Redefining in vitro fertilization success: should triplets be considered failures?

Area of Science:

• Reproductive Medicine
• In Vitro Fertilization (IVF)
• Healthcare Quality Metrics

Background:

• Assisted reproductive technology outcomes are typically measured by live birth rates.
• High-order multiple pregnancies (HOMPs) are a known risk associated with IVF.
• Current program rankings may not fully reflect the risks of HOMPs.

Purpose of the Study:

• To assess the impact of classifying high-order multiple pregnancies as negative outcomes on IVF program rankings.
• To evaluate how redefining success metrics influences the perceived performance of IVF programs.

Main Methods:

• Retrospective analysis of the 2004 Society for Assisted Reproductive Technology Clinic Outcome Reporting System.
• Inclusion of 207 IVF programs with >50 cycles, focusing on patients ≤35 years.
• Programs were ranked based on size, success rate, and embryos transferred, then re-ranked with HOMPs as negative outcomes.

Main Results:

• HOMPs increased with a higher number of embryos transferred.
• Live birth rates, excluding HOMPs, decreased as embryo transfers increased.
• Programs transferring >2.4 embryos saw their rankings decrease after HOMP exclusion.

Conclusions:

• Reclassifying HOMPs as failed cycles reduces the rank of programs with high embryo replacement rates.
• Defining success as singleton or twin births alters program rankings and perception.
• This highlights the importance of outcome definition in evaluating IVF program performance.