Fertility Treatments and Multiple Births in the United States

 

Aniket D. Kulkarni, M.B., B.S., M.P.H., Denise J. Jamieson, M.D., M.P.H., Howard W. Jones, Jr., M.D., Dmitry M. Kissin, M.D., M.P.H., Maria F. Gallo, Ph.D., Maurizio Macaluso, M.D., Dr.P.H., and Eli Y. Adashi, M.D.

N Engl J Med 2013; 369:2218-2225

 December 5, 2013DOI: 10.1056/NEJMoa1301467

Background

The advent of fertility treatments has led to an increase in the rate of multiple births in the United States. However, the trends in and magnitude of the contribution of fertility treatments to the increase are uncertain.

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Methods

We derived the rates of multiple births after natural conception from data on distributions of all births from 1962 through 1966 (before fertility treatments were available). Publicly available data on births from 1971 through 2011 were used to determine national multiple birth rates, and data on in vitro fertilization (IVF) from 1997 through 2011 were used to estimate the annual proportion of multiple births that were attributable to IVF and to non-IVF fertility treatments, after adjustment for maternal age. Trends in multiple births were examined starting from 1998, the year when clinical practice guidelines for IVF were developed with an aim toward reducing the incidence of multiple births.

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Results

We estimated that by 2011, a total of 36% of twin births and 77% of triplet and higher-order births resulted from conception assisted by fertility treatments. The observed incidence of twin births increased by a factor of 1.9 from 1971 to 2009. The incidence of triplet and higher-order births increased by a factor of 6.7 from 1971 to 1998 and decreased by 29% from 1998 to 2011. This decrease coincided with a 70% reduction in the transfer of three or more embryos during IVF (P<0 .001="" 33="" a="" and="" attributable="" births="" decrease="" higher-order="" in="" ivf="" of="" p="" proportion="" the="" to="" triplet="">

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Conclusions

Over the past four decades, the increased use of fertility treatments in the United States has been associated with a substantial rise in the rate of multiple births. The rate of triplet and higher-order births has declined over the past decade in the context of a reduction in the transfer of three or more embryos during IVF. (Funded by the Centers for Disease Control and Prevention.)

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Remember Columbine High School Massacre

he Columbine High School massacre (often known simply as Columbine) was a school shooting which occurred on April 20, 1999, at Columbine High School in Columbine, an unincorporated area of Jefferson County within the American State of Colorado. In the school shooting, two senior students named Eric Harris and Dylan Klebold murdered a total of 12 students and one teacher. They also injured 21 further students, with three other people being injured while attempting to escape the school. The pair then committed suicide.

The Columbine High School massacre is the fifth-deadliest mass murder committed upon a school campus in United States history; after the 1927Bath School disaster, the 2007 Virginia Tech massacre, the 2012 Sandy Hook shooting and the 1966 University of Texas massacre, and remains the deadliest for an American high school.

The massacre sparked debate over gun control laws, the availability of firearms within the United States and gun violence involving youths. Much discussion also centered on the nature of high school cliques, subcultures and bullying, in addition to the influence of violent movies and video games in American society. The shooting resulted in an increased emphasis on school security, and a moral panic aimed at goth culture, social outcasts,gun culture, the use of pharmaceutical anti-depressants by teenagers, teenage Internet use^[1] and violent video games.^[2][3]

Contents   [hide]  1 Preliminary activities and intent 1.1 Medication 1.2 Journals and videos 1.3 Firearms 2 April 20, 1999: The massacre 2.1 Shooting begins 2.2 Library massacre 2.3 Suicide of the perpetrators 2.4 Shooting ends 3 Immediate aftermath 4 The search for rationale 4.1 Bullying 4.2 Psychopathy and depression 4.3 Video games 4.4 Other factors explored 4.4.1 Social climate 4.4.2 Goth subculture 4.4.3 Music 4.4.4 Choice of date 5 Impact on school policies 5.1 Secret Service report on school shootings 5.2 School security 5.3 Anti-bullying policies 6 Long-term results 6.1 Police tactics 6.2 Gun control 6.3 Memorials 6.4 Becoming part of the vernacular 7 See also 8 References 8.1 Specific 8.2 General 9 Further reading 10 External links

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