Multiple births following in vitro fertilization treatment: redefining success

Umranikar, Aarti; Parmar, Dr.Dipti C.; Davies, S.; Fountain, Shaun

doi:10.1016/j.ejogrb.2013.06.031

Cited by 15 publications

(14 citation statements)

References 39 publications

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“…Twin livebirth following DET poses a significantly increased risk of obstetrical complications such as preeclampsia and gestational diabetes and perinatal morbidity and mortality associated with extreme prematurity, low birth weight, and impaired behavioral development during the neonatal and infant stages (38, 39). Since maximizing the safety of ART involves minimizing the most common ART complication, preterm birth associated with multiple gestation, the ideal pregnancy outcome of ART is a non-low birth weight singleton born at term (13, 35, 40, 41). Prior studies have shown that the cumulative term live birth rate is as good as or better with SET over two cycles than with DET in one cycle, while greatly reducing the probability of a multiple birth (42, 43).…”

Section: Discussionmentioning

confidence: 99%

Factors associated with the use of elective single-embryo transfer and pregnancy outcomes in the United States, 2004–2012

Styer

Luke

Vitek

et al. 2016

Fertility and Sterility

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Objective To evaluate factors associated with elective single embryo transfer (eSET) utilization and its effect on assisted reproductive technology (ART) outcomes in the United States. Design Historical cohort Setting Not applicable Patient(s) Fresh IVF cycles of women 18–37 years using autologous oocytes with either one (SET) or two (DET) embryos transferred and reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System between 2004 and 2012. Cycles were categorized into four groups with[+] or without[−] supernumerary embryos cryopreserved. The SET group with embryos cryopreserved was designated as eSET. Interventions None Main Outcomes Measure(s) The likelihood of eSET utilization, live birth, and singleton non-low birthweight term live birth, modeled using logistic regression. Presented as adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Result(s) The study included 263,375 cycles (21,917 SET[−]cryopreservation, 20,996 SET [+]cryopreservation, 103,371 DET[−]cryopreservation, and 117,091 DET[+]cryopreservation). The utilization of eSET (SET[+]cryopreservation) increased from 1.8% in 2004 to 14.9% in 2012 (aOR 7.66, 95% CI 6.87, 8.53), and was more likely with ART insurance coverage (1.60, 1.54–1.66), Asian race (1.26, 1.20–1.33), uterine factor diagnosis (1.48, 1.37–1.59), retrieval of ≥ 16 oocytes (2.85, 2.55–3.19), and the transfer of day 5–6 embryos (4.23, 4.06–4.40); eSET was less likely in women ages 35–37 years (0.76, 0.73–0.80). Compared to DET cycles, the likelihood of the ideal outcome, term non-low birthweight singleton live birth, was increased 45–52% with eSET. Conclusions Expanding insurance coverage for IVF would facilitate the broader use of eSET, and reduce the morbidity and healthcare costs associated with multiple pregnancies.

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Section: Discussionmentioning

confidence: 99%

Factors associated with the use of elective single-embryo transfer and pregnancy outcomes in the United States, 2004–2012

Styer

Luke

Vitek

et al. 2016

Fertility and Sterility

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“…Relative to singleton pregnancies, fetal, neonatal and perinatal mortality rates are 3-6 times higher in twin, and 5-15 times higher in other multiple pregnancies (Umranikar et al, 2013). Women with multiple pregnancies are at greater risk of miscarriage, anaemia, hypertensive disorders such as preeclampsia, diabetes, operative delivery and related postnatal illnesses.…”

Section: Discussionmentioning

confidence: 99%

Elevated levels of macromolecular damage are correlated with increased nitric oxide synthase expression in erythrocytes isolated from twin neonates

et al. 2016

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SummaryPregnancy is a state associated with an enhanced metabolism and demand for O 2 , which may lead to the overproduction of reactive oxygen species (ROS) and hence to oxidative stress. An elevated ROS level may result in delayed development and a low birth weight. The aim of this study was to reveal the consequences of multiple pregnancies on the redox status of neonatal human red blood cells (RBCs) and evaluate the role of endothelial nitric oxide synthase (NOS3) -expressing RBCs in the generation of oxidative stress. The study presents evidence of higher levels of production of hydrogen peroxide, peroxynitrite and nitrate content in the RBCs of twin neonates, clearly reflected by an elevated level of protein and lipid damages. This phenotype appears to be a consequence of multiple pregnancies, regardless of the level of maturity or the birth weight of the twins. Besides the higher level of ROS, there was a general decrease in the expression of genes coding for antioxidants. The first data are presented on NOS3-expressing neonatal human RBCs. The number of RBCs producing NOS3 was more than twice as high in twin neonates compared to singletons, with no correlation to maturity.

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“…Success for modern IVF is defined as a singleton pregnancy resulting in a healthy singleton infant born at term [42-44]. While prior prediction models have been proposed, ranging from 642 to 12,003 cycles [45-48], the current models have the advantage of much larger numbers [33,065 (SET cycle 1), 126,921 (DET cycle 1) and 8,682 cycles (SET cycle 2)].…”

Section: Discussionmentioning

confidence: 99%

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

Luke

Brown

Wantman³

et al. 2015

American Journal of Obstetrics and Gynecology

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Objective To use a validated prediction model to examine whether single embryo transfer (SET) over two cycles results in live birth rates (LBR) comparable to two embryos transferred (DET) in one cycle, while reducing the probability of a multiple birth (i.e., multiple birth rate, MBR). Study Design Prediction models of LBR and MBR for a woman considering ART developed from linked cycles from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) for 2006-2012 was used to compare SET over two cycles with DET in one cycle. The prediction model is based on a woman’s age, body mass index (BMI), gravidity, prior full-term births, infertility diagnoses, embryo state, number of embryos transferred, and number of cycles. Results To demonstrate the effect of 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; and ages 25, 35, and 40 by cycle (1st or 2nd). The cumulative LBR over two 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, age 35, BMI 30: 54.4% versus 46.5%; for women age 40, BMI 30: 31.3% versus 28.9%. The MBR with DET in one cycle was 32.8% for women age 35 and 20.9% for women age 40; with SET the cumulative MBR was 2.7% and 1.6%, respectively. Conclusions Applying this validated predictive model demonstrated that the cumulative LBR is as good as or better with SET over two cycles than with DET in one cycle, while greatly reducing the probability of a multiple birth.

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Multiple births following in vitro fertilization treatment: redefining success

Cited by 15 publications

References 39 publications

Factors associated with the use of elective single-embryo transfer and pregnancy outcomes in the United States, 2004–2012

Factors associated with the use of elective single-embryo transfer and pregnancy outcomes in the United States, 2004–2012

Elevated levels of macromolecular damage are correlated with increased nitric oxide synthase expression in erythrocytes isolated from twin neonates

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

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