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Use of outcomes-based data in reducing high-order multiple pregnancies: the role of age, diagnosis, and embryo score.
Fertil Steril. 2004 Jun; 81(6):1534-41.FS

Abstract

OBJECTIVE

To identify high-risk categories for high-order multiple pregnancy (HMP) in in vitro fertilization (IVF), establish clinic-specific HMP risk data for counseling use, and verify their utility in reducing HMP.

DESIGN

Before and after intervention study.

SETTING

Two IVF programs using the same embryology laboratory and IVF protocols.

PATIENT(S)

All IVF patients undergoing fresh embryo transfers.

INTERVENTION(S)

Use of clinic-specific age, diagnosis, and embryo score (ES) risk data in assessing individual HMP risk during informed consent.

MAIN OUTCOME MEASURE(S)

HMP and pregnancy outcomes.

RESULT(S)

In determining clinic-specific high risk categories and developing outcomes-based HMP risk data for counseling, the good outcome rate (GR) was defined as the percentage of singleton or twin deliveries per cycle and the bad outcome rate included no pregnancy or nondelivered pregnancies (miscarriages, multifetal reduction) and HMP per cycle. During 1995 to 1999, age <35 years, calculated morphologic ES, and donor egg (DE) cycles were factors shown by logistic regression to statistically significantly affect the GR. The optimal GRs for DE <35 and >or=35 years (donor age), and non-DE cycles <35 years were achieved with two (57.7%), three (43.2%), and three (43.2%) embryos transferred, respectively. A DE <35 years with >or=3 embryos transferred had the highest risk for HMP. The GR correlated (0.91) with the ES according to the formula: GR = 3.3 + 2.0 ES, when ES range was between 4 and 26. Clinic-specific risks for HMP based on age, diagnosis, and ES were developed and considered while counseling for ET during 2004. The clinic-specific HMP risk data made for a reduction in the HMP rate of 90.9% for DE-IVF (11.8% to 1%) and 53.8% for all IVF (9.1% to 4.2%), without decreases in clinical pregnancy or delivery rates. Physicians showing the greatest decline (64%) in HMP had no reduction in pregnancy or delivery rates.

CONCLUSION(S)

The use of clinic-specific HMP risk data in counseling based on age, diagnosis, and ES provided a 53% to 64% reduction in HMP without affecting rates of pregnancy or delivery. The clinic-specific ES system correlated closely with good outcomes. A standardized ES system may provide useful information for counseling during ET informed consent.

Authors+Show Affiliations

Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA. c.matthew.peterson@hsc.utah.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

15193473

Citation

Peterson, C Matthew, et al. "Use of Outcomes-based Data in Reducing High-order Multiple Pregnancies: the Role of Age, Diagnosis, and Embryo Score." Fertility and Sterility, vol. 81, no. 6, 2004, pp. 1534-41.
Peterson CM, Reading JC, Hatasaka HH, et al. Use of outcomes-based data in reducing high-order multiple pregnancies: the role of age, diagnosis, and embryo score. Fertil Steril. 2004;81(6):1534-41.
Peterson, C. M., Reading, J. C., Hatasaka, H. H., Parker Jones, K., Udoff, L. C., Adashi, E. Y., Kuneck, P. H., Erickson, L. D., Malo, J. W., Campbell, B. F., & Carrell, D. T. (2004). Use of outcomes-based data in reducing high-order multiple pregnancies: the role of age, diagnosis, and embryo score. Fertility and Sterility, 81(6), 1534-41.
Peterson CM, et al. Use of Outcomes-based Data in Reducing High-order Multiple Pregnancies: the Role of Age, Diagnosis, and Embryo Score. Fertil Steril. 2004;81(6):1534-41. PubMed PMID: 15193473.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of outcomes-based data in reducing high-order multiple pregnancies: the role of age, diagnosis, and embryo score. AU - Peterson,C Matthew, AU - Reading,James C, AU - Hatasaka,Harry H, AU - Parker Jones,Kirtly, AU - Udoff,Laurence C, AU - Adashi,Eli Y, AU - Kuneck,Paul H, AU - Erickson,Lisa D, AU - Malo,John W, AU - Campbell,Bruce F, AU - Carrell,Douglas T, PY - 2003/03/20/received PY - 2004/01/07/revised PY - 2004/01/07/accepted PY - 2004/6/15/pubmed PY - 2004/7/15/medline PY - 2004/6/15/entrez SP - 1534 EP - 41 JF - Fertility and sterility JO - Fertil. Steril. VL - 81 IS - 6 N2 - OBJECTIVE: To identify high-risk categories for high-order multiple pregnancy (HMP) in in vitro fertilization (IVF), establish clinic-specific HMP risk data for counseling use, and verify their utility in reducing HMP. DESIGN: Before and after intervention study. SETTING: Two IVF programs using the same embryology laboratory and IVF protocols. PATIENT(S): All IVF patients undergoing fresh embryo transfers. INTERVENTION(S): Use of clinic-specific age, diagnosis, and embryo score (ES) risk data in assessing individual HMP risk during informed consent. MAIN OUTCOME MEASURE(S): HMP and pregnancy outcomes. RESULT(S): In determining clinic-specific high risk categories and developing outcomes-based HMP risk data for counseling, the good outcome rate (GR) was defined as the percentage of singleton or twin deliveries per cycle and the bad outcome rate included no pregnancy or nondelivered pregnancies (miscarriages, multifetal reduction) and HMP per cycle. During 1995 to 1999, age <35 years, calculated morphologic ES, and donor egg (DE) cycles were factors shown by logistic regression to statistically significantly affect the GR. The optimal GRs for DE <35 and >or=35 years (donor age), and non-DE cycles <35 years were achieved with two (57.7%), three (43.2%), and three (43.2%) embryos transferred, respectively. A DE <35 years with >or=3 embryos transferred had the highest risk for HMP. The GR correlated (0.91) with the ES according to the formula: GR = 3.3 + 2.0 ES, when ES range was between 4 and 26. Clinic-specific risks for HMP based on age, diagnosis, and ES were developed and considered while counseling for ET during 2004. The clinic-specific HMP risk data made for a reduction in the HMP rate of 90.9% for DE-IVF (11.8% to 1%) and 53.8% for all IVF (9.1% to 4.2%), without decreases in clinical pregnancy or delivery rates. Physicians showing the greatest decline (64%) in HMP had no reduction in pregnancy or delivery rates. CONCLUSION(S): The use of clinic-specific HMP risk data in counseling based on age, diagnosis, and ES provided a 53% to 64% reduction in HMP without affecting rates of pregnancy or delivery. The clinic-specific ES system correlated closely with good outcomes. A standardized ES system may provide useful information for counseling during ET informed consent. SN - 0015-0282 UR - https://www.unboundmedicine.com/medline/citation/15193473/Use_of_outcomes_based_data_in_reducing_high_order_multiple_pregnancies:_the_role_of_age_diagnosis_and_embryo_score_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0015028204003449 DB - PRIME DP - Unbound Medicine ER -