Since the miracle of the Dionne quintuplets in Canada during the Depression, multiple births have fascinated the world. Witness the media frenzy surrounding the 1997 births of McCauley children, the world’s only surviving septuplets, the eight children of Kate and Jon of reality TV fame, and more recently, the Octomom.

 The Dionnes were the result of nature (one in 57 million odds); the McCauleys took fertility drugs; Kate Gosselin underwent interuterine insemination, and Nadya Suleman’s embryos were implanted.

The CDC monitors multiple births occurring from artificial reproductive methods such as the embryo implantation Ms Suleman underwent, but no such regulation exists for other fertility treatments.

Infertility treatments can be grouped into two basic types: (1) assisted reproductive technology (ART) which involves the manipulation of both egg and sperm in the lab, and (2) non-ART treatments in which ovulation induction medications are used with either timed intercourse or assisted insemination.

Both types of treatment are associated with an increased risk of multiple births (twins, triplets, and higher), which have higher rates of preterm birth, low birth weight and pregnancy/birth complications as well as a greater risk of complications for single babies as well. On average, about half of all twins will be preterm and more than 90 percent of triplets will be preterm.

The various types of infertility treatments have greatly benefited the growing number of couples experiencing infertility. However, the dramatic increase in multiple births in the United States has been partly attributed to the growing use of infertility treatments.

Therefore, it is critical that a means to monitor the use and outcomes of these therapies is available.

The Centers for Disease Control and Prevention (co-authors of this study) maintains the National ART Surveillance System, a population-based registry of ART treatments. Providers of ART (usually reproductive endocrinologists) in the US submit information on all ART procedures initiated and any resultant pregnancies and births. Unfortunately, no similar system exists for non-ART infertility treatments.

The aim of this paper was to estimate the proportion of infants born annually who are conceived by non-ART treatments. Having this information allows the tracking of outcomes associated with pregnancies conceived through these methods.

The study found that 4.6 percent of live births in 2005 resulted from fertility drug use, a figure four times higher than the 1.2 percent of births resulting from ART. A total of 22.8 percent of infants born as multiple births were conceived by using non-ART ovulation stimulation treatments.

The study authors conclude that more than 190,000 infants per year are conceived with fertility drug use, but also say this figure is an underestimate because there is no system for population-based surveillance of births resulting from fertility drug treatment.

Such a system would be critical in monitoring the efficacy of the medications as well as any associated health risks for the women treated and the babies conceived with these therapies.

Dr Petrini’s article was published in the American Journal of Epidemiology’s December 2009 issue. The lead author is Laura A. Schieve and is also co-authored by Owen Devine, Coleen A. Boyle, and Lee Warner all of the Centers for Disease Control and Prevention.

Dr Petrini, a Brookfield resident who joined the hospital in July, was formerly the director of the Perinatal Data Center in the Office of the Medical Director at the National March of Dimes Defects Foundation in New York, and is associate clinical professor in obstetrics and gynecology and women’s health at Albert Einstein College of Medicine in the Bronx.

Shohreh Shahabi, MD, chair of obstetrics and gynecology at Danbury Hospital, called Dr Petrini’s research “a very important contribution.”

“It is an outstanding piece of research in collaboration with the CDC, which makes it all the more prestigious,” Dr Shahabi added. “This research will provide the fuel to show that it’s even more important than ever to monitor non-ART procedures.”

Dr Petrini has co-authored several peer-reviewed publications and conducts presentations at national professional conferences. She was the 2002 recipient of the National Maternal and Child Health Epidemiology Young Professional Achievement Award.

Because there is no national registry or oversight of non-ART treatments or births, Dr Petrini and her colleagues used “modeling” estimation based on studies to come up with their conclusions in the yearlong study.

To read Dr Petrini’s article in the December 2009 issue of the American Journal of Epidemiology published by Oxford Journals, visit http://aje.oxfordjournals.org.