American Journal of Epidemiology Advance Access published online on October 23, 2009
American Journal of Epidemiology, doi:10.1093/aje/kwp281
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Original Contribution |
Estimation of the Contribution of Non–Assisted Reproductive Technology Ovulation Stimulation Fertility Treatments to US Singleton and Multiple Births
* Correspondence to Dr. Laura A. Schieve, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, MS E-86, 1600 Clifton Road, Atlanta, GA 30333 (e-mail: lschieve{at}cdc.gov).
Received for publication April 29, 2009. Accepted for publication August 10, 2009.
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.
birth rate; infertility; meta-analysis; Monte Carlo method; ovulation induction
Abbreviations: ART, assisted reproductive technology; NASS, National ART Surveillance System; triplet/+, triplet or higher order