{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T08:59:47Z","timestamp":1780045187715,"version":"3.53.1"},"reference-count":42,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Multiple gestation is one of the biggest risks after in vitro fertilization (IVF), largely due to multiple embryo transfer (MET). Single embryo transfer (SET) uptake has increased over time and has been attributed to various factors, such as mandated insurance coverage for IVF and preimplantation genetic testing for aneuploidy (PGT-A).<\/jats:p><\/jats:sec>Objective<\/jats:title>To investigate whether mandates for IVF insurance coverage are associated with decreased use of MET after PGT-A.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cohort study was conducted using data on embryo transfers reported to the Society for Assisted Reproductive Technology between 2014 and 2016. Data were analyzed from January to October 2021.<\/jats:p><\/jats:sec>Exposures<\/jats:title>State-mandated coverage for fertility treatment and type of cycle transfer performed (PGT-A, untested fresh, and untested frozen).<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Use of MET compared with SET, live birth, and live birth of multiples.<\/jats:p><\/jats:sec>Results<\/jats:title>There were 110\u202f843 embryo transfers (mean [SD] patient age, 34.0 [4.5] years; 5520 individuals identified as African American [5.0%], 10\u202f035 as Asian [9.0%], 5425 as Hispanic [4.9%], 45\u202f561 as White [41.1%], and 44\u202f302 as other or unknown race or ethnicity [40.0%]); 17\u202f650 transfers used embryos that underwent PGT-A. Overall, among transferred embryos that had PGT-A, there were 9712 live births (55.0%). The odds of live birth were 70% higher with MET vs SET after frozen embryo transfer with PGT-A (OR, 1.70; 95% CI, 1.61-1.78), but the risk of multiples was 5 times higher (OR, 5.33; 95% CI, 5.22-5.44). The odds of MET in cycles with PGT-A in states with insurance mandates were 24% lower than in states without mandates (OR, 0.76; 95% CI, 0.68-0.85).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This study found that despite the promise of using SET with PGT-A, MET after PGT-A was not uncommon. This practice was more common in states without insurance mandates and was associated with a high risk of multiples.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2022.51739","type":"journal-article","created":{"date-parts":[[2023,1,27]],"date-time":"2023-01-27T16:00:51Z","timestamp":1674835251000},"page":"e2251739","source":"Crossref","is-referenced-by-count":3,"title":["Association of State Insurance Mandates for Fertility Treatment With Multiple Embryo Transfer After Preimplantation Genetic Testing for Aneuploidy"],"prefix":"10.1001","volume":"6","author":[{"given":"Bronwyn S.","family":"Bedrick","sequence":"first","affiliation":[{"name":"Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katelin B.","family":"Nickel","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan K.","family":"Riley","sequence":"additional","affiliation":[{"name":"Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarun","family":"Jain","sequence":"additional","affiliation":[{"name":"Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily S.","family":"Jungheim","sequence":"additional","affiliation":[{"name":"Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2023,1,27]]},"reference":[{"issue":"3","key":"zoi221472r1","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1097\/AOG.0000000000002786","article-title":"Maternal and fetal risk associated with assisted reproductive technology.","volume":"132","author":"Kawwass","year":"2018","journal-title":"Obstet Gynecol"},{"issue":"4","key":"zoi221472r2","doi-asserted-by":"publisher","first-page":"938","DOI":"10.1016\/S0002-9378(00)70350-4","article-title":"Hypertensive disorders in twin versus singleton gestations.","volume":"182","author":"Sibai","year":"2000","journal-title":"Am J Obstet Gynecol"},{"issue":"4","key":"zoi221472r3","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1080\/14767050802663194","article-title":"Risk for developing gestational diabetes in women with twin pregnancies.","volume":"22","author":"Rauh-Hain","year":"2009","journal-title":"J Matern Fetal Neonatal Med"},{"issue":"4","key":"zoi221472r4","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1097\/AOG.0000000000001338","article-title":"Twin pregnancy and severe maternal outcomes: the World Health Organization Multicountry Survey on Maternal and Newborn Health.","volume":"127","author":"Santana","year":"2016","journal-title":"Obstet Gynecol"},{"issue":"13","key":"zoi221472r5","first-page":"1","article-title":"Births: final data for 2018.","volume":"68","author":"Martin","year":"2019","journal-title":"Natl Vital Stat Rep"},{"issue":"5","key":"zoi221472r6","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1203\/00006450-200211000-00011","article-title":"The risk of mortality or cerebral palsy in twins: a collaborative population-based study.","volume":"52","author":"Scher","year":"2002","journal-title":"Pediatr Res"},{"issue":"6","key":"zoi221472r7","doi-asserted-by":"publisher","first-page":"586.e1","DOI":"10.1016\/j.ajog.2013.10.005","article-title":"Healthcare expenses associated with multiple vs singleton pregnancies in the United States.","volume":"209","author":"Lemos","year":"2013","journal-title":"Am J Obstet Gynecol"},{"issue":"3","key":"zoi221472r8","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1016\/j.fertnstert.2021.12.016","article-title":"Multiple gestation associated with infertility therapy: a committee opinion.","volume":"117","author":"Practice Committee of the Society for Reproductive Endocrinology and Infertility","year":"2022","journal-title":"Fertil Steril"},{"issue":"3","key":"zoi221472r9","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1016\/j.fertnstert.2021.06.050","article-title":"Guidance on the limits to the number of embryos to transfer: a committee opinion.","volume":"116","author":"Practice Committee of the American Society for Reproductive Medicine","year":"2021","journal-title":"Fertil Steril"},{"issue":"4","key":"zoi221472r10","doi-asserted-by":"publisher","first-page":"901","DOI":"10.1016\/j.fertnstert.2017.02.107","article-title":"Guidance on the limits to the number of embryos to transfer: a committee opinion.","volume":"107","author":"Practice Committee of the American Society for Reproductive Medicine","year":"2017","journal-title":"Fertil Steril"},{"issue":"16","key":"zoi221472r11","doi-asserted-by":"publisher","first-page":"1639","DOI":"10.1056\/NEJMsa032073","article-title":"Trends in embryo-transfer practice and in outcomes of the use of assisted reproductive technology in the United States.","volume":"350","author":"Jain","year":"2004","journal-title":"N Engl J Med"},{"issue":"2","key":"zoi221472r12","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1016\/j.fertnstert.2006.09.016","article-title":"Assisted reproductive technology practice patterns and the impact of embryo transfer guidelines in the United States.","volume":"88","author":"Stern","year":"2007","journal-title":"Fertil Steril"},{"issue":"12","key":"zoi221472r13","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1097\/OGX.0000000000000737","article-title":"Preimplantation genetic testing for aneuploidy: a review.","volume":"74","author":"Kemper","year":"2019","journal-title":"Obstet Gynecol Surv"},{"issue":"3","key":"zoi221472r14","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1016\/j.fertnstert.2018.01.002","article-title":"The use of preimplantation genetic testing for aneuploidy (PGT-A): a committee opinion.","volume":"109","author":"Practice Committees of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology","year":"2018","journal-title":"Fertil Steril"},{"issue":"3","key":"zoi221472r15","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1055\/s-0032-1311526","article-title":"Comprehensive chromosome screening and embryo selection: moving toward single euploid blastocyst transfer.","volume":"30","author":"Forman","year":"2012","journal-title":"Semin Reprod Med"},{"issue":"9","key":"zoi221472r16","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1056\/NEJMsa013491","article-title":"Insurance coverage and outcomes of in vitro fertilization.","volume":"347","author":"Jain","year":"2002","journal-title":"N Engl J Med"},{"issue":"4","key":"zoi221472r19","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1097\/AOG.0000000000004712","article-title":"State-mandated insurance coverage and preimplantation genetic testing in the United States.","volume":"139","author":"Bedrick","year":"2022","journal-title":"Obstet Gynecol"},{"issue":"4","key":"zoi221472r20","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1016\/j.fertnstert.2017.12.027","article-title":"Intracytoplasmic sperm injection use in states with and without insurance coverage mandates for infertility treatment, United States, 2000-2015.","volume":"109","author":"Dieke","year":"2018","journal-title":"Fertil Steril"},{"issue":"1","key":"zoi221472r22","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/j.xfre.2020.11.001","article-title":"Disparities in access to fertility care: who\u2019s in and who\u2019s out.","volume":"2","author":"Galic","year":"2020","journal-title":"F S Rep"},{"issue":"4","key":"zoi221472r23","doi-asserted-by":"publisher","first-page":"876","DOI":"10.1016\/j.fertnstert.2005.07.1338","article-title":"Socioeconomic and racial disparities among infertility patients seeking care.","volume":"85","author":"Jain","year":"2006","journal-title":"Fertil Steril"},{"issue":"4","key":"zoi221472r24","doi-asserted-by":"publisher","first-page":"1432","DOI":"10.1016\/j.fertnstert.2009.07.987","article-title":"Embryo transfer practices in the United States: a survey of clinics registered with the Society for Assisted Reproductive Technology.","volume":"94","author":"Jungheim","year":"2010","journal-title":"Fertil Steril"},{"issue":"1","key":"zoi221472r25","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1016\/j.fertnstert.2016.02.034","article-title":"Factors associated with the use of elective single-embryo transfer and pregnancy outcomes in the United States, 2004-2012.","volume":"106","author":"Styer","year":"2016","journal-title":"Fertil Steril"},{"issue":"6","key":"zoi221472r26","doi-asserted-by":"publisher","first-page":"1895","DOI":"10.1016\/j.fertnstert.2008.09.023","article-title":"Elective single embryo transfer: a 6-year progressive implementation of 784 single blastocyst transfers and the influence of payment method on patient choice.","volume":"92","author":"Stillman","year":"2009","journal-title":"Fertil Steril"},{"issue":"3","key":"zoi221472r27","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1016\/j.fertnstert.2003.05.035","article-title":"The desire of infertile patients for multiple births.","volume":"81","author":"Ryan","year":"2004","journal-title":"Fertil Steril"},{"issue":"2","key":"zoi221472r28","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1016\/j.fertnstert.2006.06.043","article-title":"Factors affecting patients\u2019 attitudes toward single- and multiple-embryo transfer.","volume":"87","author":"Newton","year":"2007","journal-title":"Fertil Steril"},{"issue":"10","key":"zoi221472r29","first-page":"1","article-title":"Assisted reproductive technology surveillance\u2014United States, 2011.","volume":"63","author":"Sunderam","year":"2014","journal-title":"MMWR Surveill Summ"},{"issue":"9","key":"zoi221472r30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.ss6909a1","article-title":"Assisted reproductive technology surveillance\u2014United States, 2017.","volume":"69","author":"Sunderam","year":"2020","journal-title":"MMWR Surveill Summ"},{"issue":"22","key":"zoi221472r31","doi-asserted-by":"publisher","first-page":"2047","DOI":"10.1056\/NEJMoa2103613","article-title":"Live birth with or without preimplantation genetic testing for aneuploidy.","volume":"385","author":"Yan","year":"2021","journal-title":"N Engl J Med"},{"issue":"2","key":"zoi221472r32","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1016\/j.juro.2013.08.083","article-title":"Out-of-pocket fertility patient expense: data from a multicenter prospective infertility cohort.","volume":"191","author":"Wu","year":"2014","journal-title":"J Urol"},{"issue":"12","key":"zoi221472r33","doi-asserted-by":"publisher","first-page":"3725","DOI":"10.1257\/aer.20161014","article-title":"Health care access, costs, and treatment dynamics: evidence from in vitro fertilization.","volume":"108","author":"Hamilton","year":"2018","journal-title":"Am Econ Rev"},{"issue":"12","key":"zoi221472r34","doi-asserted-by":"publisher","first-page":"1273","DOI":"10.1001\/jama.2017.0727","article-title":"In vitro fertilization insurance coverage and chances of a live birth.","volume":"317","author":"Jungheim","year":"2017","journal-title":"JAMA"},{"issue":"1","key":"zoi221472r35","doi-asserted-by":"publisher","first-page":"55.e1","DOI":"10.1016\/j.ajog.2021.01.021","article-title":"The cost-effectiveness of preimplantation genetic testing for aneuploidy in the United States: an analysis of cost and birth outcomes from 158,665 in vitro fertilization cycles.","volume":"225","author":"Lee","year":"2021","journal-title":"Am J Obstet Gynecol"},{"issue":"2","key":"zoi221472r36","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1016\/j.fertnstert.2008.10.061","article-title":"Racial and ethnic disparities in assisted reproductive technology outcomes in the United States.","volume":"93","author":"Fujimoto","year":"2010","journal-title":"Fertil Steril"},{"issue":"5","key":"zoi221472r37","doi-asserted-by":"publisher","first-page":"1701","DOI":"10.1016\/j.fertnstert.2007.08.024","article-title":"Disparity in assisted reproductive technologies outcomes in Black women compared with White women.","volume":"90","author":"Seifer","year":"2008","journal-title":"Fertil Steril"},{"issue":"7","key":"zoi221472r38","doi-asserted-by":"publisher","first-page":"1937","DOI":"10.1016\/j.fertnstert.2013.01.134","article-title":"Elective single embryo transfer trends and predictors of a good perinatal outcome\u2014United States, 1999 to 2010.","volume":"99","author":"Steinberg","year":"2013","journal-title":"Fertil Steril"},{"issue":"1","key":"zoi221472r39","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.fertnstert.2019.03.007","article-title":"Factors associated with early in vitro fertilization treatment discontinuation.","volume":"112","author":"Bedrick","year":"2019","journal-title":"Fertil Steril"},{"issue":"2","key":"zoi221472r40","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1016\/j.fertnstert.2012.05.012","article-title":"Race matters: a systematic review of racial\/ethnic disparity in Society for Assisted Reproductive Technology reported outcomes.","volume":"98","author":"Wellons","year":"2012","journal-title":"Fertil Steril"},{"issue":"1","key":"zoi221472r41","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.fertnstert.2014.10.013","article-title":"Blastocyst transfer is not associated with increased rates of monozygotic twins when controlling for embryo cohort quality.","volume":"103","author":"Franasiak","year":"2015","journal-title":"Fertil Steril"},{"issue":"11","key":"zoi221472r42","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0186813","article-title":"Prevalence and risk factors of monochorionic diamniotic twinning after assisted reproduction: a six-year experience base on a large cohort of pregnancies.","volume":"12","author":"Song","year":"2017","journal-title":"PLoS One"},{"key":"zoi221472r17"},{"key":"zoi221472r18","volume-title":"2017 Assisted Reproductive Technology Fertility Clinic Success Rates Report","author":"Center for Disease Control and Prevention","year":"2019"},{"key":"zoi221472r21","unstructured":"Resolve. Insurance coverage by state. Accessed October 24, 2020. https:\/\/resolve.org\/learn\/financial-resources-for-family-building\/insurance-coverage\/insurance-coverage-by-state\/"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2800861\/bedrick_2023_oi_221472_1674184380.70175.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,27]],"date-time":"2023-01-27T16:00:57Z","timestamp":1674835257000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2800861"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,27]]},"references-count":42,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,1,3]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2022.51739","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,27]]}}}