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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 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.

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.

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