Estimation of the contribution of non-assisted reproductive technology ovulation stimulation fertility treatments to US singleton and multiple births

Am J Epidemiol. 2009 Dec 1;170(11):1396-407. doi: 10.1093/aje/kwp281. Epub 2009 Oct 23.

Abstract

Infertility treatments that include ovulation stimulation, both assisted reproductive technologies (ARTs) and non-ART ovulation stimulation, are associated with increased risks of multiple birth and concomitant sequelae and adverse outcomes, even among singletons. While a US surveillance system for ART-induced births is ongoing, no population-based tracking system exists for births resulting from non-ART treatments. The authors developed a multistage model to estimate the uncertain proportion of US infants born in 2005 who were conceived by using non-ART ovulation treatments. Using published surveillance data, they estimated proportions of US multiple births conceived naturally and by ART and assumed that the remainder were conceived with non-ART treatments. They used Bayesian meta-analyses to summarize published clinical studies on the multiple-gestation risk associated with non-ART ovulation treatments, applied a fetal survival factor, and used this multiple-birth risk estimate and their own estimate of the proportion of US multiple births attributable to non-ART ovulation stimulation to estimate the total (and, through subtraction, singleton) proportion of infants conceived with such treatments. On the basis of the model, the authors estimate that 4.6% of US infants born in 2005 (95% uncertainty range: 2.8%-7.1%) resulted from non-ART ovulation treatments. Notably, this figure is 4 times greater than the ART contribution.

MeSH terms

  • Bayes Theorem
  • Female
  • Fertility Agents, Female / adverse effects
  • Fertility Agents, Female / therapeutic use
  • Humans
  • Monte Carlo Method
  • Multiple Birth Offspring / statistics & numerical data*
  • Ovulation Induction / adverse effects
  • Ovulation Induction / statistics & numerical data*
  • Population Surveillance
  • Pregnancy
  • Reproductive Techniques, Assisted / statistics & numerical data
  • United States / epidemiology

Substances

  • Fertility Agents, Female