研究背景：少子化趨勢下，除了因社會因素考量而不願意生育小孩的人之外，更有一群女性想生育小孩，但是卻因為生理條件而無法生育，雖然可以透過輔助生殖技術幫助生育，但最大原因是因為治療費用很高，昂貴的價格阻礙了許多不孕患者接受治療，因此本研究欲透過美國強制保險對不孕患者提供財務上的補助，以活產率與多胞胎率為評估指標，探討其對女性生產結果的影響。

研究方法：採用整合分析探討在有不孕症強制保險下，其對活產率與多胞胎率的影響，並透過敏感度分析移除異質性的研究，比較移除前後之合併效果量，以檢視合併效果量的穩定度，最後由於國際婦產科聯盟（International Federation of Gynecology and Obstetrics, FIGO）對高齡產婦的定義為當女性年齡為35歲及以上者，因此我們再透過以35歲及以上的女性年齡進行整合迴歸分析。

研究結果：不孕症強制保險對於活產率的合併效果量為0.32，顯示在整合各篇研究的不孕症強制保險中，當其與活產率為正向關係時，其中有0.32的機率產生活產。而不孕症強制保險對於多胞胎率的合併效果量為0.24，顯示在整合各篇研究的不孕症強制保險中，當其與多胞胎率為正向關係時，其中有0.24的機率產生多胞胎。本文最後透過整合迴歸分析進一步發現，女性年齡對多胞胎率來說可能是一個很重要的解釋變數。

結論：透過強制保險可以增加不孕患者對昂貴醫療的可及性，但同時也可能會增加35歲及以上的高齡產婦的邊際效應，使多胞胎的發生率較高，可能會給醫療保健系統帶來額外的負擔。雖然強制保險可以減輕患者在試管嬰兒週期中移植多個胚胎的經濟壓力，但僅憑強制保險不足以減少多胞胎的情況，需要透過限制胚胎移植的數量，才能有效降低使用輔助生殖技術發生多胞胎的機率，同時也不會降低活產率。不過如果要解決少子化日益嚴重的問題，讓不想生育的民眾提高生育意願才是一個最根本的解決之道，政府應透過提供友善的生育及養育環境，讓家庭有完整的育兒支持，而企業也需創造更有利於育兒的條件，讓職場父母更能依自身需求調度時間與空間，取得家庭與工作間的平衡，因此解決少子化問題還有待政府、企業以及全體國民持續共同努力。

Background: Under the trend of declining birthrate, in addition to those who are unwilling to have children due to social factors, there are also a group of women who want to have children, but they are unable to have children due to their physical conditions. Although assisted reproductive technology can help to give birth, but the biggest reason is that the cost of treatment is very high, and the high price prevents many infertile patients from receiving treatment. This study aims to provide financial assistance to infertile patients through insurance mandates in the United States to explore its impact on female birth outcomes, including live birth rates and multiple birth rates.

Method(s): We used a meta-analysis to investigate the effect of infertility insurance mandates on the live birth rates and multiple birth rates, and removed heterogeneity through a sensitivity analysis to compare the overall effect size before and after removal to test the stability of the overall effect size. Finally, since the International Federation of Gynecology and Obstetrics defines advanced maternal age as when the female age is 35 years old and above, we conducted a meta-regression analysis by using the female age of 35 years old and above.

Result(s): The overall effect size of infertility insurance mandates on the live birth rates was 0.32, showing that in the combined studies of infertility insurance mandates, when it was positively related to the live birth rates, there was a 0.32 chance of having a live birth. The overall effect size of infertility insurance mandates on the multiple birth rates was 0.24, showing that in the combined studies of infertility insurance mandates, when it was positively related to the multiple birth rates, there was a chance of 0.24 chance of having a multiple. Finally, through meta-regression analysis, this paper further found that female age may be an important explanatory variable for the multiple birth rates.

Conclusion(s): Insurance mandates can increase access to expensive medical care for infertile patients, but it may also increase the marginal effect of advanced maternal age of 35 years old and above, resulting in higher rates of multiple birth rates, potentially placing an additional burden on the health care system. Although insurance mandates can reduce the financial pressure of patients transferring multiple embryos in the IVF cycle, insurance mandates alone is not enough to reduce multiple birth rates, we need to pass insurance mandates and limiting the number of embryo transfers to effectively reduce the chance of multiple birth rates, and without reducing the live birth rates at the same time. However, if we want to solve the increasingly serious problem of declining birthrate, the most fundamental solution is to increase the willingness of people who do not want to have children. The government should provide friendly fertility and nurturing environment, let families have complete parenting support, and enterprises also need to create conditions that are more conducive to parenting, let working parents can better arrange time and space according to their own needs, and achieve a balance between family and work. Therefore, solving the problem of declining birthrate still requires the continuous efforts of the government, enterprises, and all citizens.

摘要 i
Abstract iii
目錄 v
圖目錄 vii
表目錄 ix
第一章 緒論 1
第一節 研究背景 1
第二節 研究目的 7
第三節 研究流程 10
第四節 研究架構 11
第五節 名詞解釋 13
第二章 文獻回顧 17
第一節 試管嬰兒的誕生 17
第二節 強制保險下試管嬰兒與活產和多胞胎之間的關係 18
第三節 多胞胎造成的影響 19
第三章 研究方法 21
第一節 研究設計與架構 21
第二節 研究流程 21
第三節 文獻選取標準 22
第四節 資料分析 25
第四章 分析結果 29
第一節 活產率與多胞胎率的整合分析 29
第二節 活產率與多胞胎率的敏感度分析 31
第三節 活產率與多胞胎率的整合迴歸分析 35
第五章 結論與建議 39
參考文獻 45
附錄 53

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