Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Impact of ART on pregnancies in California: an analysis of maternity outcomes and insights into the added burden of neonatal intensive care

Journal of Perinatology volume 34, pages 345–350 (2014)Cite this article

Subjects

A Corrigendum to this article was published on 31 October 2014

Abstract

Objective:

We reviewed the occurrence of prematurity, low birth weight, multiple gestations, frequency of stillbirths and maternity care-associated variables including hospital stay and hospital charges of women conceiving using assisted reproductive technology (ART) or artificial insemination (AI) compared with women with a history of infertility who conceived naturally, and all other naturally conceived pregnancies in California at non-federal hospitals between 2009 and 2011. At a single center, infants born after ART/AI were compared with infants provided care in the normal nursery.

Study design:

Publically available inpatient data sets from the California Office of Statewide Health Planning and Development for years 2009–2011 using data from all California non-federal hospitals were used to determine the impact of ART on a variety of pregnancy-related outcomes and infant characteristics. Infant data from a single center was used to determine hospital charges for infants delivered over an 18-month period to compare the hospital and physician charges indexed to similar charges for infants admitted to the ‘normal’ newborn nursery.

Result:

Among ART/AI pregnancies, there was a 4–5-fold increase in stillbirths, compared with a 2–3-fold increase among women with infertility compared with other naturally conceiving women. ART/AI pregnancies underwent more cesarean sections (fourfold), and a near fourfold increase in the rate of preterm deliveries. Multiple gestations were increased 24–27-fold compared with naturally conceived pregnancies. Maternal hospital stay and hospital charges were increased among those undergoing ART/AI. Infant charges were increased multi-fold for singletons, twins and triplets delivered after ART/AI compared with naturally conceived infants.

Conclusion:

Multiple births, preterm births and a higher overall rate of fetal anomalies were found in California after ART/AI for 2009–2011. Cesarean section rates, longer length of maternal stay and hospital charges among women receiving ART/AI could be lowered if emphasis on elective single embryo transfers was a higher priority among providers. Charges for the care of infants delivered after ART/AI are substantially higher than among naturally conceived infants born late preterm or at term. Families seeking ART/AI need to be informed of the impact of these adverse pregnancy outcomes, including neonatal outcomes and charges for medical care for their infant(s), when considering ART/AI.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Learn more

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4

References

  1. Chandra A, Martinez GM, Mosher WD, Abma JC, Jones J . Fertility, family planning, reproductive health of U.S. women: data from the 2002 National Survey of Family Growth. Vital Health Stat 2005; 23: 1–160.

    Google Scholar 

  2. Steptoe PC, Edwards RG . Birth after the reimplantation of a human embryo. Lancet 1978; 12 (2): 366.

    Article  Google Scholar 

  3. Sullivan W . First ‘Test-Tube’ Baby in U.S., joining Successes Around World. NY Times 1981 page 1.

  4. Sunderam S, Kissin DM, Flower L, Anderson JE, Folger SG, Jamieson DJ et al. Centers for Disease Control and Prevention (CDC). Assisted reproductive technology surveillance-United States, 2009. MMWR Surveill Summ 2012; 61 (7 ss7): 1–28.

    PubMed  Google Scholar 

  5. Mneimneh AS, Boulet SL, Sunderam S, Zhang Y, Jamieson DJ, Crawford S et al. States Monitoring Assisted Reproductive Technology (SMART) Collaborative: Data Collection, Linkage, Dissemination, and Use. J Women’s Health 2013; 22 (7): 571–577.

    Article  Google Scholar 

  6. Office of Statewide Health Planning and Development. Patient discharge data file documentation January-December 2009-2011 http://www.oshpd.ca.gov/HID/Products/PatDiscjhargeData/PublicDataSet/index.html Accessed 2013.

  7. MIRCal The basics of MIRCal Edit Programs for IP E, and AS data. Office of Statewide Health Planning and Development 2007 http://www.oshpd.ca.gov/HID/MIRCal/ManualsGuides.html Accessed 2013.

  8. National Vifel statistics Reports 60(1); 11/3/11.

  9. Reddy UM, Wapner JR, Rebar RW, Tasca RJ . Infertility, assisted reproductive technology, and adverse pregnancy outcomes: executive summary of a National Institute of Child Health and Human Development workshop. Obstet Gynecol 2007; 109: 967–977.

    Article  Google Scholar 

  10. Boulet S Infertility Insurance mandates: Impact on ART use and outcomes, Division of Reproductive Health, August 14, 2013, Presented at Centers for Disease Control and Prevention, Atlanta, Ga. And Bernson D., Insurance Coverage for Infertility Treatments, presented at Centers for Disease Control and Prevention, Division of Reproductive Health Seminar, August 14 2013.

  11. McLernon DJ, Harrild K, Bergh C, Davies MJ, de Neubourg D, Dumoulin JC et al. Clinical effectiveness of elective single versus double embryo transfer: meta-analysis of individual patient data from randomized trials. BMJ 2010; 341: 6945.

    Article  Google Scholar 

  12. Practice Committee of Society for Assisted Reproductive Technology; Practice Committee of American Society for Reproductive Medicine. Elective single-embryo transfer. Fertil Steril 2012; 97 (4): 835–842.

    Article  Google Scholar 

  13. Adashi EY, Ekins MN, Lacoursiere Y . On the discharge of Hippocratic obligations: challenges and opportunities. Am J Obstet Gynecol 2004; 190 (4): 885–893.

    Article  Google Scholar 

  14. Templeton A . Avoiding multiples pregnancies in ART: replace as many embryos as you like-0ne at a time. Hum Reprod 2000; 15: 1663–1665.

    Article  Google Scholar 

  15. Kulkami AD, Jamieson DJ, Hones HW, Kissin DM, Gallo MF, Macaluso M et al. fertility treatments and multiple births in the United States. N Engl J Med 2013; 369: 2218–2225.

    Article  Google Scholar 

  16. Reynolds MA, Schieve LA, Martin JA, Jeng G, Macaluso M . Trends in multiple birth conceived using assisted reproductive technology. United States, 1997-2000. Pediatrics 2003; 111: 1159–1162.

    PubMed  Google Scholar 

  17. Guzich DS, Carson SA, Coutifaris C, Overstreet JW, Factor-Litvak P, Steinkampf MP et al. Efficacy of superovulation and intrauterine insemination in the treatment of infertility. N Engl J Med 1999; 340: 177–183.

    Article  Google Scholar 

  18. Lambert RD, Mélançon MJ . Health of ART babies and the responsibility towards future generations In: Daya S, Pierson RA, Gunby J, eds. Research Papers in Fertility and Reproductive Medicine: Proceedings of the 18th World Congress on Fertility and Sterility (IFFS 2004). Elsevier: San Diego, CA, 2004; 349–352.

    Google Scholar 

  19. Behrman RE, Butler AS (eds). Preterm Birth: Causes, Consequences, and Prevention. The National Academies Press: Washington, DC, 2007.

    Google Scholar 

  20. Kelley-Quon LI, Tseng C-H, Janzen C, Shew SB . Congenital malformations associated with assisted reproductive technology: a California statewide analysis. J Pediatr Surg 2013; 48: 1218–1224.

    Article  Google Scholar 

  21. Katz P, Nachtigall R, Showstack J . The economic impact of the assisted reproductive technologies. Nat Med 2002; 8 (S1): S29–S32.

    Article  CAS  Google Scholar 

  22. Connolly MP, Hoorens S, Chambers GM ESHRE Reproduction and Society Task Force. The costs and consequences of assisted reproductive technology: an economic perspective. Human Reprod Update 2010; 16 (6): 603–613.

    Article  Google Scholar 

  23. Gadzinowski J, Merritt TA, Jopek A, Kochanski A, Lavery A, Merritt T . In vitro babies- medical and legal aspects: a European and North American Perspective. BioTechnologia 2012; 93 (1): 9–26.

    Article  Google Scholar 

  24. Sazonova A, Källen K, Thurin-Kjellberg A, Wennerholm U-B, Bergh C . Factors affecting obstetric outcome of singletons born after IVF. Human Reprod 2011; 26 (10): 2878–2886.

    Article  Google Scholar 

  25. Schmitt SK, Sneed L, Phibbs C . Costs of newborn care in California: a population-based study. Pediatrics 2006; 117: 154–160.

    Article  Google Scholar 

  26. Wadhawan R, Oh W, Vohr B, Wrange L, Das A, Bell EF et al. Neurodevelopmental outcomes of triplets or higher-order extremely low birth weight infants. Pediatrics 2011; 127: e654–e660.

    Article  Google Scholar 

  27. Lorenz JM . Neurodevelopmental outcomes of twins. Sem Perinatol 2012; 26 (3): 201–212.

    Article  Google Scholar 

  28. Bodeau-Livinec F, Zellin J, Blondel B, Fresson J, Fresson J, Burguet A et al. Do very preterm twins and singletons differ in their neurodevelopment at 5 years of age. Arch Dis Child Fetal Neonatal Ed 2013; 98 (8): F480–F487.

    Article  Google Scholar 

  29. Luu T, Vohr B . Twinning on the brain: the effect on neurodevelopmental outcomes. Am J Med Genetics Part C: Sem in Med Genetics 2009; 151C (2): 142–147.

    Article  Google Scholar 

Download references

Acknowledgements

Appreciation is expressed to the hospital financial auditing department of Loma Linda University Medical Center and to Department financial auditors. This study was funded, in part, from a community services grant from Medimmune to the Perinatal Advocacy Committee of Greater Los Angeles.

Author information

Authors and Affiliations

  1. The Department of Pediatrics, Division of Neonatology, Loma Linda University School of Medicine, Loma Linda, CA, USA

    T A Merritt, M Goldstein, R Philips & R Peverini

  2. The Department of Obstetrics and Gynecology, and the Perinatal Education Program of Loma Linda University Children’s Hospital, Loma Linda, CA, USA

    A Rodriguez & B Oshiro

  3. The Department of Pediatrics, Loma Linda, CA, USA

    J Iwakoshi

Authors
  1. T A Merritt
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M Goldstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R Philips
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R Peverini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J Iwakoshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A Rodriguez
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. B Oshiro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T A Merritt.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Merritt, T., Goldstein, M., Philips, R. et al. Impact of ART on pregnancies in California: an analysis of maternity outcomes and insights into the added burden of neonatal intensive care. J Perinatol 34, 345–350 (2014). https://doi.org/10.1038/jp.2014.17

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2014.17

Keywords

This article is cited by

Search

Advanced search

Quick links