Successful Fertility Treatment May Mean More Babies Than Planned
Clinical pregnancies resulted in 441 of these women; a "clinical
pregnancy" is defined as a detectable fetal heartbeat. Among them, 314 were
carrying only one fetus; there were 88 sets of twins. There were 39 pregnancies
with higher orders of multiples, including 22 sets of triplets, 10 sets of
quadruplets, five sets of quintuplets, and two sets of sextuplets.
People undergoing infertility treatment need to discuss with their
physicians the financial and emotional costs of high-order multiples, Richard
A. Levinson, MD, DPA, tells WebMD. "When being treated, a couple should
support the therapy least likely to produce multiple births," says
Levinson, the associate executive director of the American Public Health
Association. He was not involved in the study.
For this to happen, both physicians and patients will have to change their
attitudes, write Siladitya Bhattacharya, MD, and Allan Templeton, MD, in an
accompanying editorial. "[A] radical change in focus for both providers and
consumers of infertility services is required," they write. "The
clinical emphasis will need to shift from the rate of pregnancy per cycle to
the cumulative rate of live births per woman. ... The safety and well-being of
women must not be compromised by competing clinics vying to outperform each
"As difficult as infertility is, patients should resist the temptation
to 'play the odds,'" Walid Saleh, MD, tells WebMD in an interview seeking
an objective assessment of this study. "Even though the rate of high-order
multiples is rare, the risks are tremendous: premature birth, low birth weight,
and, as a result, lifelong handicaps. We need to redefine success." Saleh
is a fertility specialist with the Center for Reproductive Endocrinology in
Bedminster, N.J., and he also is an affiliate with the Somerset Medical Center
in Somerset, N.J.
The final chapter in reducing the risk of high-order multiples has yet to be
written, David Meldrum, MD, tells WebMD. "Gonadotropins are a big cause of
high-order multiples, and their results are more difficult to control than is
in vitro fertilization in which only two embryos are transferred," he says.
His preference is for continued conservative use of this medication, along with
transfer of fewer embryos with IVF. Meldrum, scientific director of the
Reproductive Partners Medical Group in Redondo Beach, Calif., and a clinical
professor of medicine at the University of California at Los Angeles, provided
WebMD with an objective analysis of the study.
Although avoiding high-order multiple pregnancies is a goal shared among
many fertility specialists, several strategies are being explored, Edward E.
Wallach, MD, tells WebMD. "The authors' approach is not very revolutionary,
but they touch on a very important subject," says Wallach, who is director
of the assisted reproductive technology program at Johns Hopkins University
School of Medicine. "In our program, if we are inducing ovulation with
gonadotrophins and it appears that there is a risk of a high-order multiple
pregnancy, ... we take one of two approaches. We either cancel the cycle, or
offer the couple IVF at that point. Both of those actions reduce the chance of
high-order multiple pregnancies." Extending the culture of the embryos to
the blastocyst stage, and then implanting fewer embryos, also can help reduce
the risk, Wallach says.