Successful Fertility Treatment May Mean More Babies Than Planned
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.
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 other."
"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.