title: Singleton birth at term: an old alarm or a new debate?
abstract: In 2004, Human Reproduction published a debate series focusing on the rising tide of multiple pregnancy associated with IVF. The premise of the primary report in that debate was that by considering IVF outcomes differently-by focusing on healthy singleton birth at term rather than clinical pregnancy, the standard currency at that time-the necessary shift toward reduced numbers of embryos transferred might be accelerated. The choice of end-point in that debate-Birth Emphasizing a Successful Singleton at Term (BESST)-was not an effort to 'dumb down' the complex equation linking risks and benefits. That balance is a dynamic and various mix of issues that clinicians discuss with patients on a daily basis. And BESST was certainly not proposed as a new primary outcome for application to other treatment modalities in reproductive medicine, such as ovulation induction. It was simply a responsible and brave call for change in the accelerating and competitive world of IVF.
authors.affiliation: Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada L8N 3Z5 hughese@mcmaster.ca.
authors.forename: Edward G
authors.initials: EG
authors.lastname: Hughes
mesh_terms: D005260:Female; D006801:Humans; D007246:Infertility / Q000628:therapy*; D011247:Pregnancy; D018456:Reproductive Medicine / Q000379:methods* / Q000592:standards*
keywords: IVF outcomes; adverse outcomes; morbidity; multiple pregnancy; treatment effectiveness