Related Experiment Video
Updated: Aug 18, 2026

Modified MicroSecure Vitrification: A Safe, Simple and Highly Effective Cryopreservation Procedure for Human Blastocysts
Published on: March 2, 2017
Effects of competition among fertility centers on pregnancy and high-order multiple gestation rates
Anne Z Steiner1, Richard J Paulson, Katherine E Hartmann
1Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, Los Angeles, California 90033, USA. asteiner@usc.edu
Objective:
To measure the effect of competition among fertility centers on pregnancy and high-order multiple (HOM) gestation rates after IVF.
Design:
Retrospective cohort study.
Setting:
Four hundred eight fertility clinics registered with the Society for Assisted Reproductive Technology as providing IVF services in 2000. Competition was defined as number of clinics in a geographically defined area. Demand for services was based on the population of reproductive-aged women.
Patient(S):
Three hundred eighty-one fertility clinics reporting clinical outcomes.
Intervention(S):
Pregnancy rates, HOM gestation rates, population of reproductive-aged women, and number of competing clinics were calculated for each clinic from Society for Assisted Reproductive Technology and census data.
Main Outcome Measure(S):
The clinic HOM gestation rate (percentage of pregnancies that were HOM) and age-adjusted pregnancy rate.
Result(S):
The number of clinics in an area of competition ranged from 1 to 22. The HOM gestation rate per clinic ranged from 0% to 50%. As demand increased, competition increased. As competition increased, the number of HOM pregnancies per clinic decreased. In areas of low competition (1 to 2 clinics) the clinic HOM gestation rate was 8.43%, in areas of intermediate competition (3-7 clinics) 8.39%, and in areas of high competition (8-22 clinics) 8.24%. In areas with intermediate demand, high levels of competition resulted in fewer HOM pregnancies than intermediate competition (relative risk 0.56, 95% confidence interval 0.36-0.89) or low levels of competition (RR 0.57, 95% confidence interval 0.35-0.94). Age-adjusted pregnancy rates did not differ by level of competition.
Conclusion(S):
According to these data, the risk of HOM gestation decreases with increasing competition among clinics; however, pregnancy rates are unaffected.
More Related Videos
Related Concept Videos
Ovarian Cycle
Fertilization
In Vitro Fertilization
The IVF process begins with ovarian stimulation, during which reproductive endocrinologists prescribe hormonal medications to stimulate the ovaries to produce multiple eggs instead of the single...
Nondisjunction
Regression Toward the Mean
Teratogenicity

