Multiples

The broader use of fertility treatments over the past two decades has contributed to the rise in multiple births that we have seen over the same time period. Assisted Reproductive Technology (ART) therapies are estimated to account for 17 percent of all twins and 40 percent of triplets born in 2004.

In a typical IVF cycle, fertility medications are designed to stimulate ovaries to develop multiple follicles. More eggs can mean more embryos, and thus a better chance of success. However, the creation of multiple embryos also increases the risk of a multiple pregnancy. In general, patients undergoing IVF are 10 times more likely to experience a multiple birth than women in general. Twins are most common, but triplets, quadruplets or even greater numbers can occur.

Many couples who have spent a lot of time and money trying to conceive think achieving a multiple pregnancy is a blessing, and often it can be. However, multiple pregnancies can present many complications for the babies and the mothers. Caring for more than one baby poses its own physical, emotional and financial burdens as well. Before beginning your treatment, it is vital to speak with your doctor about the risks of a multiple pregnancy, and what steps you can take to avoid such an outcome. The desire to achieve pregnancy should not be put before the health of mother and child.

How Many Embryos to Transfer?

During IVF the doctor will consult with the patient about how many embryos to transfer. This decision is based on many factors including the quality of the embryos, the mother’s age and overall health, and the personal feelings of the couple about parenting multiples.

Recently, more clinics have been altering procedures to reduce the number of multiple pregnancies resulting from ART. Some have been doing “single embryo transfers” if the quality of the embryo is good. In this case, just one embryo is transferred during the cycle. Another option gaining attention is a “natural IVF cycle” or “low-stimulation IVF.” This is an in vitro fertilization procedure that does not use fertility drugs (or may use just very low doses). While some couples choose this procedure because it is more natural, less stressful (no injections), and less costly, many are viewing it as a way to reduce the chance of a multiple pregnancy. Without drug stimulation, ovaries normally produce only one egg. This single egg will be fertilized and transferred. Eliminating a multiple embryo transfer will help avoid a multiple outcome.

Selective Reduction

Another option in higher order multiple pregnancies is “selective reduction.” Couples that are expecting three or more babies may decide or be advised to reduce the number of fetuses. This will increase the chance of the mother having one or two healthy babies instead of potentially miscarrying or delivering prematurely all of the babies. This is often a very hard personal decision to make and poses many ethical questions for the couple.

It is important to realize that “multiple” outcomes depend on the drugs and procedures used, and on the mother’s reproductive health. Understanding the potential risks and complications associated with these pregnancies will allow you to make informed decisions regarding your treatment.