Maternal and Child Health Journal

, Volume 11, Issue 3, pp 219–225 | Cite as

Policy Efforts to Prevent ART-Related Preterm Birth

  • Blair Johnson
  • Wendy Chavkin
Original Paper


At 12.5%, the preterm birth rate is the highest it has ever been in the US. In tandem with the rise in preterm birth is a dramatic increase in multiple birth rates. The recent trend of delayed maternal age at first birth and the associated use of assisted reproductive technologies (ARTs) have led to the increase in multiple gestation and its attendant increased risk for preterm birth. While ARTs are not responsible for the majority of preterm births, the attributable fraction has increased, is iatrogenic- and preventable. Despite widespread recognition of this problem, the rate of associated twin gestation has not decreased. We offer options for policymakers on several levels—from medical to health systems to societal policy—to decrease ART-related preterm births.


Preterm birth Prematurity Policy Assisted reproduction 



We acknowledge the Institute of Medicine’s Committee on Preterm Birth, the New Century Scholar’s Program of the Fulbright Commission, the Soros Reproductive Rights Fellowship Program of the Open Society Institute and the Hewlett Foundation for their support. The opinions are those of the authors alone.


  1. 1.
    Martin JA, Hamilton BE, Menacker F, Sutton PD, Matthews TJ. Preliminary births for 2004: infant and maternal health. Health E-stats. Hyattsville, MD: National Center for Health Statistics. Released November 15, 2005.Google Scholar
  2. 2.
    Healthy People. 2010. Summary of Objectives. Section 16: Maternal, Infant and Child Health. Available online at Scholar
  3. 3.
    Kochanek KD, Martin JA. Supplemental analyses of recent trends in infant mortality. Health E- stats. Hyattsville, MD: National Center for Health Statistics. Last updated February 8, 2005.Google Scholar
  4. 4.
    Bulatao RC, ed. Global fertility transition. Supplement to Population and Development Review. 2001. Population Council: New York.Google Scholar
  5. 5.
    Lochhead C. The trend toward delayed first childbirth: health and social implications. Isuma 2000;1(2):41–4.Google Scholar
  6. 6.
    US Census 2000. Data available online at Scholar
  7. 7.
    Hamilton BE, Martin JA, Ventura SJ, Sutton PD, Menacker F. Births: Preliminary data for 2004. National Vital Statistics Report 2005;54(8).Google Scholar
  8. 8.
    Frank OB, Campana A. The end of fertility: age, fecundity, and fecundibility in women. Journal of Biosocial Science 1994;26(3):349–68.PubMedCrossRefGoogle Scholar
  9. 9.
    Dunson DC, Baird DD. Changes with age in the level and duration of fertility in the menstrual cycle. Human Reproduction 2002;17(5):1399–403.PubMedCrossRefGoogle Scholar
  10. 10.
    2003: Assisted Reproductive Technology Success Rates. Jointly published Centers for Disease Control and Prevention and American Society for Reproductive Medicine; 2005.Google Scholar
  11. 11.
    Wright VC, Chang, J, Jeng G, Macaluso M. Assisted reproductive technology surveillance—United States, 2003. Morbidity and Mortality Weekly Report 2006;55(SS04):1–22.Google Scholar
  12. 12.
    Reynolds MA, Schieve LA, Martin JA, et al. Trends in multiple births conceived using assisted reproductive technology, United States, 1997–2000. Pediatrics 2003;111(5):1159–66.PubMedGoogle Scholar
  13. 13.
    Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Munson ML. Births: Final data for 2003. National Vital Statistics Reports 2005;54(2):1–116.Google Scholar
  14. 14.
    Fauser BC, Devroey P, Macklon NS. Multiple birth resulting from ovarian stimulation for subfertility treatment. Lancet 2005;365(9473):1807–16.PubMedCrossRefGoogle Scholar
  15. 15.
    Martin JA, Hamilton BE, Ventura SJ, Menacker F, Park MM, Sutton PD. Births: Final data for 2001. National Vital Statistics Reports 2002;51(2):1–102.PubMedGoogle Scholar
  16. 16.
    Jackson RA, Gibson KA, Wu YW, Croughan MS. Perinatal outcomes in singletons following in vitro fertilization: a meta-analysis. Obstetrics and Gynecology 2004;103(3):551–63.PubMedGoogle Scholar
  17. 17.
    Manoura A, Korakaki E, Hatzidaki E, Bikouvarakis S, Papageorgiou M, Giannakopoulou C. Perinatal outcome of twin pregnancies after in vitro fertilization. Acta Obstetrica Gynecologica Scandinavia 2004;83:1079–84.CrossRefGoogle Scholar
  18. 18.
    Wright V, Schieve LA, Vahratian A, Reynolds MA. Monozygotic twinning associated with day 5 embryo transfer in pregnancies conceived after IVF. Human Reproduction 2004;19(8):1831–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Evers JLH. Female subfertility. Lancet 2002;360:151–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Min JK, Breheny SA, MacLachlan C, Healy DL. What is the most relevant standard of success in assisted reproduction? The singleton, term gestation, live birth rate per cycle intiated: The BESST endpoint for assisted reproduction. Human Reproduction 2004;19(1):3–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Barbieri RL. Too many embryos for one woman: What counts as success or failure in ART? OBG Management. July edition; 2005;8–9.Google Scholar
  22. 22.
    American Society of Reproductive Medicine. Guidelines on the number of embryos transferred. The Practice Committee of the Society for Assisted Reproductive Technology and the American Society of Reproductive Medicine. Fertility and Sterility 2004;82(3):773–4.Google Scholar
  23. 23.
    Anderson AN, Gianaroli L, Felberbaum R, de Mouzon J. Assisted reproductive technology in Europe, 2001. Results generated from European register by ESHRE. Human Reproduction 2005;20(5):1158–76.CrossRefGoogle Scholar
  24. 24.
    Saldeen P, Sundstrom P. Would legislation imposing single embryo transfer be a feasible way to reduce the rate of multiple pregnancies after IVF treatment? Human Reproduction 2005;20(1):4–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Lukassen HGM, Braat DD, Wetzels AMM, Zielhuis GA, Adang EMM, Scheenjes E, Kremer JAM. Two cycles with single embryo transfer versus one cycle with double embryo transfer: A randomized controlled trial. Human Reproduction 2005;20(3):702–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Thurin A, Hausken J, Hillensjo T, Jablonowska B, Pinborg A, Stranfell A, Bergh C. Elective Single-embryo Transfer in in vitro fertilization. New England Journal of Medicine 2004;351(23): 2392–402.PubMedCrossRefGoogle Scholar
  27. 27.
    Hildebaugh DA, Thompson IE, Berger MJ. Cost of assisted reproductive technologies for a health maintenance organization. Journal of Reproductive Medicine 1997;(42):570–4.Google Scholar
  28. 28.
    Katz P, Nachtigall R, Showstack J. The economic impact of the assisted reproductive technologies. Nature; 2002. Published online and available at Scholar
  29. 29.
    The National Fertility Directory. 2000. The costs of in vitro fertilization: 2000 survey of SART members. 2004. Foundation for Research in Healthcare. Available online at Scholar
  30. 30.
    The International Council on Infertility Information Dissemination, Inc. State mandates for infertility coverage. Accessed April 2006. Available online at Scholar
  31. 31.
    Griffin M, Panak W. The economic cost of infertility-related services: An examination of the MA infertility insurance mandate. Fertility and Sterility 1998;70(1):22–9.PubMedCrossRefGoogle Scholar
  32. 32.
    Jain T, Harlow BL, Hornstein MD. Insurance coverage and outcomes of in vitro fertilization. New England Journal of Medicine 2002;347(9):661–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Reynolds MA, Schieve LA, Jeng G, Peterson HB. Does insurance coverage decrease the risk for multiple births associated with assisted reproductive technology? Fertility and Sterility 2003;80(1):16–23.PubMedCrossRefGoogle Scholar
  34. 34.
    Diamond D. The evolution of the housing finance policy in Hungary. The Urban Institution 1999.Google Scholar
  35. 35.
    Diamond D. The evolution of the housing finance policy in Hungary. The Urban Institution 1999.Google Scholar
  36. 36.
    Keun-min B. Campaign promotes childbirth. Korea Times; 2005.Google Scholar
  37. 37.
    Incentives pale next to model Singapore. The Standard; 2005.Google Scholar
  38. 38.
    Keun-min B. Campaign promotes childbirth. Korea Times; 2005.Google Scholar
  39. 39.
    Olah L. Gendering fertility: second birth in Sweden and Hungary. Population Research and Policy Review 2003;22:171–200.CrossRefGoogle Scholar
  40. 40.
    OEDC. Balancing work and family life: helping parents into paid employment; 2001.Google Scholar
  41. 41.
    Statistics EG. Families and household, Iceland: Act on maternity/paternity leave; 2000.Google Scholar
  42. 42.
    New fathers will be entitled to nine months paid leave. The Daily Mail; 2005.Google Scholar
  43. 43.
    OEDC. Balancing work and family life: helping parents into paid employment; 2001.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2006

Authors and Affiliations

  1. 1.Division of Maternal Fetal MedicineDepartment of Obstetrics and Gynecology, Columbia Presbyterian Medical CenterNew YorkUSA
  2. 2.Department of Population and Family HealthMailman School of Public Health, Columbia UniversityNew YorkUSA

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