Portland has the lowest rate of preterm births of any city in the nation — according to a new study by The March of Dimes.

After decades of increases, the rate of premature birth in the U.S. is now declining. But not fast enough, according to the charity March of Dimes.  So it graded 100 cities on their rates.

At 7.2 percent, Portland's rate was much lower than anywhere else. Nationally, about 9.6 percent of births are preterm.

Aaron Caughey, the chair of the department of obstetrics at OHSU, said: "One of the reasons why we can do things here in Oregon that might be harder in other states, is there’s a willingness to work together with disregard of our own personal agenda, our own personal egos, to the best outcomes for the women that we care for.”

Babies born before 37 weeks can suffer from short-term breathing and heart problems, as well as long-term complications like cerebral palsy and poor vision.

A couple of days after two of Oregon’s largest health care organizations announced a merger, two competitors say they’re also going to collaborate.

PeaceHealth and Providence have signed a letter of intent to develop a new health and wellness center in Vancouver, Washington.

They companies said it’s the first of multiple initiatives.

Dave Underriner, CEO of Providence in Oregon, said his organization and health care services around the nation are reacting to the Affordable Care Act.

“I think you’re going to see all sorts of partnerships and affiliations and collaborations, different ways for organizations to come together to work in concern, in terms of serving communities,” he said.Underriner said the PeaceHealth Providence collaborative will likely result in more jobs — both from building the new center and staffing it.

The recently announced merger between Legacy and PacificSource is also expected to create jobs.

Mardi Palan is a 30-year-old hair dresser from Portland. She has a partner and a one-year-old son. She hopes to carry twins for a gay couple from Israel.

If successful, she’ll get about $30,000 — money she hopes to use to buy a home.

In August, she had two embryos transferred and just found out via a blood test, that she’s pregnant. Does she feel different?

“Not really. I mean, like there were a couple of songs on the radio that I started crying to and that’s like how I knew," said Palan. "I was like, 'Oh yeah. Something's up.'"

As part of her contract with the intended parents, Palan has agreed to what people in the industry call "selective reduction" — that is, if an embryo develops a serious medical problem, or if it divides and she ends up carrying triplets.

"They have the right to abort the child if they don't want to go with it," she said. "They do a lot of testing when I'm carrying the baby to see if it has Down syndrome or things like that ... but I talked to them and they said if it was disabled they'd still have it."

In some countries like India or Nepal, it’s not unusual for three, four or more embryos to be transferred at a time — and to improve the odds, some companies will transfer that many eggs into multiple surrogates.

That can lead to a lot of "selective reduction" terminations.

But Palan is working with Oregon Reproductive Medicine in Portland.

Dr. Brandon Bankowski, who’s a partner at ORM, said the company focuses on reducing its rate of "selective reduction" by improving the science.

"Our goal is to get to the point where we transfer one embryo and we have one baby," said Bankowski. "The only options that we offer to our patients now are transferring one or two embryos. We would never transfer more than that."

On average, ORM transfers 1.7 embryos. Ten years ago, that average stood at about three embryos.  Still, said Bankowski, they do perform "selective reductions."

"This used to be something that we would talk about much more commonly," he said. "But because we only transfer one or two, it’s an incredibly rare thing for us to have to talk about. It’s essentially a needle procedure where you terminate one of the pregnancies. You can lose the entire pregnancy by doing that.”

Terminations are carried out well within legal time limits for abortion.

So, what is ORM’s success rate?

For women who use donated eggs, about 70 percent of transfers result in live births  — that’s according to the Society for Assisted Reproductive Technology (SART).

The national success rate is 56 percent.

SART is the in vitro fertilization industry's trade group and governing body. It audits success rates and makes them publicly available.

Bankowski said ORM has a high success rate for several reasons. It does an extensive medical check of egg donors, turning away 93 percent of applicants.

It also freezes and thaws eggs in a very specific way.

“That is sort of the secret sauce of the embryologist," he said. "Sometimes they’re keeping an embryo in a bath for five seconds longer.”

And the lab where eggs are collected? It’s essentially a clean room.

“It’s not just, 'Oh, well. Here’s a room and we’ll put in a little filter and here’s some incubators.' It was designed as this special box within a box after we consulted with the clean-room engineers at Intel,” said Bankowski.

People who go into the lab are asked not to wear perfume, because the volatile organic compounds they contain may harm developing eggs. Even new machines are left to air-out before being installed.

But Bankowski said their latest scientific improvement involves taking a tiny slice off the outside of a developing embryo and putting it on a microchip.

That chip contains a series of sensors that can tell whether or not a certain gene is corrupted.

“Four or five years ago, if we were to test an embryo, we would attach about 10 genetic probes to it," he said. "Now we attach about 500,000.”

Craig Reisser, a former banker who lives in London, chose to use Oregon Reproductive Medicine after putting together a spreadsheet comparing clinics across the world on their success rates and costs.

“We felt that where we had the best chance of success the first time round, was also the most financially cost effective place to go,” Reisser said.

Meanwhile, Palan is enthusiastic about the next nine months.  She’ll find out in about six weeks — via ultrasound — whether she’s carrying twins.

She gets an extra $5,000 for twins.

After years of debate about whether the government should encourage end-of-life plans, the feds have proposed reimbursing doctors to have those conversations.

Medicare, which insures 55 million older and disabled people, is taking another look at paying doctors to talk to patients about how they’d like to be kept alive if they become too sick to speak.

The idea was lambasted by former Alaska Gov. Sarah Palin, as a "death panel."

But Oregon doctors have been squeezing in such conversations during scheduled appointments for years. They just haven’t been able to bill for them.

Dr. Susan Tolle with the Center for Ethics in Health Care at Oregon Health & Science University welcomes the idea.

"What it does is it gives this really important conversation dignity and standing," she said.

Patients in Oregon make their end-of-life directions clear on what’s known as a POLST form. Over the last five years, a quarter of a million forms have been submitted to the state POLST registry.