse Outcomes Associated With Assisted Reproductive Technology Pediatrics, July 1, 2004; 114(1): 256 - 259. [Full Text] [PDF]
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L. A. Schieve and M. A. Reynolds What is the most relevant standard of success in assisted reproduction?: Challenges in measuring and reporting success rates for assisted reproductive technology treatments: What is optimal? Hum. Reprod., April 1, 2004; 19(4): 778 - 782. [Abstract] [Full Text] [PDF]
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A. Vahratian, L. A. Schieve, M. A. Reynolds, and G. Jeng Live-birth rates and multiple-birth risk of assisted reproductive technology pregnancies conceived using thawed embryos, USA 1999-2000 Hum. Reprod., July 1, 2003; 18(7): 1442 - 1448. [Abstract] [Full Text] [PDF]
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