Do IVF births always end up in the ICU?

About 17% of neonatal intensive care unit (NICU) admissions are multiple gestations following assisted reproductive technology (ART).  In the U.S., about 32% of in vitro fertilizations (IVFs) result in multiple births, and about 50% of IVF twins are preterm and thus NICU admits. Triplets and higher-order multiples are even more likely to be preterm.1

Singleton IVF births are about 10% likely to go to NICU, only a little higher than normal births (8%).2

The primary cause of the excess prematurity is the frequency of multiple embryos. Why are IVF pregnancies so likely to result in multiple births? Because each cycle is so expensive and stressful, there is a strong temptation to transfer multiple embryos on each cycle.

In some other countries where IVF is covered by insurance, there is less motivation to transfer many embryos and single-embryo transfer is the norm. In Sweden only 6% of IVFs result in multiple births, with accordingly lower incidence of premature births.1

My thoughts:

  1. Although the hyperbole of IVF births "always" ending up in ICU is clearly wrong, the percentage of NICU admits is much higher than I would have guessed before looking it up.

  2. If insurance companies refuse to cover fertility treatments but remain on the hook for NICU care, they might be making a mistake; ironically it might be cheaper to pay for the IVF and discourage multiple-embryo transfer.


1 Janvier, Annie. “Jumping to Premature Conclusions.” Virtual Mentor, American Medical Association Journal of Ethics. October 2008, Volume 10, Number 10: 659-664.

2 Wang, Yueping Alex, Jishan Dean, Tim Badgery-Parker, and Elizabeth A. Sullivan. “Assisted reproduction technology in Australia and New Zealand 2006.” Australian Institute of Health and Welfare National Perinatal Statistics Unit and Fertility Society of Australia, Assisted Reproduction Technology Series, Number 12. September 2008.