I did not go into IVF with the intent of conceiving twins. When it happened, though, I initially gave no thought to the risks associated with multiple births. Nor did I consider why my doctor was less than thrilled. I assumed that he intended to help me conceive and helping me get pregnant with two babies was even better. Now I know that he may have been acknowledging pressure on many fertility specialitists to limit conception of mulitples. One of the primary concerns with multiple pregnancies is the likelihood that women carrying more than one child will give birth prematurely. More than 50% of twins are born early, and that percentage increases drastically with high order multiples. The March of Dimes claims that there has been a 36% increase in prematurity in the last 25 years, largely due to fertility treatments that result in the conception of multiples.
The care for premature infants is expensive. Moreover, it is extremely hard on the baby, the mother, and the family. I know from experience, thankfully experience with a happy ending, that spending the first weeks and months of life in a Neonatal Intensive Care Unit is scary, and heart-wrenching, and definitely something that needs attention if the numbers are drastically increasing. One solution is to limit the number of multiple births by limiting the number of embryos transferred in IVF.
Fertility specialists, however, are not fully on board with making single embryo transfers commonplace. Not only do they want to do everything in their power to help a woman sucessfully conceive, they also aren’t convinced that single embryo transfers will have the same results. Less success means their personal reputation and the clinic’s in tarnished. Moreover, the majority of patients are self-pay, have suffered infertility for a long time, and are often looking to the doctor as their last hope. It is not surprising that doctors are reluctant to take drastic measures to try to curb prematurity and cut the number of multiples conceived.
Prematurity, especially in the extreme, is very scary. I don’t necessarily agree that limiting the number of embryos is the answer though. I know a lot of people who transferred two or more embryos who are not parenting twins, triplets, or more. The large majority of those I know who underwent fertility treatment have had success conceiving one healthy baby, and unfortunately many have had no success at all. I guess what I am saying is that there is no direct correlation between transferring two embryos and the patient conceiving twins. My personal bias gets in the way here, though, because I do think that it should be a physician’s responsiblity to cancel IUI procedures if a large number of eggs are present. I also think that putting age factors aside and making special concessions for those cases, the number of embryos transferred in IVF should also be limited – I just don’t agree that it should be only one.
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November 3rd, 2009 at 2:12 pm
IVF is a catch 22 as you discussed. The fertility specialist is concerned about a successful conception and the OB/GYN is concerned about the health of the babies and the mother. Unfortunately that is the risk that most couples are willing to take to conceive and that is why the numbers are growing so fast. That is why every effort to conceive naturally should be the first priority of every couple. Also, if adoption in this country was not so full of red tape and expense you would probably see more couples go the adoption route vs. IVF.