title: Redefining in vitro fertilization success: should triplets be considered failures?
abstract: OBJECTIVE
  To evaluate how the ranking of IVF programs changes if high-order multiple pregnancies (HOMPs) are considered negative outcomes.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  The 2004 Society for Assisted Reproductive Technology Clinic Outcome Reporting System.
  
  
  METHODS
  Two hundred seven programs that performed >50 IVF cycles were analyzed, and only patients <or=35 years of age were included.
  
  
  METHODS
  Program size, success rate, and number of embryos transferred were recorded for each program. All programs were ranked in accordance to these variables.
  
  
  METHODS
  The programs were re-ranked after considering HOMPs as negative, rather than as positive, outcomes.
  
  
  RESULTS
  High-order multiple pregnancies were more abundant as the number of embryos replaced increased. The live birth rate, after excluding HOMPs, significantly decreased as the number of embryos transferred increased. The lowest ranked programs performed transfers with the greatest number of embryos (2.4-4.5). After HOMP exclusion, the rank of programs that transferred >2.4 embryos decreased, as opposed to the programs that transferred fewer embryos (1.8-2.4).
  
  
  CONCLUSIONS
  Reclassifying HOMPs as failed cycles will result in a reduced rank in programs that maintain high embryo replacements. Redefining success as a singleton or twin birth significantly changes the ranking order of programs and, potentially, how programs are perceived.
authors: Department of Obstetrics and Gynecology, Mount Sinai School of Medicine, New York, New York 10022, USA.
authors: Lawrence
authors: L
authors: Grunfeld
authors: Martha
authors: M
authors: Luna
authors: Tanmoy
authors: T
authors: Mukherjee
authors: Benjamin
authors: B
authors: Sandler
authors: Yui
authors: Y
authors: Nagashima
authors: Alan B
authors: AB
authors: Copperman
mesh_terms: D000328:Adult; D005260:Female; D005307:Fertilization in Vitro / Q000706:statistics & numerical data*; D006801:Humans; D007246:Infertility / Q000453:epidemiology* / Q000628:therapy*; D009518:New York / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014310:Triplets