Decline in Triplets and Higher-Order Births Linked to Fertility Treatment Guidelines

The rates of triplet and higher-order births in the United States have significantly declined over the past two decades, according to a new report by the Centers for Disease Control and Prevention (CDC). This decrease is largely attributed to changes in guidelines surrounding embryo transfer during fertility treatments like in vitro fertilization (IVF).

The report, published in July 2023, revealed that the rate of triplet and higher-order births fell 62% between 1998 and 2023. This progress is particularly notable considering the rise in the use of assisted reproductive technologies during that time period.

Impact of Guidelines on Multiple Births

One key factor driving this decline is the implementation of guidelines concerning the number of embryos transferred during IVF. Dr. Micah Hill, president of the Society for Assisted Reproductive Technology (SART), explained that these guidelines, which have been updated multiple times since 2004, recommend transferring a smaller number of embryos based on factors like the woman’s age. They aim to reduce the risk of complications associated with multiple pregnancies.

This strategy has proven successful. Dr. Amanda Williams, Interim Chief Medical Officer for the March of Dimes, stated, “Separately, there have also been shifts in the use of fetal reduction during fertility treatments, a procedure} to reduce the number of fetuses when a pregnancy with triplets or more occurs. ”

Declining Trends in Multiple Births Across Different Demographics

While the overall decline in triplet and higher-order births is encouraging, the report also highlights racial disparities. Rates among White mothers decreased by 71%, while Hispanic mothers saw a 25% decline. However, rates among Black mothers increased by 25% from 1998 to 2023.

Dr. Williams attributes this discrepancy to factors such as access to more advanced assisted reproductive technologies. She suggests that Black women and those with lower incomes may be more likely to utilize less technologically advanced techniques which may lead to higher rates of twins and triplets.

Positive Outcomes for Maternal and Infant Health

The decrease in multiple births has a positive effect on maternal and infant health. As Dr. Williams pointed out:

“When you have three or more babies inside, you are at a markedly increased risk for preterm birth, for low birth weight, for infant mortality, for NICU stays, and then on the maternal side, increased risk for gestational diabetes, increased risk for gestational hypertensive disorders like preeclampsia. So this is good news for families, because triplets and higher order pregnancies are so much riskier for mom and baby.”

Call to Action:

While progress has been made, more efforts are needed to address racial disparities in assisted reproductive