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• W3091215603 abstract "In the early years of in vitro fertilization, overall pregnancy rates were low, and it was considered necessary to transfer more than one embryo to increase the chances of pregnancy. It was not until advances in assisted reproductive technologies resulting in increased pregnancy rates that the concept of transferring just one embryo was considered possible. A consequence of improvements in implantation rates was also an increase in multiple pregnancies when more than one embryo was transferred. Although some countries have reduced the number of embryos transferred, international data show that in many parts of the world high twin and higher order multiple pregnancy rates still exist. Even in developed countries these problems persist depending on clinical practice, funding of health services, and patient demands. Perinatal and other outcomes are significantly worse with twins compared with singleton pregnancies and there is an urgent need to reduce multiple pregnancy rates to at least 10%. This has been achieved in several countries and clinics by introducing single embryo transfer but there are many barriers to the introduction of this technique in most clinics worldwide. We discuss the background to the high multiple rate in assisted reproduction and the factors that contribute to its persistence even in excellent clinics and in high-quality health services. Practices that may promote single embryo transfer are discussed. In the early years of in vitro fertilization, overall pregnancy rates were low, and it was considered necessary to transfer more than one embryo to increase the chances of pregnancy. It was not until advances in assisted reproductive technologies resulting in increased pregnancy rates that the concept of transferring just one embryo was considered possible. A consequence of improvements in implantation rates was also an increase in multiple pregnancies when more than one embryo was transferred. Although some countries have reduced the number of embryos transferred, international data show that in many parts of the world high twin and higher order multiple pregnancy rates still exist. Even in developed countries these problems persist depending on clinical practice, funding of health services, and patient demands. Perinatal and other outcomes are significantly worse with twins compared with singleton pregnancies and there is an urgent need to reduce multiple pregnancy rates to at least 10%. This has been achieved in several countries and clinics by introducing single embryo transfer but there are many barriers to the introduction of this technique in most clinics worldwide. We discuss the background to the high multiple rate in assisted reproduction and the factors that contribute to its persistence even in excellent clinics and in high-quality health services. Practices that may promote single embryo transfer are discussed. Discuss: You can discuss this article with its authors and other readers at https://www.fertstertdialog.com/posts/31344 Discuss: You can discuss this article with its authors and other readers at https://www.fertstertdialog.com/posts/31344 The birth of Louise Brown in 1978 resulted after 102 failed embryo transfers–a live birth rate (LBR) per cycle start of <1% (1Brindsen P. The Story of Patrick Steptoe, Robert Edwards, Jean Purdy and Bourn Hall Clinic.in: Kovacs G. Brinsden P. DeCherney A. The History of IVF. Cambridge University Press, Cambridge2019: 28-36Google Scholar). Since then, in vitro fertilization (IVF) has come a long way with LBRs globally in 2015 of 19.2% per oocyte retrieval with fresh embryo transfer and 24.8% with frozen embryo transfer (FET) (2Adamson GD, Dyer S, Chambers G, Ishihara O, Mansour R, Banker M, et al. for International Committee for Monitoring ART. International Committee for Monitoring Assisted Reproductive Technologies (ICMART) Preliminary World Report on ART, 2015. Session 40. O-144. European and global ART monitoring. ESHRE Annual Meeting, 2019.Google Scholar). In 2017 the cumulative LBR per intended oocyte retrieval following all embryo transfers for women younger than age 35 in the United States was 54.7% (3https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?reportingYear=2017Date accessed: August 13, 2020Google Scholar). This increased pregnancy rate resulted from many scientific, technological, and clinical advancements in assisted reproductive technology (ART) practice (4Niederberger C. Pellicer A. Cohen J. Gardner D.K. Palermo G.D. O'Neill C.L. et al.Forty years of IVF.Fertil Steril. 2018; 110: 185-324Abstract Full Text Full Text PDF PubMed Scopus (115) Google Scholar). However, the increased implantation rate associated with this significant progress resulted in an epidemic of multiple births associated with IVF, which in turn has led to poorer outcomes for mothers, babies, and society and challenged the dictum primum non nocere (5Practice Committee of the American Society for Reproductive MedicineMultiple gestation associated with infertility therapy: an American Society for Reproductive Medicine Practice Committee opinion.Fertil Steril. 2012; 97: 825-834Abstract Full Text Full Text PDF PubMed Scopus (156) Google Scholar, 6Adamson G.D. Baker V.L. Multiple births from assisted reproductive technologies: a challenge that must be met.Fertil Steril. 2004; 81: 517-522Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar, 7https://www.oxfordreference.com/view/10.1093/oi/authority.20110803100345841#:~:text=Quick%20Reference,its%20source%20is%20not%20knownDate accessed: August 15, 2020Google Scholar). In vitro fertilization practitioners should be compelled to ask the following questions: “Why do higher multiple rates occur with ART?”, “Why is there so much variability globally?”, and “What can we do about it?” Because all progress starts by examining the facts and telling the truth, it is constructive to review the global data on multiple birth and single embryo transfer (SET) rates to understand the available data with respect to multiple birth rates and SET and how we can learn from each other (8Sullivan D. https://resources.strategiccoach.com/the-multiplier-mindset-blog/dan-sullivan-s-best-career-advice-10-secrets-to-success-for-today-s-entrepreneurDate accessed: August 15, 2020Google Scholar). Importantly, data collected in registries globally do not allow for differentiation between elective SET (eSET) and obligatory SET so in this article SET refers to both (9www.icmartivf.orgDate accessed: August 19, 2020Google Scholar, 10Gerris J. de Sutter P. Racowsky C. Adamson G.D. Elective single embryo transfer. Cambridge Press, Cambridge2009Crossref Scopus (2) Google Scholar). We will address these questions by doing the following: reviewing the International Committee for Monitoring Assisted Reproductive Technologies (ICMART) global data on ART since the year 2000, and specifically multiple births; assessing changes in twin rates over time; identifying reasons for the wide variability in different countries and regions; noting reasons for increased ART twin birth rates compared with natural occurrence; evaluating the role of SET; considering how the optimal twin rate should be determined and who should decide; and recommending actions that can be taken now to reduce multiple rates in ART (11Adamson G.D. de Mouzon J. Lancaster P. Nygren K.G. Sullivan E. Zegers-Hochschild F. International Committee Monitoring Assisted Reproductive Technology World Collaborative Report on In Vitro Fertilization, 2000.Fertil Steril. 2006; 85: 1586-1622Abstract Full Text Full Text PDF PubMed Scopus (144) Google Scholar, 12de Mouzon J. Lancaster P. Nygren K. Sullivan E. Zegers-Hochschild F. Mansour R. et al.International Committee Monitoring Assisted Reproductive Technology World Collaborative Report on Assisted Reproductive Technology, 2002.Hum Reprod. 2009; 24: 2310-2320Crossref PubMed Scopus (132) Google Scholar, 13Nygren K.G. Sullivan E. Zegers-Hochschild F. Mansour R. Ishihara O. Adamson G.D. et al.International Committee for Monitoring Assisted Reproductive Technology (ICMART) World Report on Assisted Reproductive Technology, 2003.Fertil Steril. 2011; 95: 2209-2222Abstract Full Text Full Text PDF PubMed Scopus (88) Google Scholar, 14Sullivan E. Zegers-Hochschild F. Mansour R. Ishihara O. de Mouzon J. Nygren K.G. et al.International Committee for Monitoring Assisted Reproductive Technology (ICMART) World Report on Assisted Reproductive Technology, 2004.Hum Reprod. 2013; 28: 1375-1390Crossref PubMed Scopus (145) Google Scholar, 15Zegers-Hochschild F. Mansour R. Ishihara O. Adamson G.D. de Mouzon J. Nygren K.G. et al.International Committee for Monitoring Assisted Reproductive Technologies (ICMART) World Report on Assisted Reproductive Technology, 2005.Fertil Steril. 2014; 101: 366-378Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar, 16Mansour R. Ishihara O. Adamson G.D. de Mouzon J. Sullivan E. Zegers-Hochschild R. International Committee for Monitoring Assisted Reproductive Technology (ICMART) World Report on Assisted Reproductive Technology, 2006.Hum Reprod. 2014; 29: 1536-1551Crossref PubMed Scopus (103) Google Scholar, 17Ishihara O. Adamson G.D. de Mouzon J. Sullivan E. Zegers-Hochschild R. Mansour R. International Committee for Monitoring Assisted Reproductive Technologies: world report on assisted reproductive technologies, 2007.Fertil Steril. 2015; 103: 402-413Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar, 18Dyer S. Chambers G.M. de Mouzon J. Nygren K.G. Zegers-Hochschild F. Mansour R. et al.International Committee for Monitoring Assisted Reproductive Technologies world report: Assisted Reproductive Technology 2008, 2009 and 2010.Hum Reprod. 2016; 31: 1588-1609Crossref PubMed Scopus (285) Google Scholar, 19Adamson G.D. de Mouzon J. Chambers G. Zegers-Hochschild F. Mansour R. Ishihara O. et al.International Committee for Monitoring Assisted Reproductive Technology: world report on assisted reproductive technology, 2011.Fertil Steril. 2018; 110: 1067-1080Abstract Full Text Full Text PDF PubMed Scopus (179) Google Scholar, 20Mouzon J. Chambers G.M. Zegers-Hochschild F. Mansour R. Ishihara O. Banker M. et al.International Committee for Monitoring Assisted Reproductive Technologies. World Report: on Assisted Reproductive Technologies, 2012.Hum Reprod. 2020; 35: 1900-1913Crossref PubMed Scopus (54) Google Scholar). To simplify discussion, the focus will be primarily on twin multiple births because they are much more common and because triplet and higher order multiple rates will decrease if the twin rate decreases. This is not intended in any way to understate the greatly increased morbidity and mortality associated with higher order multiple pregnancy for both mothers and babies. Indisputable data confirm increased maternal, neonatal, and childhood morbidity and mortality in ART pregnancies, both singleton and multiple (21Palomba S. Homburg R. Santagni S. Battista La Sala G. Orvieto R. Risk of adverse pregnancy and perinatal outcomes after high technology infertility treatment: a comprehensive systematic review.Reprod Biol Endocrinol. 2016; 14: 76Crossref PubMed Scopus (53) Google Scholar, 22Multiple gestation pregnancy. The ESHRE Capri Workshop Group.Hum Reprod. 2000; 15: 1856-1864Crossref PubMed Google Scholar). This results in poorer clinical outcomes, more immediate cost to society and individuals, and increased lifetime costs and emotional distress for families and society. The issue of poorer outcomes after ART is complex because there are many confounding variables, including the following: population characteristics of those undergoing ART; impact of ART ovarian stimulation and clinical protocols; and influence of laboratory procedures manipulating gametes, embryo culture, and cryopreservation. However, the most important reason for poorer outcomes is the increased rate of multiple pregnancy with ART compared with non-ART pregnancies and that is the issue that will be addressed in this article. Natural and ART twin pregnancies have differences in outcomes also, although ART pregnancies are not always worse (23Andrijasevic S. Dotlic J. Aksam S. Micic J. Terzic M. Impact of conception method on twin pregnancy course and outcome.Geburtshilfe Frauenheilkd. 2014; 74: 933-939Crossref PubMed Scopus (16) Google Scholar, 24Baxi A. Kaushal M. Outcome of twin pregnancies conceived after assisted reproductive techniques.J Hum Reprod Sci. 2008; 1: 25-28Crossref PubMed Google Scholar). However, both have significantly poorer outcomes as multiples than singleton non-ART and ART pregnancies. Therefore, we maintain that lowering ART twin rates would benefit patients, professionals, and society. The major factor determining multiple pregnancy rate (MPR) in ART is the lack of eSET, defined as the transfer of one (a single) embryo selected from a larger cohort of available embryos (25Zegers F.Z. Adamson G.D. Dyer S. Racowsky C. de Mouzon J. Sokol R. et al.The International Glossary on Infertility and Fertility Care, 2017: Led by ICMART in Partnership with ASRM, ESHRE, IFFS, March of Dimes, AFS, GIERAF, ASPIRE, MEFS, REDLARA, FIGO.Fertil Steril. 2017; 108: 393-406Abstract Full Text Full Text PDF PubMed Scopus (443) Google Scholar). The clinical decision to perform eSET can be complex (26Glujovsky D. Sueldo C.E. Coscia A. Carvalho P. Lancuba S. Martinez G. et al.Physicians and patients' motivations to perform elective single or double-embryo transfers: a nationwide survey.Patient Educ Couns. 2018; 101: 945-950Crossref PubMed Scopus (3) Google Scholar). The ICMART has published reports in peer-reviewed journals since 2000 (11Adamson G.D. de Mouzon J. Lancaster P. Nygren K.G. Sullivan E. Zegers-Hochschild F. International Committee Monitoring Assisted Reproductive Technology World Collaborative Report on In Vitro Fertilization, 2000.Fertil Steril. 2006; 85: 1586-1622Abstract Full Text Full Text PDF PubMed Scopus (144) Google Scholar, 12de Mouzon J. Lancaster P. Nygren K. Sullivan E. Zegers-Hochschild F. Mansour R. et al.International Committee Monitoring Assisted Reproductive Technology World Collaborative Report on Assisted Reproductive Technology, 2002.Hum Reprod. 2009; 24: 2310-2320Crossref PubMed Scopus (132) Google Scholar, 13Nygren K.G. Sullivan E. Zegers-Hochschild F. Mansour R. Ishihara O. Adamson G.D. et al.International Committee for Monitoring Assisted Reproductive Technology (ICMART) World Report on Assisted Reproductive Technology, 2003.Fertil Steril. 2011; 95: 2209-2222Abstract Full Text Full Text PDF PubMed Scopus (88) Google Scholar, 14Sullivan E. Zegers-Hochschild F. Mansour R. Ishihara O. de Mouzon J. Nygren K.G. et al.International Committee for Monitoring Assisted Reproductive Technology (ICMART) World Report on Assisted Reproductive Technology, 2004.Hum Reprod. 2013; 28: 1375-1390Crossref PubMed Scopus (145) Google Scholar, 15Zegers-Hochschild F. Mansour R. Ishihara O. Adamson G.D. de Mouzon J. Nygren K.G. et al.International Committee for Monitoring Assisted Reproductive Technologies (ICMART) World Report on Assisted Reproductive Technology, 2005.Fertil Steril. 2014; 101: 366-378Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar, 16Mansour R. Ishihara O. Adamson G.D. de Mouzon J. Sullivan E. Zegers-Hochschild R. International Committee for Monitoring Assisted Reproductive Technology (ICMART) World Report on Assisted Reproductive Technology, 2006.Hum Reprod. 2014; 29: 1536-1551Crossref PubMed Scopus (103) Google Scholar, 17Ishihara O. Adamson G.D. de Mouzon J. Sullivan E. Zegers-Hochschild R. Mansour R. International Committee for Monitoring Assisted Reproductive Technologies: world report on assisted reproductive technologies, 2007.Fertil Steril. 2015; 103: 402-413Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar, 18Dyer S. Chambers G.M. de Mouzon J. Nygren K.G. Zegers-Hochschild F. Mansour R. et al.International Committee for Monitoring Assisted Reproductive Technologies world report: Assisted Reproductive Technology 2008, 2009 and 2010.Hum Reprod. 2016; 31: 1588-1609Crossref PubMed Scopus (285) Google Scholar, 19Adamson G.D. de Mouzon J. Chambers G. Zegers-Hochschild F. Mansour R. Ishihara O. et al.International Committee for Monitoring Assisted Reproductive Technology: world report on assisted reproductive technology, 2011.Fertil Steril. 2018; 110: 1067-1080Abstract Full Text Full Text PDF PubMed Scopus (179) Google Scholar, 20Mouzon J. Chambers G.M. Zegers-Hochschild F. Mansour R. Ishihara O. Banker M. et al.International Committee for Monitoring Assisted Reproductive Technologies. World Report: on Assisted Reproductive Technologies, 2012.Hum Reprod. 2020; 35: 1900-1913Crossref PubMed Scopus (54) Google Scholar). The last published reports were for 2011 and 2012. Manuscripts accepted for publication and in preparation for 2013 and 2014 and data collected by ICMART for 2015 and 2016 have similar findings (9www.icmartivf.orgDate accessed: August 19, 2020Google Scholar). There are wide variations in outcomes across the participating countries as reported to ICMART. The most important observations are the wide variation in LBRs per oocyte retrieval, twin delivery rate per delivery, SET rate per embryo transfer, and overall average number of embryos transferred (Table 1). With fresh embryo transfer, the delivery rate per oocyte retrieval was almost three times as high in the highest region compared with the lowest, the twin delivery rate almost four times higher, the SET rate over six times higher, and the average number of embryos transferred more than twice as high. For countries the differences were even greater. With FET the range of differences for similar metrics was also startling and similar in pattern to fresh embryo transfer (Table 2). However, although the delivery rate was 7% higher with FET compared with fresh transfers, the twin delivery rate was only 57% that of fresh transfers, the SET rate 64% higher, and the average number of embryos transferred was 17% lower. More recent data from the first registry report from China for 2016 showed a twin rate with IVF, intracytoplasmic sperm injection (ICSI), and FET of 27.9%, 27.2%, and 24.2%, respectively (27Bai F. Wang D.Y. Fan Y.J. Qiu J. Wang L. Dai Y. et al.Assisted reproductive technology service availability, efficacy and safety in mainland China: 2016.Hum Reprod. 2020; 35: 446-452Crossref PubMed Scopus (40) Google Scholar). For Latin America in 2017 the IVF/ICSI twin rate was 17.3% with a SET rate of 26.9%, and for FET the twin rate was 16.1% and the SET rate 38.1% (28Zegers-Hochschild F. Crosby J.A. Musri C. Masoli D. Posada N. on behalf of the Latin American Network of Assisted Reproduction. Assisted reproductive technology in Latin America: the Latin American Registry, 2017.RBMO. 2020; 41: 44-54Google Scholar). The highest twin rate from fresh nondonor IVF and ICSI with at least 100 embryo transfers was Taiwan at 35.4% and the lowest was Japan at 4.2%. For frozen nondonor with at least 100 embryo transfer cycles the highest twin rate was in Romania at 26.7% and the lowest was in Japan at 4.2%.Table 1Global delivery, twin and single embryo transfer rates, and number of embryos transferred for fresh nondonor in vitro fertilization and intracytoplasmic sperm injection cycles.Fresh nondonor IVF and ICSI cyclesDelivery rate/retrievalTwin deliveries/deliverySET/embryo transferAverage no. embryos transferred, nGlobal average20.019.631.41.91Region Asia11.116.749.71.78 Australia/New Zealand19.86.968.41.33 Europe20.618.527.51.90 Latin America23.121.113.92.22 Middle East27.825.310.62.59 Middle East (Israel)15.9NANANA North America32.326.718.92.21 Sub-Saharan Africa22.723.113.92.83Country HighestaOnly countries with >100 cycles included.59.435.474.83.15 LowestaOnly countries with >100 cycles included.7.94.26.11.25Note: Data is presented as percent, unless stated otherwise. Adapted from Adamson et al. ICMART World Report 2011 (19Adamson G.D. de Mouzon J. Chambers G. Zegers-Hochschild F. Mansour R. Ishihara O. et al.International Committee for Monitoring Assisted Reproductive Technology: world report on assisted reproductive technology, 2011.Fertil Steril. 2018; 110: 1067-1080Abstract Full Text Full Text PDF PubMed Scopus (179) Google Scholar). ICSI = intracytoplasmic sperm injection; IVF = in vitro fertilization; NA = not available; SET = single embryo transfer.a Only countries with >100 cycles included. Open table in a new tab Table 2Global delivery, twin and single embryo transfer rates, and number of embryos transferred for frozen embryo nondonor post-in vitro fertilization and intracytoplasmic sperm injection cycles.FET nondonor cyclesDelivery rate/embryo transferTwin deliveries/deliverySET/embryo transferAverage no. embryos transferred, nGlobal average21.411.151.61.59Region Asia24.05.069.81.39 Australia/New Zealand20.96.680.01.20 Europe15.912.737.91.72 Latin America23.617.814.82.18 Middle East14.518.510.92.59 Middle East (Israel)NANANANA North America32.921.132.51.86 Sub-Saharan Africa16.415.425.02.25Country HighestaOnly countries with >100 cycles included.35.226.789.02.74 LowestaOnly countries with >100 cycles included.5.64.25.41.11Note: Data is presented as percent, unless stated otherwise. Adapted from Adamson et al., ICMART World Report 2011 (19Adamson G.D. de Mouzon J. Chambers G. Zegers-Hochschild F. Mansour R. Ishihara O. et al.International Committee for Monitoring Assisted Reproductive Technology: world report on assisted reproductive technology, 2011.Fertil Steril. 2018; 110: 1067-1080Abstract Full Text Full Text PDF PubMed Scopus (179) Google Scholar). ICSI = intracytoplasmic sperm injection; IVF = in vitro fertilization; NA = not available; SET = single embryo transfer.a Only countries with >100 cycles included. Open table in a new tab Note: Data is presented as percent, unless stated otherwise. Adapted from Adamson et al. ICMART World Report 2011 (19Adamson G.D. de Mouzon J. Chambers G. Zegers-Hochschild F. Mansour R. Ishihara O. et al.International Committee for Monitoring Assisted Reproductive Technology: world report on assisted reproductive technology, 2011.Fertil Steril. 2018; 110: 1067-1080Abstract Full Text Full Text PDF PubMed Scopus (179) Google Scholar). ICSI = intracytoplasmic sperm injection; IVF = in vitro fertilization; NA = not available; SET = single embryo transfer. Note: Data is presented as percent, unless stated otherwise. Adapted from Adamson et al., ICMART World Report 2011 (19Adamson G.D. de Mouzon J. Chambers G. Zegers-Hochschild F. Mansour R. Ishihara O. et al.International Committee for Monitoring Assisted Reproductive Technology: world report on assisted reproductive technology, 2011.Fertil Steril. 2018; 110: 1067-1080Abstract Full Text Full Text PDF PubMed Scopus (179) Google Scholar). ICSI = intracytoplasmic sperm injection; IVF = in vitro fertilization; NA = not available; SET = single embryo transfer. A retrospective analysis of the accumulated ICMART world ART registry between 2003 and 2014 was presented using ICMART data at the virtual European Society of Human Reproduction and Embryology (ESHRE) meeting in 2020 (29Ishihara O, Zegers-Hochschild F, de Mouzon J, Dyer S, Mansour R, Banker M, et al. SET in a global perspective. Regional similarities and differences. ESHRE Annual Meeting (Virtual). O-158. 2020:i69.Google Scholar). From 2003 to 2014 the global MPR after fresh embryo transfer decreased from 26.8% to 16.7% and with FET from 17.8% to 10.3%. The global SET rate increased with fresh embryo transfer from 14.7% to 40.0% and for FET from 23.4% to 61.6%. These data, and ICMART data in the annual publications, demonstrate the strong correlation between MPR and SET (30https://www.icmartivf.org/reports-publications/Date accessed: August 20, 2020Google Scholar) (Figure 1). However, the data also show wide variations with some countries performing well at the beginning and throughout the time interval, others improving significantly, and some having high MPRs that did not change much during the period studied (30https://www.icmartivf.org/reports-publications/Date accessed: August 20, 2020Google Scholar) (Figure 1). Of note, global LBRs have remained stable over this interval in many countries but also have decreased in some countries that have moved to a large majority of SET cycles (11Adamson G.D. de Mouzon J. Lancaster P. Nygren K.G. Sullivan E. Zegers-Hochschild F. International Committee Monitoring Assisted Reproductive Technology World Collaborative Report on In Vitro Fertilization, 2000.Fertil Steril. 2006; 85: 1586-1622Abstract Full Text Full Text PDF PubMed Scopus (144) Google Scholar, 12de Mouzon J. Lancaster P. Nygren K. Sullivan E. Zegers-Hochschild F. Mansour R. et al.International Committee Monitoring Assisted Reproductive Technology World Collaborative Report on Assisted Reproductive Technology, 2002.Hum Reprod. 2009; 24: 2310-2320Crossref PubMed Scopus (132) Google Scholar, 13Nygren K.G. Sullivan E. Zegers-Hochschild F. Mansour R. Ishihara O. Adamson G.D. et al.International Committee for Monitoring Assisted Reproductive Technology (ICMART) World Report on Assisted Reproductive Technology, 2003.Fertil Steril. 2011; 95: 2209-2222Abstract Full Text Full Text PDF PubMed Scopus (88) Google Scholar, 14Sullivan E. Zegers-Hochschild F. Mansour R. Ishihara O. de Mouzon J. Nygren K.G. et al.International Committee for Monitoring Assisted Reproductive Technology (ICMART) World Report on Assisted Reproductive Technology, 2004.Hum Reprod. 2013; 28: 1375-1390Crossref PubMed Scopus (145) Google Scholar, 15Zegers-Hochschild F. Mansour R. Ishihara O. Adamson G.D. de Mouzon J. Nygren K.G. et al.International Committee for Monitoring Assisted Reproductive Technologies (ICMART) World Report on Assisted Reproductive Technology, 2005.Fertil Steril. 2014; 101: 366-378Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar, 16Mansour R. Ishihara O. Adamson G.D. de Mouzon J. Sullivan E. Zegers-Hochschild R. International Committee for Monitoring Assisted Reproductive Technology (ICMART) World Report on Assisted Reproductive Technology, 2006.Hum Reprod. 2014; 29: 1536-1551Crossref PubMed Scopus (103) Google Scholar, 17Ishihara O. Adamson G.D. de Mouzon J. Sullivan E. Zegers-Hochschild R. Mansour R. International Committee for Monitoring Assisted Reproductive Technologies: world report on assisted reproductive technologies, 2007.Fertil Steril. 2015; 103: 402-413Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar, 18Dyer S. Chambers G.M. de Mouzon J. Nygren K.G. Zegers-Hochschild F. Mansour R. et al.International Committee for Monitoring Assisted Reproductive Technologies world report: Assisted Reproductive Technology 2008, 2009 and 2010.Hum Reprod. 2016; 31: 1588-1609Crossref PubMed Scopus (285) Google Scholar, 19Adamson G.D. de Mouzon J. Chambers G. Zegers-Hochschild F. Mansour R. Ishihara O. et al.International Committee for Monitoring Assisted Reproductive Technology: world report on assisted reproductive technology, 2011.Fertil Steril. 2018; 110: 1067-1080Abstract Full Text Full Text PDF PubMed Scopus (179) Google Scholar, 20Mouzon J. Chambers G.M. Zegers-Hochschild F. Mansour R. Ishihara O. Banker M. et al.International Committee for Monitoring Assisted Reproductive Technologies. World Report: on Assisted Reproductive Technologies, 2012.Hum Reprod. 2020; 35: 1900-1913Crossref PubMed Scopus (54) Google Scholar). The ICMART reports LBR per fresh nondonor IVF and ICSI cycle with an egg retrieval only for cycles in which an embryo transfer is performed. Cycles in which all embryos are frozen are not included in the calculation, so the reduction in global LBR per egg retrieval is likely a real trend. However, it must be noted that this likely is due to transfer of fewer fresh embryos, which, of course, means more embryos are available for subsequent FET. Therefore, the small decrease in LBRs from fresh transfers does not mean that the cumulative LBR is decreasing. Indeed, although more recent data are needed to analyze current trends, it is likely that cumulative LBRs are steady or increasing while twin delivery rates are decreasing. Multiple birth following ART is primarily the result of transfer of more than one embryo, emphasizing the ideal of moving to a SET every time regardless of embryo quality and maternal age (31Kamath M.S. Mascarenhas M. Kirubakaran R. Bhattacharya S. Number of embryos for transfer following in vitro fertilisation or intra-cytoplasmic sperm injection.Cochrane Database of Systematic Reviews. 2020; (Accessed August 21, 2020)CD003416PubMed Google Scholar). However, numerous factors affect the decision regarding the use of eSET and why this ideal is far from being achieved. Female age is the most important demographic factor determining the number of embryos transferred because of the rapidly reducing pregnancy rates with oocytes from older women (32McLernon D.J. Steyerberg E.W. te Velde E.R. Lee A.J. Bhattacharya S. Predicting the chances of a live birth after one or more complete cycles of in vitro fertilisation: population based study of linked cycle data from 113 873 women.BMJ. 2016; 355: i5735Crossref PubMed Scopus (0) Google Scholar, 33American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and The Practice Committee of the American Society for Reproductive MedicineFemale age-related fertility decline.Fertil Steril. 2014; 101: 633-634Abstract Full Text Full Text PDF PubMed Scopus (230) Google Scholar). There is also the time pressure on older women to have their family and multiples are often initially welcomed as a way to complete rapidly a family in the shortest time. A longer duration of infertility and previous unsuccessful cycles increase the number of embryos transfe" @default.
• W3091215603 created "2020-10-08" @default.
• W3091215603 creator A5030764643 @default.
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• W3091215603 date "2020-10-01" @default.
• W3091215603 modified "2023-10-14" @default.
• W3091215603 title "Why are multiple pregnancy rates and single embryo transfer rates so different globally, and what do we do about it?" @default.
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• W3091215603 doi "https://doi.org/10.1016/j.fertnstert.2020.09.003" @default.
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