Backgrounder: Charlotte Infertility Experts Weigh in on Octuplets Born with IVF

Technological Advances Offer Higher Pregnancy Rates with Single Embryo Transfer, Reduces Risk of High Order Multiple Pregnancies

 
In the wake of national media coverage about IVF patient Nadya Suleman, the 33-year-old Los Angeles single mother who gave birth to octuplets in January, doctors at Reproductive Endocrinology Associates of Charlotte are voicing their concern about impressions created by the delivery. “This makes our jaws drop. It is most unfortunate and potentially misleading to some people about IVF," said REACH fertility specialist Dr. Seth Katz.
 
“Now, in women younger than 36, we achieve high rates of successful pregnancy with the transfer of just one better-developed five-day-old embryo (compared with a three-day-old embryo as in the past.) High-order multiple births are uncommon in Charlotte and throughout the country these days,” said Katz. In the first 30 years since the first so-called “test-tube baby” was born in the United States, numerous embryos were transferred during IVF, and infertility patients accepted the possibility of giving birth to twins, triplets, or quadruplets in hopes of producing just one healthy baby.
 
For many years, REACH doctors have advised patients against having more than two babies at a time in compliance with medical guidelines established by American Society for Reproductive Medicine (ASRM) that recommend transferring no more than two embryos per procedure in women under 35 except in "extraordinary circumstances."
 
"We are committed to reducing the number of multiple births associated with infertility treatment. For appropriate patients, we recommend single blastocyst transfer with IVF because it is the best method of achieving a single pregnancy with a term delivery. Our policy is two good-quality embryos in women under the age of 40. Except in the rarest of circumstances, we’re not comfortable with the risk of high order multiple births,” said Katz. “I would have strongly counseled Ms. Suleman and suggested she see our psychologists to discuss why she wanted so many embryos transferred.”
 
The major risk of high-order multiple pregnancies is preterm delivery, which occurs in over 50 percent of twin pregnancies, 90 percent of triplet pregnancies, and all other higher order pregnancies. The earlier a baby is born, the greater its risk of dying or facing significant lifelong problems. Many premature babies face greater risk of:

1. lower birth weight
2. bleeding in the brain
3. intestinal problems
4. cerebral palsy
5. respiratory distress syndrome,
6. developmental delays
7. learning disabilities that could last throughout their lives
8. death

 
For the mother, there are also higher risks of preeclampsia, diabetes, placental problems, caesarean section and other delivery complications.
 
Sample statistics on multiple births:

1. Birth defects such as spina bifida and heart abnormalities are about twice as common in multiple pregnancies as in single births.
2. Cerebral palsy occurs eight times more often in twin pregnancies and 47 times more often among triplets.
3. The risks continue even after birth: according to the Journal of Pediatrics, twins are five times more likely and triplets are 13 times likelier to die in the first year of life than single babies.
4. Maternal anemia occurs more than twice as often in multiple pregnancies, and high blood pressure is more than three times as likely.

 
“Twins, triplets and quadruplets might appeal to infertility patients who’ve struggled years to conceive,” Katz said. “But they don’t see the reality of a preemie or other complications that can be life threatening.”
 
The March 2004 issue of Fertility and Sterility reported that reproductive endocrinologists from the University of Iowa who surveyed more than 400 infertility patients found that 20.2 percent said they would prefer a multiple birth. Of that group, 94 percent hoped for twins; two percent wanted triplets, and four percent said they preferred quadruplets or more.