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Fertil Steril. 2013 Feb;99(2):393-9. doi: 10.1016/j.fertnstert.2012.10.018. Epub 2012 Nov 8.

The cumulative probability of liveborn multiples after in vitro fertilization: a cohort study of more than 10,000 women.

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1
Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. bethmalizia@gmail.com

Abstract

OBJECTIVE:

To estimate the cumulative probability of liveborn multiples after IVF to improve patient counseling regarding this significant morbidity.

DESIGN:

Retrospective cohort study.

SETTING:

Large academic-affiliated infertility practice.

PATIENT(S):

A total of 10,169 women were followed from their first fresh, nondonor IVF cycle through up to six fresh and frozen IVF cycles from 2000-2010.

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Delivery of a liveborn infant(s).

RESULT(S):

After three IVF cycles the cumulative live birth rate (CLBR) was 53.2%. The singleton, twin, and triplet CLBRs were 38.0%, 14.5%, and 0.7%. After six IVF cycles the CLBR was 73.8%, with 52.8%, 19.8%, 1.3% for singletons, twins, and triplets. Of the 5,433 live births, 71.4% were singletons, 27.1% were twins, and 1.5% were triplets. Women more than 39 years had the lowest incidence of liveborn multiples with CLBRs of 5.2% after three cycles and 9.5% after six cycles. The twin CLBR doubled from cycles 1 through 3 with the rate of increase slowing from cycles 3 through 6. Although very low in absolute terms, the triplet CLBR also doubled from cycles 1 through 3 and doubled again from cycles 3 through 6. Of the 1,970 pregnancies that began as multifetal on ultrasound, 77.4% resulted in liveborn multiples.

CONCLUSION(S):

Providers should be aware of the cumulative probability of liveborn multiples to effectively counsel patients on this important issue. With nearly three-quarters of all women having live birth after up to six IVF cycles, it is encouraging to report a low incidence of liveborn multiples.

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