Fri, Oct 14, 2016 - Page 9 News List

Experts advise minimizing multiple births through IVF

US fertility clinics that want to attract customers by advertising high pregnancy rates mislead women into accepting multiple embryos

By Jane Brody  /  NY Times News Service

Illustration: Mountain People

This summer Louise Brown, the world’s first “test-tube baby,” celebrated her 38th birthday as a mother of two naturally conceived children. In the decades since Brown’s celebrated birth, the techniques of in vitro fertilization, or IVF, have improved tremendously, resulting in an estimated 5 million babies worldwide born to couples unable to conceive on their own.

The many happy stories about couples whose families were enhanced by IVF tend to overshadow the many more failures rarely talked about, creating the impression that the procedure is far more effective than it really is.

At the same time, the techniques usually used have led to a rash of multiple births — more than 40 percent of all IVF deliveries in the US are of twins or higher — because doctors commonly transfer two or more embryos in hopes of achieving a successful pregnancy.

As Allan Templeton of the University of Aberdeen and Aberdeen Maternity Hospital in Scotland reported: “In the United States, between 1980 and 2001, a four-fold increase in triplets and high-order births was documented, as was a 60 percent increase in twin births.”

Fast-forward to 2013, the latest year for which comprehensive data on IVF births in the US became available. More than 60,000 babies — about 1.6 percent of all infants born there — were conceived through IVF, and 41.1 percent of all IVF deliveries were multiples, “directly attributable to the common practice of transferring multiple embryos to the uterus to enhance pregnancy rates,” Abigail Mancuso and colleagues at the University of Iowa Carver College of Medicine and at the US Centers for Disease Control and Prevention (CDC) reported this summer in Fertility and Sterility.

It might surprise many to know that Brown was born following the transfer of just one embryo that had been fertilized externally and transferred to her mother’s womb. And contrary to current practice, her mother had not been treated with drugs to induce the production of a slew of eggs — just one egg was used.

Of three women I know who became pregnant through IVF since 2000, two had twins and one had triplets — although three other friends came away empty-handed, financially and emotionally drained, each after several attempts at IVF. An estimated 36 percent of recent twin births and 77 percent of births of triplets or more in the US resulted primarily from medically assisted pregnancies.

The creation of an instant family of four or more might sound wonderful to couples who struggled for years to conceive and to older women nearing the end of their best childbearing years. However, as “cute” as twins and triplets might seem, multiple pregnancies can be fraught with complications that compromise a successful outcome and the health of mothers and their babies.

Most of the about 500 fertility clinics in the US are private profit-making facilities and as IVF grew in popularity, those seeking to attract patients by advertising high pregnancy rates began inserting multiple embryos.

However, the new study of US IVF clinics by Mancuso’s team revealed that transferring a single embryo in women younger than 38 resulted in a marked reduction in multiple birthrates, but no decline in live birthrates.

Although transferring multiple embryos could result in more live births, many of those babies are born prematurely and spend weeks or months in a neonatal intensive care unit. Some die hours or days after birth, and a significant number of surviving infants emerge with lasting physical and developmental scars like cerebral palsy.

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