Single embryo transfer reduces the risk of perinatal mortality, a population study

Sullivan, EA; Wang, YA; Hayward, I; Chambers, GM; Illingworth, P; McBain, J; Norman, RJ

Single embryo transfer reduces the risk of perinatal mortality, a population study

Sullivan, EA

Wang, YA

Hayward, I Chambers, GM Illingworth, P McBain, J Norman, RJ

Permalink

Publication Type:: Journal Article
Citation:: Human Reproduction, 2012, 27 (12), pp. 3609 - 3615
Issue Date:: 2012-01-01

Closed Access

	Filename	Description	Size
	2013003107OK.pdf		164.39 kB	Adobe PDF	View/Open

Copyright Clearance Process

Recently Added
In Progress
Closed Access

This item is closed access and not available.

Full metadata record

Field	Value	Language
dc.contributor.author	Sullivan, EA https://orcid.org/0000-0002-8718-2753	en_US
dc.contributor.author	Wang, YA https://orcid.org/0000-0002-3656-4284	en_US
dc.contributor.author	Hayward, I	en_US
dc.contributor.author	Chambers, GM	en_US
dc.contributor.author	Illingworth, P	en_US
dc.contributor.author	McBain, J	en_US
dc.contributor.author	Norman, RJ	en_US
dc.date.issued	2012-01-01	en_US
dc.identifier.citation	Human Reproduction, 2012, 27 (12), pp. 3609 - 3615	en_US
dc.identifier.issn	0268-1161	en_US
dc.identifier.uri	http://hdl.handle.net/10453/29628
dc.description.abstract	STUDY QUESTIONDo births following single embryo transfers (SET) have a reduced risk of perinatal mortality compared with those following double embryo transfers (DET)?SUMMARY ANSWERSET is associated with reduced risk of perinatal mortality compared with DET. WHAT IS KNOWN ALREADYFetal, neonatal and perinatal mortality are important indicators for monitoring pregnancy and childbirth, particularly for births following assisted reproductive technology (ART) treatments. Following the introduction of SET, there has been a decline in the perinatal mortality rate (PMR) among babies born after ART in Australia and New Zealand. STUDY DESIGN, SIZE, DURATIONThis population study (census) included 50 258 births of <20 weeks gestation and/or <400 g of birthweight following embryos transfer cycles in Australia and New Zealand during the period 2004-2008. PARTICIPANTS/MATERIALS, SETTING, METHODSThe PMR was calculated according to the number of embryos transferred and other demographic and treatment-related factors. Perinatal deaths were defined as the number of fetal deaths (stillbirths) plus the number of neonatal deaths (deaths that occur before 28 days after birth). MAIN RESULTS AND THE ROLE OF CHANCEThe PMR was 16. 2 per 1000 births (n=813). Of the 813 perinatal deaths, 630 were fetal deaths and 183 neonatal deaths. Twins had a significantly higher PMR (27. 8 per 1000 births) than singletons (12. 4 per 1000 births). The risk of perinatal mortality for all births following DET was 53 higher than for all births following SET (adjusted risk ratio 1. 53, 95 confidence interval (95 CI): 1. 29-1. 80). Births following fresh DET had a 58 increased risk of perinatal mortality compared with births following fresh SET (risk ratio 1. 58, 95 CI: 1. 32-1. 90). LIMITATIONS, REASONS FOR CAUTIONInformation on outcomes was missing from <1 of clinical pregnancies recorded in Australian and New Zealand Assisted Reproduction Database for the study period. There are no data on the timing of fetal death, the cause of perinatal death or on late termination of pregnancy at <20 weeks' gestation. WIDER IMPLICATIONS OF THE FINDINGSDouble and higher order embryo transfer is associated with a higher risk of perinatal mortality when compared with SET. The number of embryos transferred is determined by the clinician with consent of the patient and is a modifiable treatment factor. SET should be advocated as the first-line management in ART as it is the single most effective public health intervention for preventing excess perinatal mortality among ART pregnancies. STUDY FUNDING/COMPETING INTEREST(S)Nil. © 2012 The Author.	en_US
dc.relation.ispartof	Human Reproduction	en_US
dc.relation.isbasedon	10.1093/humrep/des315	en_US
dc.subject.classification	Obstetrics & Reproductive Medicine	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Fetal Death	en_US
dc.subject.mesh	Embryo Transfer	en_US
dc.subject.mesh	Infant Mortality	en_US
dc.subject.mesh	Pregnancy	en_US
dc.subject.mesh	Pregnancy, Multiple	en_US
dc.subject.mesh	Twins	en_US
dc.subject.mesh	Twins, Dizygotic	en_US
dc.subject.mesh	Twins, Monozygotic	en_US
dc.subject.mesh	Adult	en_US
dc.subject.mesh	Infant, Newborn	en_US
dc.subject.mesh	Australia	en_US
dc.subject.mesh	New Zealand	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Perinatal Mortality	en_US
dc.subject.mesh	Single Embryo Transfer	en_US
dc.title	Single embryo transfer reduces the risk of perinatal mortality, a population study	en_US
dc.type	Journal Article
utslib.citation.volume	12	en_US
utslib.citation.volume	27	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	11 Medical and Health Sciences	en_US
utslib.for	16 Studies in Human Society	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Public Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
utslib.copyright.status	closed_access
pubs.issue	12	en_US
pubs.publication-status	Published	en_US
pubs.volume	27	en_US

Abstract:

STUDY QUESTIONDo births following single embryo transfers (SET) have a reduced risk of perinatal mortality compared with those following double embryo transfers (DET)?SUMMARY ANSWERSET is associated with reduced risk of perinatal mortality compared with DET. WHAT IS KNOWN ALREADYFetal, neonatal and perinatal mortality are important indicators for monitoring pregnancy and childbirth, particularly for births following assisted reproductive technology (ART) treatments. Following the introduction of SET, there has been a decline in the perinatal mortality rate (PMR) among babies born after ART in Australia and New Zealand. STUDY DESIGN, SIZE, DURATIONThis population study (census) included 50 258 births of <20 weeks gestation and/or <400 g of birthweight following embryos transfer cycles in Australia and New Zealand during the period 2004-2008. PARTICIPANTS/MATERIALS, SETTING, METHODSThe PMR was calculated according to the number of embryos transferred and other demographic and treatment-related factors. Perinatal deaths were defined as the number of fetal deaths (stillbirths) plus the number of neonatal deaths (deaths that occur before 28 days after birth). MAIN RESULTS AND THE ROLE OF CHANCEThe PMR was 16. 2 per 1000 births (n=813). Of the 813 perinatal deaths, 630 were fetal deaths and 183 neonatal deaths. Twins had a significantly higher PMR (27. 8 per 1000 births) than singletons (12. 4 per 1000 births). The risk of perinatal mortality for all births following DET was 53 higher than for all births following SET (adjusted risk ratio 1. 53, 95 confidence interval (95 CI): 1. 29-1. 80). Births following fresh DET had a 58 increased risk of perinatal mortality compared with births following fresh SET (risk ratio 1. 58, 95 CI: 1. 32-1. 90). LIMITATIONS, REASONS FOR CAUTIONInformation on outcomes was missing from <1 of clinical pregnancies recorded in Australian and New Zealand Assisted Reproduction Database for the study period. There are no data on the timing of fetal death, the cause of perinatal death or on late termination of pregnancy at <20 weeks' gestation. WIDER IMPLICATIONS OF THE FINDINGSDouble and higher order embryo transfer is associated with a higher risk of perinatal mortality when compared with SET. The number of embryos transferred is determined by the clinician with consent of the patient and is a modifiable treatment factor. SET should be advocated as the first-line management in ART as it is the single most effective public health intervention for preventing excess perinatal mortality among ART pregnancies. STUDY FUNDING/COMPETING INTEREST(S)Nil. © 2012 The Author.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/29628