{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:06:24Z","timestamp":1787313984346,"version":"build-2736575974"},"reference-count":21,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,5,6]],"date-time":"2025-05-06T00:00:00Z","timestamp":1746489600000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Obstet and Gynaecol"],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To evaluate the impact of health insurance coverage for assisted reproductive technology (ART), introduced in Japan in April 2022, on the number of multiple embryo transfers (METs) and multiple pregnancies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed Japanese ART registry data from over 600 registered ART facilities, comparing the rates and numbers of multiple pregnancies in 2022 with those in previous years. Furthermore, age\u2010specific MET rates and proportions of blastocyst transfers in METs were examined separately for fresh and frozen\u2013thawed embryo transfers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In 2022, 3209 multiple pregnancies were reported, showing an increasing trend and a level equivalent to that in 2007, before single embryo transfer was recommended in the Japan Society for Obstetrics and Gynecology guidelines. For all embryo transfers, the MET rate was significantly lower in 2022 than in 2021, decreasing from 15.4% to 15.0% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), resulting in a similar rate of multiple pregnancies (2.98% vs. 3.05%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.17). Age\u2010specific MET rates demonstrated a similar increasing trend with age between 2021 and 2022. However, the blastocyst utilization rate in METs was significantly higher in 2022 than in 2021 across almost all age strata in frozen\u2013thawed embryo transfers.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In 2022, the MET rate significantly decreased from 2021, whereas the multiple pregnancy rate remained similar. However, the absolute number of multiple pregnancies increased to the level before the single embryo transfer guideline, and the proportion of blastocyst transfers in MET also increased. Continuous monitoring is necessary to capture trends in the number of multiple pregnancies following ART in Japan.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jog.16304","type":"journal-article","created":{"date-parts":[[2025,5,6]],"date-time":"2025-05-06T19:24:19Z","timestamp":1746559459000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Impact of health insurance coverage for assisted reproductive technology on multiple embryo transfers and multiple pregnancies in Japan"],"prefix":"10.1111","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9102-2322","authenticated-orcid":false,"given":"Ayumu","family":"Ito","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Toho University Faculty of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8815-5714","authenticated-orcid":false,"given":"Seung Chik","family":"Jwa","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Jichi Medical University  Tochigi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Kuwahara","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Graduate School of Biomedical Sciences Tokushima University  Tokushima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8139-9292","authenticated-orcid":false,"given":"Akihiko","family":"Ueda","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics Kyoto University Graduate School of Medicine  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mai","family":"Ohashi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Jichi Medical University  Tochigi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiyotaka","family":"Kawai","sequence":"additional","affiliation":[{"name":"Department of Reproductive Medicine Kameda IVF Clinic Makuhari  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshikazu","family":"Kitahara","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Gunma University Graduate School of Medicine  Gunma Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshihiro","family":"Habara","sequence":"additional","affiliation":[{"name":"Okayama Couple's Clinic  Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukiko","family":"Katagiri","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Toho University Faculty of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Iwase","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Gunma University Graduate School of Medicine  Gunma Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,5,6]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2024.07.009"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/den014"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2012.09.038"},{"key":"e_1_2_9_5_1","unstructured":"Japan Society of Obstetrics and Gynecology.Prevention of multiple gestation associated with infertility therapy: The Committee opinion [Internet]. [cited 2025 Mar 17]. Available from:https:\/\/fa.kyorin.co.jp\/jsog\/readPDF.php?file=76\/8\/076080771.pdf#page=6"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2015.10.002"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/rmb2.12620"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000005443"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1472-6483(10)61854-8"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.ss6804a1"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rbmo.2010.05.020"},{"issue":"2","key":"e_1_2_9_12_1","first-page":"179","article-title":"Single\u2010embryo transfer: a key strategy to reduce the risk for multiple pregnancy in assisted human reproduction","volume":"2","author":"Reimundo P","year":"2021","journal-title":"Adv Lab Med"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10815-017-0885-7"},{"key":"e_1_2_9_14_1","unstructured":"Human Fertilisation & Embryology Authority.One at a time [Internet]. [cited 2025 Mar 19]. Available from:https:\/\/www.hfea.gov.uk\/about\u2010us\/our\u2010campaign\u2010to\u2010reduce\u2010multiple\u2010births\/#:~:text=We%20launched%20One%20at%20a the%20effects%20are%20sometimes%20lifelong"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1080\/14647270400006929"},{"issue":"32","key":"e_1_2_9_16_1","first-page":"2476","article-title":"Good results of single embryo transfer after in vitro fertilization. The first follow\u2010up report after the introduction of a new regulatory guideline","volume":"101","author":"Sundstr\u00f6m P","year":"2004","journal-title":"Lakartidningen"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmh048"},{"issue":"4","key":"e_1_2_9_18_1","first-page":"189","article-title":"The twin epidemic in infertility care\u2014why do we persist in transferring too many embryos?","volume":"8","author":"Ombelet W","year":"2016","journal-title":"Facts Views Vis Obgyn"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa041032"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12958-022-00984-5"},{"issue":"6","key":"e_1_2_9_21_1","article-title":"Cleavage\u2010stage versus blastocyst\u2010stage embryo transfer in assisted reproductive technology","volume":"5","author":"Glujovsky D","year":"2022","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deh398"}],"container-title":["Journal of Obstetrics and Gynaecology Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jog.16304","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,25]],"date-time":"2025-05-25T19:29:38Z","timestamp":1748201378000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/jog.16304"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5]]},"references-count":21,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1111\/jog.16304"],"URL":"https:\/\/doi.org\/10.1111\/jog.16304","archive":["Portico"],"relation":{},"ISSN":["1341-8076","1447-0756"],"issn-type":[{"value":"1341-8076","type":"print"},{"value":"1447-0756","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5]]},"assertion":[{"value":"2025-04-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-06","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e16304"}}