The goal of Infertility treatment is the birth of a healthy child. However, many of the options for treatment of infertility are associated with high risks of multiple births. The incidence of twins and higher order multiple Gestations has increased dramatically over the last 15 years, and this rise is primarily attributed to the use of gonadotropins for Ovulation Induction and assisted reproduction.
It is of paramount importance to decrease multiple pregnancies because the complications of multiple gestation's affect both mother and babies. The most significant complication associated with the Fetus and newborn is prematurity. Preterm delivery occurs in over 50% of twin pregnancies, 90% of triplet pregnancies and virtually all other higher order pregnancies. Prematurity is associated with increased risk of respiratory distress syndrome, low birth weight and cerebral palsy. Maternal complications include increased risks of pregnancy–induced hypertension and diabetes, anemia and Cesarean section.
The risks of multiple births are particularly notable with Ovulation induction and superovulation therapies. Attempts to decrease these risks include conservative dosing of the medications, careful monitoring by Ultrasound and Hormone levels, and cancellation of cycles when patients are deemed to be at high risk of multiple births. Despite these strategies, it is not possible to prevent multiple pregnancies with superovulation in all cases.
In contrast to superovulation, in vitro fertilization (IVF) with transfer of limited numbers of embryos offers the most reliable option to reducing the risk of multiple gestation's. Recent advancements in the Embryo culture system allow patients to limit the number of blastocysts to transfer to one or two while maintaining excellent pregnancy rates and reducing the rate of higher order multiple births.
For all the above reasons, we are strongly committed to reducing the number of multiple births associated with infertility treatment. In the appropriate patients, we are recommending single blastocyst transfer with IVF, and we feel this is the best method of achieving a single pregnancy with a term delivery.
The Society for Assisted Reproduction and Technology (SART) recently published guidelines recommending an optimal number of embryos for transfer based on the age of the patient, the quality of the embryo and the overall prognosis for pregnancy. Additionally, the ASRM published a practice guideline on Multiple Pregnancy Associated with Infertility Therapy in its journal Fertility and Sterility, November 2006. For a copy of either of these two helpful and informative publications, please ask your doctor or nurse. If you prefer to use the internet, the ASRM has two helpful Patient’s Fact Sheet related to multiple pregnancies: Complications of Multiple Pregnancy and Challenges of Parenting Multiples, at www.asrm.org/Patients/FactSheets/. Other helpful links include a support group for parents of multiple pregnancies, Mom’s of Multiples (MOMs) at www.momsofmultiples.org.