title: Use of outcomes-based data in reducing high-order multiple pregnancies: the role of age, diagnosis, and embryo score.
abstract: OBJECTIVE
  To identify high-risk categories for high-order multiple pregnancy (HMP) in in vitro fertilization (IVF), establish clinic-specific HMP risk data for counseling use, and verify their utility in reducing HMP.
  
  
  METHODS
  Before and after intervention study.
  
  
  METHODS
  Two IVF programs using the same embryology laboratory and IVF protocols.
  
  
  METHODS
  All IVF patients undergoing fresh embryo transfers.
  
  
  METHODS
  Use of clinic-specific age, diagnosis, and embryo score (ES) risk data in assessing individual HMP risk during informed consent.
  
  
  METHODS
  HMP and pregnancy outcomes.
  
  
  RESULTS
  In determining clinic-specific high risk categories and developing outcomes-based HMP risk data for counseling, the good outcome rate (GR) was defined as the percentage of singleton or twin deliveries per cycle and the bad outcome rate included no pregnancy or nondelivered pregnancies (miscarriages, multifetal reduction) and HMP per cycle. During 1995 to 1999, age <35 years, calculated morphologic ES, and donor egg (DE) cycles were factors shown by logistic regression to statistically significantly affect the GR. The optimal GRs for DE <35 and >or=35 years (donor age), and non-DE cycles <35 years were achieved with two (57.7%), three (43.2%), and three (43.2%) embryos transferred, respectively. A DE <35 years with >or=3 embryos transferred had the highest risk for HMP. The GR correlated (0.91) with the ES according to the formula: GR = 3.3 + 2.0 ES, when ES range was between 4 and 26. Clinic-specific risks for HMP based on age, diagnosis, and ES were developed and considered while counseling for ET during 2004. The clinic-specific HMP risk data made for a reduction in the HMP rate of 90.9% for DE-IVF (11.8% to 1%) and 53.8% for all IVF (9.1% to 4.2%), without decreases in clinical pregnancy or delivery rates. Physicians showing the greatest decline (64%) in HMP had no reduction in pregnancy or delivery rates.
  
  
  CONCLUSIONS
  The use of clinic-specific HMP risk data in counseling based on age, diagnosis, and ES provided a 53% to 64% reduction in HMP without affecting rates of pregnancy or delivery. The clinic-specific ES system correlated closely with good outcomes. A standardized ES system may provide useful information for counseling during ET informed consent.
authors.affiliation: Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA. c.matthew.peterson@hsc.utah.edu
authors.forename: C Matthew
authors.initials: CM
authors.lastname: Peterson
authors.forename: James C
authors.initials: JC
authors.lastname: Reading
authors.forename: Harry H
authors.initials: HH
authors.lastname: Hatasaka
authors.forename: Kirtly
authors.initials: K
authors.lastname: Parker Jones
authors.forename: Laurence C
authors.initials: LC
authors.lastname: Udoff
authors.forename: Eli Y
authors.initials: EY
authors.lastname: Adashi
authors.forename: Paul H
authors.initials: PH
authors.lastname: Kuneck
authors.forename: Lisa D
authors.initials: LD
authors.lastname: Erickson
authors.forename: John W
authors.initials: JW
authors.lastname: Malo
authors.forename: Bruce F
authors.initials: BF
authors.lastname: Campbell
authors.forename: Douglas T
authors.initials: DT
authors.lastname: Carrell
mesh_terms: D000328:Adult; D004622:Embryo, Mammalian / Q000166:cytology* / Q000502:physiology; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007246:Infertility / Q000209:etiology*; D016015:Logistic Models; D008423:Maternal Age; D008499:Medical Records; D011247:Pregnancy; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple; D011315:Preventive Medicine / Q000379:methods*; D018570:Risk Assessment