{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T08:48:11Z","timestamp":1791794891047,"version":"4.3.4"},"reference-count":41,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":201,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Reprod Medicine &amp; Biology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study examined whether the application of public insurance on assisted reproductive technology in Japan was associated with changes in the incidence of multiple blastocyst transfer (MBT) and subsequent multiple pregnancies (MP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 2764 blastocyst transfer cycles performed at IVF Osaka Clinic from the pre\u2010insurance period (January 2020\u2013March 2022) were retrospectively compared with 4,326\u2009cycles from the insurance period (April 2022\u2013February 2025). MP was defined as two or more gestational sacs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Baseline analysis showed that patients' age after insurance coverage was significantly younger with fewer previous ET attempts than pre\u2010insurance. MBT rose from 5.8% pre\u2010insurance to 20.1% under insurance, and MP increased from 0.7% to 2.6%, simultaneously. Insurance coverage was independently associated with a higher likelihood of MBT, an association most pronounced in the older age cohort. MBT exhibited the highest risk profile for MP. Significant upward trends in MBT and MP were observed as patients approached their final insured cycles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Findings suggest a correlation between insured cycle limits and clinical practice toward prioritizing per\u2010cycle success. Although alleviating financial burden, the policy appears to be associated with increased MBT and MP, making it necessary to deliberate its impact on maternal and neonatal safety.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/rmb2.70078","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T08:34:46Z","timestamp":1784622886000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Positive and Negative Aspects of Public Insurance Coverage on\n                    <scp>ART<\/scp>\n                    With Respect to Multiple Gestation in Japan"],"prefix":"10.1002","volume":"25","author":[{"given":"Aisaku","family":"Fukuda","sequence":"first","affiliation":[{"name":"IVF Osaka Clinic  Higashi\u2010Osaka City Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8528-2884","authenticated-orcid":false,"given":"Hiroshi","family":"Matsumoto","sequence":"additional","affiliation":[{"name":"IVF Osaka Clinic  Higashi\u2010Osaka City Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isao","family":"Tsuji","sequence":"additional","affiliation":[{"name":"IVF Osaka Clinic  Higashi\u2010Osaka City Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoko","family":"Fujioka","sequence":"additional","affiliation":[{"name":"IVF Osaka Clinic  Higashi\u2010Osaka City Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiharu","family":"Morimoto","sequence":"additional","affiliation":[{"name":"HORAC Grand Front Osaka Clinic  Kita\u2010ku Osaka Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01129627"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/0140\u20106736(92)92425\u2010F"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(84)92840\u2010X"},{"issue":"8","key":"e_1_2_12_5_1","first-page":"1537","article-title":"Notification: Recommendation of Single Embryo Transfer","volume":"60","author":"Japan Society of Obstetrics and Gynecology","year":"2008","journal-title":"Acta Obstetrica et Gynaecologica Japonica"},{"key":"e_1_2_12_6_1","unstructured":"Ministry of Health Labour and Welfare Infertility Treatment Covered by Public Insurance [Internet](2022) https:\/\/kouseikyoku.mhlw.go.jp\/shikoku\/iryo_shido\/000234364.pdf."},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/rmb2.12620"},{"key":"e_1_2_12_8_1","volume-title":"ART Data Book 2023","author":"Japan Society of Obstetrics and Gynecology","year":"2025"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10815\u2010021\u201002347\u20102"},{"key":"e_1_2_12_10_1","first-page":"378","volume-title":"Towards Reproductive Certainty: Fertility and Genetics Beyond 1999: The Plenary Proceedings of the 11th World Congress on In\u00a0Vitro Fertilization & Human Reproductive Genetics","author":"Gardner D. 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