title: Embryo transfer practices and multiple births resulting from assisted reproductive technology: an opportunity for prevention.
abstract: OBJECTIVE
  To evaluate assisted reproductive technology (ART) ET practices in the United States and assess the impact of these practices on multiple births, which pose health risks for both mothers and infants.
  
  
  METHODS
  Retrospective cohort analysis using the National ART Surveillance System data.
  
  
  METHODS
  US fertility centers reporting to the National ART Surveillance System.
  
  
  METHODS
  Noncanceled ART cycles conducted in the United States in 2012.
  
  
  METHODS
  None.
  
  
  METHODS
  Multiple birth (birth of two or more infants, at least one of whom was live-born).
  
  
  RESULTS
  Of 134,381 ART transfer cycles performed in 2012, 51,262 resulted in live births, of which 13,563 (26.5%) were multiple births: 13,123 twin and 440 triplet and higher order births. Almost half (46.1%) of these multiple births resulted from the following four cycle types: two fresh blastocyst transfers among favorable or average prognosis patients less than 35 years (1,931 and 1,341 multiple births, respectively), two fresh blastocyst transfers among donor-oocyte recipients (1,532 multiple births), and two frozen/thawed ETs among patients less than 35 years (1,452 multiple births). More than half of triplet or higher order births resulted from the transfer of two embryos (52.5% of births among fresh autologous transfers, 67.2% of births among donor-oocyte recipient transfers, and 42.9% among frozen/thawed autologous transfers).
  
  
  CONCLUSIONS
  A substantial reduction of ART-related multiple (both twin and triplet or higher order) births in the United States could be achieved by single blastocyst transfers among favorable and average prognosis patients less than 35 years of age and donor-oocyte recipients.
authors: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Electronic address: DKissin@cdc.gov.
authors: Dmitry M
authors: DM
authors: Kissin
authors: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Aniket D
authors: AD
authors: Kulkarni
authors: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Allison
authors: A
authors: Mneimneh
authors: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Lee
authors: L
authors: Warner
authors: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Sheree L
authors: SL
authors: Boulet
authors: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Sara
authors: S
authors: Crawford
authors: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors: Denise J
authors: DJ
authors: Jamieson
mesh_terms: D000328:Adult; D004624:Embryo Transfer / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D009099:Multiple Birth Offspring / Q000706:statistics & numerical data; D011159:Population Surveillance; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple / Q000706:statistics & numerical data; D011315:Preventive Medicine / Q000379:methods*; D027724:Reproductive Techniques, Assisted / Q000592:standards / Q000706:statistics & numerical data; D012189:Retrospective Studies; D056826:Single Embryo Transfer / Q000706:statistics & numerical data
keywords: Assisted reproductive technology (ART); embryo transfer guidelines; in vitro fertilization (IVF); multiple birth
references: Fertil Steril. 2004 Sep;82(3):773-4
references: 15374741
references: Fertil Steril. 2009 Nov;92(5):1518-9
references: 19836732
references: Fertil Steril. 2007 Aug;88(2):275-82
references: 17445805
references: Fertil Steril. 2012 Apr;97(4):890-3
references: 22265032
references: Fertil Steril. 2008 Nov;90(5 Suppl):S163-4
references: 19007617
references: Fertil Steril. 2014 Jul;102(1):82-9
references: 24794318
references: MMWR Surveill Summ. 2013 Dec 6;62(9):1-24
references: 24304902
references: Fertil Steril. 2014 Mar;101(3):683-9
references: 24388206
references: Fertil Steril. 2006 Nov;86(5 Suppl 1):S51-2
references: 17055845
references: NCHS Data Brief. 2012 Jan;(80):1-8
references: 22617378
references: N Engl J Med. 2013 Dec 5;369(23):2218-25
references: 24304051
references: Hum Reprod. 2014 Jun;29(6):1313-9
references: 24706002
references: JAMA. 2011 Sep 14;306(10):1135-6
references: 21917583
references: Hum Reprod. 2000 Aug;15(8):1856-64
references: 10920117
references: Best Pract Res Clin Obstet Gynaecol. 2004 Aug;18(4):557-76
references: 15279817
references: Med J Aust. 2011 Nov 21;195(10):594-8
references: 22107009
references: Fertil Steril. 2012 Apr;97(4):835-42
references: 22196716
references: Reproduction. 2008 Oct;136(4):377-86
references: 18577552
references: Obstet Gynecol. 2015 Jan;125(1):111-117
references: 25560112
references: Fertil Steril. 2013 Jan;99(1):44-46
references: 23095140
references: Hum Reprod. 2013 Oct;28(10):2709-19
references: 23820420
references: Cochrane Database Syst Rev. 2013 Jul 29;(7):CD003416
references: 23897513
references: Hum Reprod Update. 2009 Jan-Feb;15(1):45-55
references: 18927071
references: Fertil Steril. 2013 Jun;99(7):1937-43
references: 23453121
references: Hum Reprod. 2007 Aug;22(8):2202-7
references: 17562674
references: Fertil Steril. 2014 Jan;101(1):191-198.e4
references: 24156958
references: Obstet Gynecol. 2014 Feb;123(2 Pt 1):239-247
references: 24402601
references: N Engl J Med. 2004 Dec 2;351(23):2392-402
references: 15575055