Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, and the Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina.
Obstet Gynecol. 2016 Dec;128(6):1205-1214. doi: 10.1097/AOG.0000000000001733.
To examine the association between state-mandated insurance coverage for in vitro fertilization (IVF) and the incidence of multiple birth while controlling for differences in baseline patient characteristics.
We conducted a retrospective cohort study using the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System from 2007 to 2011 to examine the association between state-mandated insurance coverage for IVF and the incidence of multiple birth while controlling for differences in baseline patient characteristics. Analyses were stratified according to patient age and day of embryo transfer (3 or 5).
Of the 173,968 cycles included in the analysis, 45,011 (25.9%) were performed in mandated states and 128,957 (74.1%) in nonmandated states. The multiple birth rate was significantly lower in mandated states (29.0% compared with 32.8%, adjusted odds ratio [OR] 0.87, 99.95% confidence interval [CI] 0.80-0.94). After stratification, this association remained statistically significant only in women younger than 35 years old who underwent transfer on day 5 (33.1% compared with 38.6%, adjusted OR 0.81, 99.95% CI 0.71-0.92). Among women younger than 35 years with day 5 transfer, the elective single embryo transfer rate was significantly higher in mandated states (21.8% compared with 13.1%, adjusted OR 2.36, 99.95% CI 2.09-2.67).
State-mandated insurance coverage for IVF is associated with decreased odds of multiple birth. This relationship is driven by increased use of elective single embryo transfer among young women undergoing day 5 transfer.
在控制基线患者特征差异的情况下，研究州授权的体外受精（IVF）保险覆盖范围与多胎妊娠发生率之间的关联。
我们使用 2007 年至 2011 年的辅助生殖技术协会临床结果报告系统进行了回顾性队列研究，以在控制基线患者特征差异的情况下，研究州授权的 IVF 保险覆盖范围与多胎妊娠发生率之间的关联。分析根据患者年龄和胚胎移植日（3 或 5 日）进行分层。
在纳入分析的 173968 个周期中，45011 个（25.9%）在授权州进行，128957 个（74.1%）在非授权州进行。多胎妊娠率在授权州明显较低（29.0%比 32.8%，调整后的优势比[OR]0.87，99.95%置信区间[CI]0.80-0.94）。分层后，这一关联在年龄小于 35 岁且在第 5 天进行转移的女性中仍然具有统计学意义（33.1%比 38.6%，调整后的 OR 0.81，99.95%CI 0.71-0.92）。在年龄小于 35 岁且第 5 天进行转移的女性中，授权州的选择性单胚胎转移率明显更高（21.8%比 13.1%，调整后的 OR 2.36，99.95%CI 2.09-2.67）。
州授权的 IVF 保险覆盖范围与降低多胎妊娠的几率相关。这种关系是由年轻女性在第 5 天进行转移时更多地选择选择性单胚胎转移所驱动的。
