Details:

Alternative Title:
MMWR Surveill Summ
Publisher's site:
http://dx.doi.org/10.15585/mmwr.ss6909a1
Personal Author:
Sunderam, Saswati ; Kissin, Dmitry M. ; Zhang, Yujia ; Jewett, Amy ; Boulet, Sheree L. ; ... More +
Sunderam, Saswati ; Kissin, Dmitry M. ; Zhang, Yujia ; Jewett, Amy ; Boulet, Sheree L. ; Warner, Lee ; Kroelinger, Charlan D. ; Barfield, Wanda D. Less -
Corporate Authors:
National Center for Chronic Disease Prevention and Health Promotion (U.S.). Division of Reproductive Health. ; Emory University School of Medicine.
National Center for Chronic Disease Prevention and Health Promotion (U.S.). Division of Reproductive Health. ; Emory University School of Medicine. Less -
Description:
Problem/Condition

Since the first U.S. infant conceived with assisted reproductive technology (ART) was born in 1981, both the use of ART and the number of fertility clinics providing ART services have increased steadily in the United States. ART includes fertility treatments in which eggs or embryos are handled in the laboratory (i.e., in vitro fertilization [IVF] and related procedures). Although the majority of infants conceived through ART are singletons, women who undergo ART procedures are more likely than women who conceive naturally to have multiple-birth infants because multiple embryos may be transferred. Multiple births can pose substantial risks for both mothers and infants, including obstetric complications, preterm birth (<37 weeks), and low birthweight (<2,500 g). This report provides state-specific information for the United States (including the District of Columbia and Puerto Rico) on ART procedures performed in 2017 and compares birth outcomes that occurred in 2017 (resulting from ART procedures performed in 2016 and 2017) with outcomes for all infants born in the United States in 2017.

Period Covered

2017.

Description of System

In 1995, CDC began collecting data on ART procedures performed in fertility clinics in the United States as mandated by the Fertility Clinic Success Rate and Certification Act of 1992 (Public Law 102–493 [October 24, 1992]). Data are collected through the National ART Surveillance System (NASS), a web-based data collection system developed by CDC. This report includes data from the 50 states, the District of Columbia, and Puerto Rico.

Results

In 2017, a total of 196,454 ART procedures (range: 162 in Alaska to 24,179 in California) with at least one embryo transferred were performed in 448 U.S. fertility clinics and reported to CDC. These procedures resulted in 68,908 live-birth deliveries (range: 67 in Puerto Rico to 8,852 in California) and 78,052 infants born (range: 85 in Puerto Rico to 9,926 in California). Nationally, the number of ART procedures performed per 1 million women of reproductive age (15–44 years) was 3,040. ART use rates exceeded the national rate in 14 states (Connecticut, Delaware, District of Columbia, Hawaii, Illinois, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island, Utah, Vermont, and Virginia). ART use exceeded 1.5 times the national rate in seven states (Connecticut, the District of Columbia, Illinois, Maryland, Massachusetts, New Jersey, and New York).

Interpretation

Although singleton infants accounted for the majority of ART-conceived infants, multiple births from ART still contributed to a substantial proportion of all twins, triplets, and higher-order infants born in the United States. Variations in SET rates among states and territories were noted, reflecting variations in embryo-transfer practices among fertility clinics, which might in part account for higher multiple birth from ART observed in some states and territories.

Public Health Action

Reducing the number of embryos transferred and increasing use of SET, when clinically appropriate, can help reduce multiple births and related adverse health consequences for both mothers and infants. Because infants from multiple births are at increased risk for numerous adverse sequelae that cannot be ascertained from the data collected through NASS alone, long-term follow-up for ART infants through integration of existing maternal and infant health surveillance systems and registries with data available from NASS might be useful for monitoring adverse outcomes on a population basis.


Subject:
[+]
Adolescent
Adult
Female
Humans
Infant, Low Birth Weight
Infant, Newborn
Infant, Premature
Population Surveillance
Pregnancy
Pregnancy, Multiple
Pregnancy Outcome
Premature Birth
Reproductive Techniques, Assisted
Young Adult

Source:
MMWR Surveill Summ. 69(9):1-20
Series:
MMWR. Surveillance summaries : Morbidity and mortality weekly report. Surveillance summaries ; v. 69, no. 9
Pubmed ID:
33332294
Pubmed Central ID:
PMC7755269
Document Type:
Journal Issue
Place as Subject:
United States
Collection(s):
Morbidity and Mortality Weekly Report (MMWR)
Main Document Checksum:
[+]
urn:sha256:df9be27d604e9d37228a7d38b08b2b064cca4d8bb90300df5704c1afa263e596
File Type:

Supporting Files

• 	ss6909a1-F1.gif	gif
  	ss6909a1-F1.jpg	jpeg
  	ss6909a1-F2.gif	gif
  	ss6909a1-F2.jpg	jpeg
  	ss6909a1-F3.gif	gif
  	ss6909a1-F3.jpg	jpeg
  	ss6909a1.nxml	xml

More +