Perinatal and Neonatal Outcomes of Twin Pregnancies in Turkey

2011 ◽  
Vol 14 (2) ◽  
pp. 201-212 ◽  
Author(s):  
Selda Demircan Sezer ◽  
Mert Küçük ◽  
Hasan Yüksel ◽  
Ali Riza Odabaşi ◽  
Münevver Türkmen ◽  
...  
Keyword(s):  
Neonatal Mortality ◽  
Birth Rate ◽  
Multiple Pregnancy ◽  
Mortality Rates ◽  
Multiple Pregnancies ◽  
Turkish Literature ◽  
The Status ◽  
The Mean ◽  
Twin Pregnancies ◽  
Multiple Pregnancy Rate

This study was conducted for the purpose of assessing, in the light of results of other research carried out in the present researchers' clinic and in Turkey, the status of twin pregnancies in Turkey, the incidence of twin births, perinatal and mortality rates associated with twin pregnancies, and the problems experienced in Turkey in cases of multiple and twin pregnancies.Materials and Methodology:The outcomes of twin births that occurred at the researchers' clinic during the period 2001–2009 were studied retrospectively. Seventeen studies conducted in Turkey on multiple and twin pregnancies during the years 1991–2010 were included in the study.Findings:It was observed that the mean multiple pregnancy rate in Turkey is 1.9% and the mean twin birth rate is 1.7%. It was also observed that a large majority (80–97.3%) of multiple pregnancies in Turkey are twin pregnancies. It was noted from Turkish literature that the mean gestational age of twins at birth varies between 33–36.2 weeks and that mean birthweights are 2065–2327 grams for the first-born twin and 1887–2262 grams for the second-born. These findings were observed to be lower than what is indicated in the literature. Perinatal and neonatal mortality, at 58–156/1000 and 40–98/1000 respectively, were seen to be higher than in the literature.Conclusion:It can be seen that preterm birth rates for twin pregnancies in Turkey are higher than what is indicated in the literature and that prenatal and neonatal mortality rates are also similarly higher.

The North of England Survey of Twin and Multiple Pregnancy

2012 ◽  
Vol 16 (1) ◽  
pp. 112-116 ◽  
Author(s):  
Svetlana V. Glinianaia ◽  
Judith Rankin ◽  
Stephen N. Sturgiss ◽  
Martin P. Ward Platt ◽  
Danielle Crowder ◽  
...  
Keyword(s):  
Neonatal Mortality ◽  
Multiple Pregnancy ◽  
Mortality Rates ◽  
Population Based ◽  
Mortality Data ◽  
Multiple Pregnancies ◽  
Essential Information ◽  
Live Births ◽  
Explicit Consent ◽  
Identifiable Data

The population-based Northern Survey of Twin and Multiple Pregnancy (NorSTAMP, formerly the Multiple Pregnancy Register) has collected data since 1998 on all multiple pregnancies in North of England (UK) from the earliest point of ascertainment in pregnancy. This paper updates recent developments to the NorSTAMP and presents some early mortality data from the first 10 years of data collection (1998–2007). Since 2005, mothers have been asked to give explicit consent for their identifiable data to be held by the survey, in line with changing guidance and legal frameworks for identifiable data. In 2009, regional standards of care for multiple pregnancies were developed, agreed, and disseminated. During 1998–2007, 4,865 twin maternities (pregnancies with at least one live birth or stillbirth) were registered, with an average twinning rate of 14.9 per 1,000 maternities. The overall stillbirth and neonatal mortality rates in twins were 18.0/1,000 births and 23.0/1,000 live births respectively. Stillbirth and neonatal mortality rates were significantly higher in monochorionic than dichorionic twins: 44.4 versus 12.2 per 1,000 births (relative risk [RR] 3.6, 95% Confidence Intervals [CI] 2.6–5.1), and 32.4 versus 21.4 per 1,000 live births (RR 1.5, 95% CI 1.04–2.2) respectively. There was no significant improvement during this period in either stillbirth or neonatal mortality rates in either chorionicity group. This population-based survey is an important source of data on multiple pregnancies, which allows monitoring of trends in multiple birth rates and pregnancy losses, providing essential information to support improvements in clinical care and for epidemiological research.

P–281 Is it worth to go to blastocyst when there are less than 4 embryos on day 3?

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
B Gonzale. Marti ◽  
C Pessah ◽  
F Entezami
Keyword(s):  
Poor Prognosis ◽  
Birth Rate ◽  
Multiple Pregnancy ◽  
Live Birth Rate ◽  
Cleavage Stage ◽  
Female Age ◽  
Embryo Yield ◽  
Stage Embryo ◽  
The Mean ◽  
Transfer Group

Abstract Study question Are pregnancy rates similar with blastocyst transfer compared to D3 transfer for patient with a poor embryo yield. Summary answer In poor prognosis patients, more D3 embryos are needed to result in similar outcome compared to single blastocyst and it increases the multiple pregnancy risk. What is known already Good prognosis patients benefit from a blastocyst transfer rather than cleavage-stage embryo because day 3 morphology has limited predictive value for subsequent developmental. A Cochrane meta-analysis in 2016 found a higher live birth rate per transfer in the blastocyst group compared to cleavage-stage and no difference in miscarriage and multiple pregnancies. However, in unselected patients, studies have yielded conflicting results and especially in poor prognosis patients at risk of transfer cancellation. A threshold of four good embryos on the third day has been previously correlated with blastocyst yield and live birth rate compared with cleavage-stage embryo transfer. Study design, size, duration We analyzed the outcome of 1115 cycles with less than 4 embryos during 2019–2020 and compared the results between two groups of D3 and D5 transfers. Participants/materials, setting, methods Amongst 1115 study cycles, in 691 cycles a D3 transfer was performed and in 424 cycles a D5 transfer was performed. We compared transfer cancellation rates, mean number of transferred embryos and ongoing pregnancy rates between the two groups and also in subgroups with female age <37 and female age >37. The statistical analyses were done by Chi square and t-test for paired samples. Main results and the role of chance In the overall study population, the mean female age was 36.3 ± 4.3 years, the mean number of obtained embryos was 2.4 ± 1.0, the mean number of transferred embryos was 1.4 ± 0.8. 17.2% of the cycles resulted in transfer cancellation (6.2% in D3 transfer group and 35.0% in D5 transfer group). After D3 transfer the ongoing pregnancy rate (OPR) per transfer was 21.5% compared to 39.7% in D5 transfers (p < 0.05). A similar pattern was observed in subgroups of age <37 years and >37 years with OPR per transfer significantly higher when D5 transfer was performed. Notably more embryos were transferred on D3 compared to D5 (mean number 1.4 for D3 and 1 for D5). Nonetheless, OPR were similar per cycle in both groups and subgroups of different ages. Limitations, reasons for caution A prospective randomized controlled trial is needed to confirm these results that are consistent with previously reports on retrospective and observational studies. Wider implications of the findings: In poor prognosis patients with low embryo yield, D3 and D5 transfers result in similar OPR per cycle. Transferring at blastocyst stage is not inferior to D3, despite the high cancellation rate, and appears safer permitting a single embryo transfer to avoid multiple pregnancy. Trial registration number Not applicable

scholarly journals Controlled Ovarian Stimulation Should Not Be Recommended for Male Infertility Treated With IUI

2020 ◽  
Author(s):  
Yan Tang ◽  
Qian-Dong He ◽  
Ting-Ting Zhang ◽  
Jing-Jing Wang ◽  
Si-Chong Huang ◽  
...  
Keyword(s):  
Male Infertility ◽  
Pregnancy Rate ◽  
Ovarian Stimulation ◽  
Birth Rate ◽  
Multiple Pregnancy ◽  
Live Birth Rate ◽  
Abortion Rate ◽  
Clinical Pregnancy ◽  
Ovulatory Follicles ◽  
Multiple Pregnancy Rate

Abstract Background: Some studies stated that intra-uterine insemination (IUI) with controlled ovarian stimulation (COS) might increase the chance of pregnancy, while others suggested that IUI in natural cycle (NC) should be the treatment of first choice. Whether it is necessary to use COS at the same time, when IUI is applied to treat male infertility solely? There is still no consensus.Objective: To investigate the efficacy of IUI with COS in male infertility solely?Methods: 544 IUI cycles from 280 couples who sought medical care for male infertility from January 2010 to February 2019 were divided into two groups: group NC-IUI and group COS-IUI. Besides, the COS-IUI group was further divided into two subgroups according to the number of pre-ovulatory follicles on the day of HCG: cycles with monofollicular development (1 follicle group) and cycles with at least two pre-ovulatory follicles (≥ 2 follicles group). The outcome of IUI, including clinical pregnancy rate, live birth rate, spontaneous abortion rate, ectopic pregnancy rate and multiple pregnancy rate were compared.Results: The clinical pregnancy rate, live birth rate, early spontaneous abortion rate, and ectopic pregnancy rate were comparable between NC-IUI group and COS-IUI group. Similar results were observed among NC-IUI group, 1 follicle group and ≥ 2 follicles group. However, when it comes to the multiple pregnancy rate, a trend toward higher multiple pregnancy rate was observed in the COS-IUI group compared that in the NC-IUI group (10.5% (2/19) vs. 0 (0/42), P=0.093), furthermore, a significant difference was found between NC-IUI group and ≥ 2 follicles group (0 vs. 20%, P =0.034).Conclusion: For male infertility, since in cycles with COS, especially in those with at least two pre-ovulatory follicles cycles, the multiple pregnancy rate increased without substantial gain in overall pregnancy rate, COS in IUI should not be recommended. If COS is required, one stimulated follicle and one health baby should be the goal considering the safety both for mothers and fetuses.

scholarly journals Live birth rate and neonatal outcomes of different quantities and qualities of frozen transferred blastocyst in patients requiring whole embryo freezing stratified by age

2020 ◽  
Author(s):  
Shiping Chen ◽  
Hongzi Du ◽  
Jianqiao Liu ◽  
Haiying Liu ◽  
Lei Li ◽  
...  
Keyword(s):  
Birth Weight ◽  
Live Birth ◽  
Birth Rate ◽  
Multiple Pregnancy ◽  
Live Birth Rate ◽  
Neonatal Outcomes ◽  
Blastocyst Transfer ◽  
Multiple Pregnancies ◽  
Average Quality ◽  
Embryo Freezing

Abstract Background: Multiple pregnancies are associated with significant complications and health risks for both mothers and infants. Single blastocyst transfer (SBT) is a logical and effective measure to reduce the incidence of multiple pregnancy with assisted reproductive technology (ART). Whether it is suitable for everyone undergoing SBT was inconclusive, in view of the consideration of embryo quality and patients’ age. Therefore, this study aimed to explore live birth rate (LBR) and neonatal outcomes of different quantities and qualities of blastocysts in patients stratified by age, using a cutoff of 35 years, who required whole embryo freezing and underwent a subsequent frozen thawed transfer (FET) cycle.Methods: A total of 3,362 patients were divided into five groups: group A (n=1569) received a single good-quality blastocyst, group B (n=1113) received two good-quality blastocysts, group C (n=313) received one good- and one average-quality blastocyst, group D (n=222) received two average-quality blastocysts, and group E (n=145) received one average-quality blastocyst.Results: For patients who received good-quality blastocysts, irrespective of age, the LBR of double blastocyst transfer (DBT) was about 50–65% and the multiple pregnancy rate (MPR) was 40–60%; however, the LBR of SBT was 40–55%, and the MPR was 3.5–6.3%. For patients who only had average-quality blastocysts, the MPR of double average-quality blastocyst transfer was as high as 30–50%. Moreover, about 70–90% of preterm births resulted from multiple pregnancies, and about 85–95% of low birth weight babies come from multiple pregnancies. The neonatal outcomes (gestational age, birth weight, and birth height) of DBT were significantly lower than those of SBT regardless of age, and this statistical difference disappeared if the patients were subgrouped by singleton or twin. There is no significant difference in neonatal outcomes between single good-quality blastocyst and single average-quality blastocyst transfer.Conclusions: SBT is a preferable option for patients regardless of age when good-quality blastocysts are available. For patients who only had average-quality blastocysts, they should be informed that DBT was associated with higher multiple pregnancy and adverse neonatal outcomes when compared with SBT regardless of age, suggesting that the practice of SBT is also feasible for these patients.

scholarly journals Live Birth Rate and Neonatal Outcomes of Different Quantities and Qualities of Frozen Transferred Blastocyst in Patients Requiring Whole Embryo Freezing Stratified by Age

2020 ◽  
Author(s):  
Shiping Chen ◽  
Hongzi Du ◽  
Jianqiao Liu ◽  
Haiying Liu ◽  
Lei Li ◽  
...  
Keyword(s):  
Birth Weight ◽  
Birth Rate ◽  
Multiple Pregnancy ◽  
Live Birth Rate ◽  
Neonatal Outcomes ◽  
Blastocyst Transfer ◽  
Multiple Pregnancies ◽  
Average Quality ◽  
Embryo Freezing ◽  
Single Blastocyst Transfer

Abstract Background: Multiple pregnancies are associated with significant complications and health risks for both the mothers and infants. Single blastocyst transfer (SBT) is a logical and effective measure to reduce the incidence of multiple pregnancy with assisted reproductive technology (ART). Whether it is suitable for everyone undergoing SBT was inconclusive, in view of the consideration of embryo quality and patients’ age.Objective: To explored live birth rate (LBR) and neonatal outcomes of different quantities and qualities of blastocysts in patients stratified by age, using a cutoff of 35 years, who required whole embryo freezing and underwent a subsequent frozen-thawed transfer (FET) cycle.Methods: A total of 3362 patients were divided into five groups: group A (n=1569) received a single good-quality blastocyst; group B (n=1113) received two good-quality blastocysts; group C (n=313) received one good- and one average-quality blastocyst; group D (n=222) received two average-quality blastocysts; and group E (n=145) received one average-quality blastocyst. Results: For patients have good-quality blastocysts, irrespective of age, the LBR of double blastocyst transfer (DBT) were about 50-65% and multiple pregnancy rate (MPR) were 40-60%, however, the LBR of single blastocyst transfer (SBT) were 40-55% and MPR were 3.5-6.3%. For patients who only had average-quality blastocysts, the MPR of double average-quality blastocysts transfer was as high as 30-50%. Moreover, about 70-90% of preterm births resulted from multiple pregnancies, and about 85-95% of low birth weight babies come from multiple pregnancies. The neonatal outcomes (gestational age, birth weight and birth height ) of SBT were significantly lower than those of DBT regardless of age, and this statistical difference disappeared if the patients were sub-grouped by singleton or twin. There is no significant difference in neonatal outcomes between single good-quality blastocyst and single average-quality blastocyst transfer. Conclusions: SBT is a preferable option for patients regardless of age when good-quality blastocysts are available. For patients who only had average-quality blastocysts, patients should be informed that DBT was associated with higher multiple pregnancy and adverse neonatal outcomes when compared with SBT regardless of age, suggesting that the practice of SBT is also feasible for these patients.

scholarly journals Live birth rate and neonatal outcomes of different quantities and qualities of frozen transferred blastocyst in patients requiring whole embryo freezing stratified by age

2020 ◽  
Author(s):  
Shiping Chen ◽  
Hongzi Du ◽  
Jianqiao Liu ◽  
Haiying Liu ◽  
Lei Li ◽  
...  
Keyword(s):  
Birth Weight ◽  
Live Birth ◽  
Birth Rate ◽  
Multiple Pregnancy ◽  
Live Birth Rate ◽  
Neonatal Outcomes ◽  
Blastocyst Transfer ◽  
Multiple Pregnancies ◽  
Average Quality ◽  
Embryo Freezing

Abstract Background: Multiple pregnancies are associated with significant complications and health risks for both mothers and infants. Single blastocyst transfer (SBT) is a logical and effective measure to reduce the incidence of multiple pregnancy with assisted reproductive technology (ART). Whether it is suitable for everyone undergoing SBT was inconclusive, in view of the consideration of embryo quality and patients’ age. Therefore, this study aimed to explore live birth rate (LBR) and neonatal outcomes of different quantities and qualities of blastocysts in patients stratified by age, using a cutoff of 35 years, who required whole embryo freezing and underwent a subsequent frozen thawed transfer (FET) cycle.Methods: A total of 3,362 patients were divided into five groups: group A (n=1569) received a single good-quality blastocyst, group B (n=1113) received two good-quality blastocysts, group C (n=313) received one good- and one average-quality blastocyst, group D (n=222) received two average-quality blastocysts, and group E (n=145) received one average-quality blastocyst.Results: For patients who received good-quality blastocysts, irrespective of age, the LBR of double blastocyst transfer (DBT) was about 50–65% and the multiple pregnancy rate (MPR) was 40–60%; however, the LBR of SBT was 40–55%, and the MPR was 3.5–6.3%. For patients who only had average-quality blastocysts, the MPR of double average-quality blastocyst transfer was as high as 30–50%. Moreover, about 70–90% of preterm births resulted from multiple pregnancies, and about 85–95% of low birth weight babies come from multiple pregnancies. The neonatal outcomes (gestational age, birth weight, and birth height) of DBT were significantly lower than those of SBT regardless of age, and this statistical difference disappeared if the patients were subgrouped by singleton or twin. There is no significant difference in neonatal outcomes between single good-quality blastocyst and single average-quality blastocyst transfer.Conclusions: SBT is a preferable option for patients regardless of age when good-quality blastocysts are available. For patients who only had average-quality blastocysts, they should be informed that DBT was associated with higher multiple pregnancy and adverse neonatal outcomes when compared with SBT regardless of age, suggesting that the practice of SBT is also feasible for these patients.

scholarly journals Twin Pregnancies in Dairy Cattle: Observations in a Large Herd of Holstein-Friesian Dairy Cows

Animals ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 2165
Author(s):  
Fernando López-Gatius ◽  
Irina Garcia-Ispierto ◽  
Ronald H. F. Hunter
Keyword(s):  
Dairy Cattle ◽  
Multiple Pregnancy ◽  
Warm Season ◽  
Uterine Horn ◽  
Warm Period ◽  
Multiple Pregnancies ◽  
Cool Period ◽  
Holstein Friesian ◽  
Large Herd ◽  
Twin Pregnancies

Multiple pregnancies have devastating consequences on the herd economy of dairy cattle. This observational study examines incidence patterns based on data from the ultrasonographic examination of 1130 multiple pregnancies in cows in their third lactation or more carrying twins (98.8%), triplets (1.1%), or quadruplets (0.08%), and 3160 of their peers carrying singletons. Cows became pregnant following a spontaneous estrus with no previous hormone treatments. Irrespective of a significant decrease (p < 0.0001) in the conception rate (28–34 days post-insemination) during the warm period of the year, the multiple pregnancy rate was similar for both warm (26.5%) and cool (26.3%) periods. The incidence of unilateral multiple pregnancies (all embryos in the same uterine horn) was higher than that of bilateral pregnancies (at least one embryo in each uterine horn): 54.4% versus 45.6% (p < 0.0001). This difference rose to 17% during the warm season (p = 0.03). Pregnancy was monitored in unilateral multiple pregnancies until abortion or parturition (n = 615). In the warm period, the parturition rate was 43% compared to 61% recorded in the cool period (p < 0.0001). Thus, a warm climate is the main factor compromising the fate of multiple pregnancies. Some clinical suggestions are provided.

Time Trends in Characteristics and Outcome of Twin Pregnancies

1991 ◽  
Vol 40 (2) ◽  
pp. 181-192 ◽  
Author(s):  
L. Moreault ◽  
S. Marcoux ◽  
J. Fabia ◽  
S. Tennina
Keyword(s):  
Mortality Rate ◽  
Neonatal Mortality ◽  
Low Birthweight ◽  
Preterm Births ◽  
Mortality Rates ◽  
Fetal Mortality ◽  
Neonatal Mortality Rate ◽  
Risk Of Death ◽  
Twin Pregnancies ◽  
Over Time

AbstractThis study describes the evolution in fetal and neonatal mortality rates among twin pairs born in 22 hospitals located in the eastern regions of the province of Quebec in 1976-1978 (n = 776 pairs) and 1982-1985 (n = 712 pairs). It also assesses the contribution of maternal factors, obstetrical care and characteristics of twins in the variation of the risk of death over time. The fetal mortality rate did not improve from 1976-1978 (22.6 per 1000) to 1982-1985 (28.1 per 1000). However, the neonatal mortality rate declined from 44.7 to 34.7 per 1000 liveborn first twins and from 56.8 to 36.1 per 1000 liveborn second twins. For first twins as for second twins, birthweight-specific neonatal mortality rates decreased within birth weight categories under 2500 g. In the second period, 96.9% of twin pregnancies were detected before confinement compared to 59.6% in the earlier period. The proportion of twins delivered by obstetricians, the percentage of twin births occurring in ultraspecialized perinatal units and the frequency of caesarean sections increased markedly. The proportion of preterm births increased over time (34.5% vs 43.1%) whereas the percentage of low birthweight twins decreased but not significantly (54.3% 51.6%). In this study, changes in maternal age, parity, educational level, sex of pairs, qualification of the physician, and level of care available at the hospital of birth, did not account for the decrease in neonatal mortality rates among twins. The increase in the frequency of caesarean sections seemed to explain only a small proportion of the decrease in the neonatal mortality rate among second twins. In the second as well as in the first period, the neonatal mortality rate for twins was six times higher than that for singletons.

scholarly journals Twins in Dairy Herds. Is It Better to Maintain or Reduce a Pregnancy?

Animals ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 2006 ◽  
Author(s):  
Fernando López-Gatius
Keyword(s):  
Pregnancy Loss ◽  
Animal Health ◽  
Multiple Pregnancy ◽  
Prostaglandin F2α ◽  
Hormone Treatment ◽  
Dairy Herds ◽  
Multiple Pregnancies ◽  
Pregnancy Diagnosis ◽  
Best Management ◽  
Twin Pregnancies

Multiple ovulations and so multiple pregnancies have increased recently in dairy cattle. The incidence of the double ovulation impact in high producers at insemination may be over 20%. Twin pregnancies are undesirable as they seriously compromise the welfare and productive lifespan of the cow and herd economy. Clinical problems extend from the time of pregnancy diagnosis to pregnancy loss, abortion or parturition. Early pregnancy loss or abortion of multiple pregnancies lead in most cases to culling. In cows reaching their term, mean productive lifespan is up to about 300 days shorter for cows delivering twins than for cows delivering singletons. While there is an urgent need to address multiple pregnancy prevention procedures in the foreseeable future, the incidence of twin pregnancies continues to rise in parallel with increased milk production. Herein, we review two contrasting measures proposed for the time of twin pregnancy diagnosis: (1) gonadotropin-releasing hormone treatment for pregnancy maintenance, or (2) embryo reduction. These options are discussed in terms of their implications for individual animal health and herd economy. Our main conclusions find that manual twin reduction has proven to be the best management option, whereas the use of prostaglandin F2α for inducing abortion may be a better option than doing nothing.

scholarly journals CARTR Plus: the creation of an ART registry in Canada

2020 ◽  
Vol 2020 (3) ◽  
Author(s):  
A Lanes ◽  
DB Fell ◽  
M Teitelbaum ◽  
AE Sprague ◽  
M Johnson ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Embryo Transfer ◽  
Birth Outcomes ◽  
Birth Rate ◽  
Multiple Pregnancy ◽  
Pregnancy Rates ◽  
Clinical Pregnancy ◽  
Fertility Treatment ◽  
Live Births ◽  
Multiple Pregnancy Rate

Abstract STUDY QUESTION What is the status of fertility treatment and birth outcomes documented over the first 6 years of the Canadian Assisted Reproductive Technologies Register (CARTR) Plus registry? SUMMARY ANSWER The CARTR Plus registry is a robust database containing comprehensive Canadian fertility treatment data to assist with providing evidence-based rationale for clinical practice change. WHAT IS KNOWN ALREADY The rate of infertility is increasing globally and having data on fertility treatment cycles and outcomes at a population level is important for accurately documenting and effecting changes in clinical practice. STUDY DESIGN, SIZE, DURATION This is a descriptive manuscript of 183 739 fertility treatment cycles from 36 Canadian clinics over 6 years from the CARTR Plus registry. PARTICIPANTS/MATERIALS, SETTING, METHODS Canadian ART treatment cycles from 2013 through 2018 were included. This manuscript described trends in type of fertility treatment cycles, pregnancy rates, multiple pregnancy rates, primary transfer rates and birth outcomes. MAIN RESULTS AND THE ROLE OF CHANCE Over the 6 years of the CARTR Plus registry, the number of treatment cycles performed ranged from less than 200 to greater than 1000 per clinic. Patient age and the underlying cause of infertility were two of the most variable characteristics across clinics. Similar clinical pregnancy rates were found among IVF and frozen embryo transfer (FET) cycles with own oocytes (38.9 and 39.7% per embryo transfer cycle, respectively). Fertility treatment cycles that used donor oocytes had a higher clinical pregnancy rate among IVF cycles compared with FET cycles (54.9 and 39.8% per embryo transfer cycle, respectively). The multiple pregnancy rate was 7.4% per ongoing clinical pregnancy in 2018, which reflected a decreasing trend across the study period. Between 2013 and 2017, there were 31 811 pregnancies that had live births from all ART treatment cycles, which corresponded to a live birth rate of 21.4% per cycle start and 89.1% of these pregnancies were singleton live births. The low multiple pregnancy rate and high singleton birth rate are associated with the increase in single embryo transfers. LIMITATIONS, REASONS FOR CAUTION There is potential for misclassification of data, which is present in all administrative health databases. WIDER IMPLICATIONS OF THE FINDINGS The CARTR Plus registry is a robust resource for ART data in Canada. It provides easily accessible aggregated data for Canadian fertility clinics, and it contains data that are internationally comparable. STUDY FUNDING/COMPETING INTEREST(S) There was no funding provided for this study. The authors have no competing interests to declare.

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