Assisted reproductive technology and multiple pregnancy in Malta - A population based study.

Area of Science:

• Reproductive Medicine
• Public Health
• Perinatal Epidemiology

Background:

• Assisted reproductive technology (ART) is crucial for addressing rising infertility rates.
• ART-conceived pregnancies are associated with increased perinatal and maternal risks.
• Malta offers a unique setting for studying ART trends due to comprehensive national data.

Purpose of the Study:

• To investigate the trends in ART utilization in Malta between 2000 and 2019.
• To analyze the proportion of ART in singleton, twin, and triplet deliveries over the study period.

Main Methods:

• Utilized anonymous data from the Malta National Obstetric Information System (NOIS).
• Aggregated all ART methods into a single category for analysis.
• Focused on deliveries of single pregnancies and analyzed multiple gestations separately.

Main Results:

• Overall ART deliveries constituted 2% of 82,356 deliveries from 2000-2019.
• A significant increasing trend in all deliveries (ART and non-ART) was observed over time (p=0.012).
• ART proportion rose significantly for singletons (3.4-4.6% since 2018) and multiples (over 25% for twins/triplets since 2013).

Conclusions:

• Maltese rates of twin and triplet births plateaued, potentially due to single embryo transfer practices.
• Smaller nations with single neonatal units should optimize ART services to prevent strain on neonatal care.
• Careful management of ART services is essential to mitigate adverse neonatal outcomes.