Redefining in vitro fertilization success: should triplets be considered failures?

Objective: To evaluate how the ranking of IVF programs changes if high-order multiple pregnancies (HOMPs) are considered negative outcomes. Design: Retrospective analysis. Setting: The 2004 Society for Assisted Reproductive Technology Clinic Outcome Reporting System. Patient(s): Two hundred seven programs that performed >50 IVF cycles were analyzed, and only patients <35 years of age were included. Intervention(s): Program size, success rate, and number of embryos transferred were recorded for each program. All programs were ranked in accordance to these variables. Main Outcome Measure(s): The programs were re-ranked after considering HOMPs as negative, rather than as positive, outcomes. Result(s): High-order multiple pregnancies were more abundant as the number of embryos replaced increased. The live birth rate, after excluding HOMPs, significantly decreased as the number of embryos transferred increased. The lowest ranked programs performed transfers with the greatest number of embryos (2.4-4.5). After HOMP exclusion, the rank of programs that transferred >2.4 embryos decreased, as opposed to the programs that transferred fewer embryos (1.8-2.4). Conclusion(s): Reclassifying HOMPs as failed cycles will result in a reduced rank in programs that maintain high embryo replacements. Redefining success as a singleton or twin birth significantly changes the ranking order of programs and, potentially, how programs are perceived.