Assisted Reproductive Technology Surveillance United States 2009

Problem/Condition: Since the birth of the first U.S. infant conceived with Assisted Reproductive Technology (ART) in 1981, use of advanced technologies to overcome the problem of infertility has increased steadily, as has the number of fertility clinics providing ART services in the United States. ART includes fertility treatments in which both eggs and sperm are handled in the laboratory (i.e., in vitro fertilization [IVF] and related procedures). Women who undergo ART procedures are more likely to deliver multiple-birth infants than those who conceive naturally. Multiple births pose substantial risks to both mothers and infants, including pregnancy complications, preterm delivery, and low birthweight infants. This report presents the most recent data on ART use and birth outcomes for U.S. states and territories. Reporting Period Covered: 2009. Description of System: In 1996, CDC began collecting data on all ART procedures performed in the United States, as mandated by the Fertility Clinic Success Rate and Certification Act of 1992 (FCSRCA) (Public Law 102-493 [October 24, 1992]). ART data for 1995-2003 were obtained from the Society of Assisted Reproductive Technology (SART) through its proprietary Clinical Outcomes Reporting System data base (SART CORS). Since 2004, CDC has contracted with Westat, Inc., a statistical survey research organization, to obtain data from fertility clinics in the United States through the National ART Surveillance System (NASS), a web-based data collection system developed by CDC. Results: In 2009, a total of 146,244 ART procedures were reported to CDC. These procedures resulted in 45,870 live-birth deliveries and 60,190 infants. The largest numbers of ART procedures were performed among residents of California (18,405), New York (14,539), Illinois (10,192), Massachusetts (9,845), New Jersey (9,146), and Texas (8,244). Together, these six states reported the highest number of live-birth deliveries as a result of ART and accounted for 48% of all ART procedures initiated, 46% of all infants born from ART, and 45% of all ART multiple-birth deliveries but only 34% of all births in the United States. Nationally, the average number of ART procedures performed per 1 million women of reproductive age (15-44 years), which is a proxy indicator of ART utilization, was 2,361. In four states (Massachusetts, New York, New Jersey, and Connecticut) and the District of Columbia, this proxy measure of ART use exceeded twice the national average. Nationally, the average number of embryos transferred was 2.1 among women aged 35 years, 2.5 among women aged 35-40 years, and 3.0 among women aged 40 years (and varied most in this age group from 1.7 in Maine to 3.5 in Missouri). Age-specific elective single-embryo transfer (eSET) rates were approximately 7% among women aged 35 years, 3% among women aged 35-40 years, and 0.5% among women aged 40 years. The highest rates of eSET were observed among women aged 35 years (41% in Delaware, 20% in Iowa, and 17% Massachusetts). Overall, ART contributed to 1.4% of U.S. births (ranging from 0.2% in Puerto Rico to 4.3 % in Massachusetts). The proportion of ART to total infants born in the state or territory, which is another measure of ART utilization, was highest in Massachusetts (4%) with high rates also observed in New Jersey, New York, Connecticut, and the District of Columbia (>3% of all infants born). Infants conceived with ART accounted for 20% of all multiple-birth infants (ranging from 4% in Maine to 41% in New York), 19% of all twin births (ranging from 4% in Maine to 42% in New York) and 34% of triplet or higher order births (ranging from 0 in several states to 61.5% in New Jersey). Among infants conceived with ART, 47% were born as multiple-birth infants (ranging from 35% in Delaware to 60.8% in Wyoming), compared with only 3% of infants among the general birth population (ranging from 1% in New York to 5% in Connecticut).

Offers a comprehensive guide to assisted reproductive technology surveillance, describing its history, global variations, and best practices.

Despite recent declines in infant mortality, the rates of low birthweight deliveries in the United States continue to be high. Part I of this volume defines the significance of the problems, presents current data on risk factors and etiology, and reviews recent state and national trends in the incidence of low birthweight among various groups. Part II describes the preventive approaches found most desirable and considers their costs. Research needs are discussed throughout the volume.

This book is published open access under a CC BY 4.0 license. This open access book provides an overview of childlessness throughout Europe. It offers a collection of papers written by leading demographers and sociologists that examine contexts, causes, and consequences of childlessness in countries throughout the region.The book features data from all over Europe. It specifically highlights patterns of childlessness in Germany, France, the United Kingdom, Finland, Sweden, Austria and Switzerland. An additional chapter on childlessness in the United States puts the European experience in perspective. The book offers readers such insights as the determinants of lifelong childlessness, whether governments can and should counteract increasing childlessness, how the phenomenon differs across social strata and the role economic uncertainties play. In addition, the book also examines life course dynamics and biographical patterns, assisted reproduction as well as the consequences of childlessness. Childlessness has been increasing rapidly in most European countries in recent decades. This book offers readers expert analysis into this issue from leading experts in the field of family behavior. From causes to consequences, it explores the many facets of childlessness throughout Europe to present a comprehensive portrait of this important demographic and sociological trend.

Emergency Medicine, 2nd Edition delivers all the relevant clinical core concepts you need for practice and certification, all in a comprehensive, easy-to-absorb, and highly visual format. This well-regarded emergency medicine reference offers fast-access diagnosis and treatment guidelines that quickly provide the pearls and secrets of your field, helping you optimize safety, efficiency, and quality in the ED as well as study for the boards. Consult this title on your favorite e-reader with intuitive search tools and adjustable font sizes. Elsevier eBooks provide instant portable access to your entire library, no matter what device you're using or where you're located. Get clear, concise descriptions and evidence-based treatment guidelines for a full range of clinical conditions, ranging from the common to the unusual. Find the information you need quickly with a highly visual format that features hundreds of full-color clinical photographs, illustrations, algorithms, tables, and graphs, plus key information highlighted for fast reference. Consult high-yield text boxes in every chapter for Priority Actions, Facts and Formulas, Documentation, Patient Teaching Tips, Red Flags, and Tips and Tricks. Make the most of your limited time with easy-to-digest blocks of information, consistently presented for clear readability and quick reference. Study efficiently and effectively for the boards, or rapidly consult this title in daily practice, thanks to well-organized chapters, a superb use of images and diagrams, and clinically relevant, easy-to-understand content. Benefit from the knowledge and expertise of renowned educators, dedicated to compiling today’s best knowledge in emergency medicine into one highly useful, readable text. Be prepared to manage increasingly prevalent problems seen in the ED, such as emergent complications of fertility treatment and management of patients who have had bariatric surgery. Deliver high-quality care to your younger patients with expanded pediatrics content. Stay up to date with new chapters on Clotting Disorders and Hemophilia, Patient-Centered Care, Health Disparities and Diversity in Emergency Medicine, Cost-Effectiveness Analysis, Antibiotic Recommendations for Empirical Treatment of Selected Infectious Diseases, and Cardiac Emergency Ultrasound: Evaluation for Pericardial Effusion & Cardiac Activity. Access the complete contents of Emergency Medicine online, fully searchable, at www.expertconsult.com, with downloadable images, tables and boxes, and expanded chapters, plus videos demonstrating ultrasound-guided vascular access, sonography for trauma, and more.