Risks of Multiples with Fertility TreatmentsKatlyn Joy |20, May 2014
For those who have suffered through pregnancy losses, or years of infertility treatments, the only thing more exciting than news of a baby on the way is two... or more. However, a new study published online in the journal Fertility and Sterility, raises caution about having multiples and fertility treatments.
Funded by the March of Dimes, researchers from the Yale Fertility Center, and the Hastings Center (the independent bioethics research center), analyzed research to develop recommendations for policies regarding multiples and fertility procedures.
Fertility treatments and multiple births have a strong association. According to the Centers for Disease Control and Prevention, 3.3 percent of births in the US in 2012 were twins. The New England Journal of Medicine found approximately 36 percent of twins and 77 percent of triplets or higher multiples were conceived via assisted reproduction or fertility treatments. In fact, in the past 20 years, twin births have increased by 76 percent in the United States. This is attributed to both fertility treatments and more older women giving birth.
Reasons Couples Opt for Multiples
Many couples count it a blessing — not a worry — when discovering they are carrying twins. They have waited years for a child most likely and know as time passes, the window of opportunity is beginning to close. Time is of the essence, and if they are carrying two babies, they know they will have those two children if later attempts to conceive fail, particularly if they want to space the pregnancies and they are already at an advanced age for conceiving.
Another reason is simply finances. IVF treatments are quite expensive, costing perhaps ,000 USD for an entire, single cycle. Most couples aren't successful on their first try, either. Since in a cycle, multiple embryos can be implanted, the chances of a successful pregnancy are boosted than if only one embryo is transferred.
Even if the woman is young, under 35, and considered a higher success rate, if only a single embryo is implanted, the odds of pregnancy are low. According to CDC statistics, only 12 percent of such cases resulted in pregnancy when a single embryo was transferred, by 2011 numbers.
The director of the Yale Fertility Center, and co-author of the article in Fertility and Sterility, Dr. Pasquale Patrizio, estimates that of women under 35 who are patients in his clinic, 35-38 percent will get pregnant with a single embryo transfer, while the odds are upped to 50 percent with a double embryo transfer. However, with two embryos placed at once, the odds of twins rank at 25 percent.
If the clinics freeze embryos, couples can opt to have singleton pregnancies, but not all professionals think this is the best option for older women or those with low ovarian function.
In an interview with The Wall Street Journal, Dr. Norbert Gleicher, medical director and chief scientist with the Center for Human Reproduction in Manhattan states, "I believe it should be the patient, after being properly informed, to make the decision whether she wants to take the chance of having twins, which comes with a higher pregnancy chance, or whether she doesn't want to have the risk of twins, which comes with a lower pregnancy chance."
However, there is hope for better options. More genetic testing information will help doctors raise the odds of successful singleton pregnancies. In fact, some measures are already possible for couples now in assisted reproduction.
Dr. Patrizio states at their clinic, for several years they have seen better outcomes when observing the embryos in IVF for a full five days, rather than the minimum three, before transfer. This allows the clinic to better identify embryos with the best chance for pregnancy prior to transfer.
Recommendations from the Researchers
- Expanded insurance coverage for IVF procedures.
- Encouraging single embryo transfers for IVF
- Improved education of parents about risks of multiples births
- Limiting the use of controlled ovarian stimulation.
Risks of Childbirth With Multiples
- Miscarriage of one or all fetuses
- Brain hemorrhage
- Problems with the development of the lungs, stomach or intestinal tract
- Problems involving the nervous system
- Low birthweight
- Preterm birth which increases the odds of physical or developmental problems
- Conditions affecting the mother including bleeding before or following deliver, preeclampsia, gestational diabetes, and increased symptoms of pregnancy such as morning sickness.
"Complications and Problems Associated With Multiple Births." American Society for Reproductive Medicine, Web, 2008
"Fertility Study Warns of Risks From Multiple Births.", The Wall Street Journal, Web, April 28, 2014
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