title: The relative contribution of assisted reproductive technologies and ovulation induction to multiple births in the United States 5 years after the Society for Assisted Reproductive Technology/American Society for Reproductive Medicine recommendation to limit the number of embryos transferred.
abstract: OBJECTIVE
  To examine the effect of the 1998 Society for Assisted Reproductive Technology/American Society for Reproductive Medicine (SART/ASRM) Practice Committee recommendation to limit the number of embryos transferred on high order multiple births (HOMB) due to assisted reproduction technology (ART) and ovulation induction (OI) in the United States.
  
  
  METHODS
  None.
  
  
  METHODS
  Analysis of U.S. natality files, and U.S. Centers for Disease Control and Prevention (CDC) and ASRM/SART registry reports.
  
  
  METHODS
  None.
  
  
  METHODS
  None.
  
  
  METHODS
  None.
  
  
  METHODS
  Number and ratio of twin, triplet, and quadruplet or higher order (quadruplet/+) multiple births. Percentage of HOMB due to ART, OI, natural conception, and unexplained.
  
  
  RESULTS
  Between 1998 and 2003, the number of twin births (number of live-born infants in twin deliveries) in the United States increased 17%, and the number of HOMB was unchanged. Since 1998, total births due to ART increased 67%, twin births increased 65%, triplet births deceased 8%, and quadruplet/+ births decreased 35%. The ratio of twin, triplet, and quadruplet/+ births to total ART births decreased 2%, 45%, and 61% respectively. In 2003, the estimated percentages of multiple births due to ART and OI were twins 16% and 21%, triplets 45% and 37%, and quadruplets/+ 30% and 62%, respectively.
  
  
  CONCLUSIONS
  Following publication of the SART/ASRM recommended limits on number of embryos transferred, the ratio of HOMB births to total ART births decreased substantially; however, U.S. HOMB did not decrease due to a 67% increase in total ART births and an increase in triplet births from OI.
authors.affiliation: Department of Obstetrics and Gynecology, Louisiana State University School of Medicine, New Orleans, USA. rdickeyrei@fertilityinstitute.com
authors.forename: Richard P
authors.initials: RP
authors.lastname: Dickey
mesh_terms: D000328:Adult; D002452:Cell Count; D002487:Centers for Disease Control and Prevention, U.S.; D004624:Embryo Transfer / Q000379:methods / Q000639:trends; D005260:Female; D005307:Fertilization in Vitro / Q000639:trends; D019983:Guideline Adherence; D006287:Health Planning Guidelines; D006801:Humans; D009099:Multiple Birth Offspring / Q000706:statistics & numerical data*; D010062:Ovulation Induction; D011247:Pregnancy; D011272:Pregnancy, Multiple / Q000706:statistics & numerical data; D012042:Registries; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects / Q000706:statistics & numerical data; D012955:Societies, Medical; D014481:United States