Multiple Births Following Fertility Treatment: Causes, Consequences, and Opportunities for Change

Hastings Center Investigators: Josephine Johnston and Michael K. Gusmano

Co-Investigator: Pasquale Patrizio, director, Yale Fertility Center

Funder: March of Dimes

Since 1980, the number of twin births in the United States has increased 76 percent and the number of triples or higher-order multiples has increased over 400 percent. Two kinds of fertility treatment are the leading causes of increased rates of multiple births in the U.S., accounting for 40 percent of them each year: controlled ovarian stimulation (COS), in which a woman receives medicine that stimulates the production of eggs, and in vitro fertilization (IVF). Multiple gestations are associated with increases in a variety of risks to the health of mothers and babies, including pregnancy complications, miscarriage, preterm delivery, infant death, and lifelong neurological and other impairments. They are also linked to increased medical costs during pregnancy, birth, and beyond.

While higher order multiple births are considered a suboptimal outcome of fertility medicine, there is disagreement about what can and should be come to reduce the incidence of multiple births following fertility treatment, especially where those changes would result in lower pregnancy rates per treatment cycle. This project conducted an investigation into these issues, including a two-day workshop with leading clinicians, professional association leaders, patient advocates, and insurance industry representative. It sought to understand the reasons for multiple births following fertility treatment and the reasons for the underlying debate. It also sought to identify and assess clinical and policy interventions that could lower the multiple births rates in this context. Outcomes of the project included the following publications: