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Successful Fertility Treatment May Mean More Babies Than Planned

WebMD Health News

July 5, 2000 -- For couples struggling with fertility problems, there are many important decisions to be made along the road to parenthood. The medications and techniques used by fertility specialists put many women at risk for "high-order multiple pregnancies" -- triplets or more. While these couples can rejoice about becoming pregnant after successful treatment, many problems can lie ahead, because carrying a multiple pregnancy (even twins) places the woman and the babies at a higher risk for complications.

"We want patients to be educated about the risks of multiple gestation. ... We try to caution our membership about their responsibility to patients and the need to serve patients' best interest," Jeffrey Chang, MD, tells WebMD. He is the president of the American Society of Reproductive Medicine (ASRM) and a professor of reproductive medicine at the University of California-San Diego.

Although some of these births make headlines, they don't make for good quality of life. Women carrying such high numbers of fetuses are more likely to have pregnancy-induced hypertension and diabetes, which can compromise both the mother's and the babies' health before and after delivery. High-order multiples are more likely to be born prematurely or smaller than would have been expected for the stage of the pregnancy. Cesarean deliveries are much more likely for twins than for single babies and are almost always performed for three or more babies.

Fertility specialists are well aware of these risks, although it is usually the maternal-fetal medicine specialists and neonatologists who care for the mothers, fetuses, and newborns. After the septuplets born in Des Moines and the octuplets born in Houston, many of these physicians have been working to find ways to help infertile couples become pregnant while lowering their risk of carrying high numbers of fetuses.

Fertility specialists can reduce the risk of such pregnancies if they lower the dose of gonadotropin, the medication used to stimulate ovulation, according to an article published in this week's issue of The New England Journal of Medicine. However, it's not an easy answer, because giving lower doses of gonadotropins is associated with lower overall pregnancy rates.

A treatment that results in a higher number of embryos surviving is a modification of traditional in vitro fertilization (IVF). This procedure involves implantation of more mature embryos, known as blastocysts, which are typically more than 5 days old as opposed to implantation of embryos that are only 3 days old. By inserting into the uterus only two robust embryos, the risk of triplets is virtually eliminated. (It is not totally eliminated because, in rare cases, a developing embryo can split, resulting in a set of twins.)

After reviewing the data of 1,494 women treated at their clinic, the authors suggest that current treatment guidelines still "result in an unacceptably high incidence of high-order multiple pregnancies," write Norbert Gleicher, MD, and colleagues. Gleicher is affiliated with the Center for Human Reproduction in Chicago.

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