Multiple births: beyond the facts

The world was stunned when the full details of Nadya Suleman's octuplet pregnancy were revealed, making it one of the most popular topics around the water cooler. The physician at the fertility clinic who implanted six embryos in Ms. Suleman did not appear to have followed fertility guidelines set by the American Society of Reproductive Medicine.

In Canada, the Canadian Fertility and Andrology Society (CFAS) and the Society of Obstetricians and Gynaecologists (SOGC) came together to develop joint CFAS-SOGC guidelines for the number of embryos to transfer following IVF (in-vitro fertilization). In general, the recommended number of embryos to be transferred per cycle depends on a number of factors, one of which is age.

There is a higher proportion of multiple births linked to IVF procedures and other fertility treatments than seen with naturally occurring pregnancies. Of the 1,645 deliveries resulting from IVF and intracytoplasmic sperm injection (ICSI) procedures in 2001, 31.5% were multiple births.

Complications surrounding multiple births are also well documented. For example, more than 50% of twins and 90% of triplets are born preterm (before 37 weeks) and have low birth weight, among other potential complications. Compared with single births, twins are born on average three weeks early and triplets six weeks early. It's also important to keep in mind that being pregnant with multiple births also put the mother at risk of serious complications.

Dr. Jon Barrett, chief of maternal and fetal medicine at Sunnybrook Hospital in Toronto, said in a recent Globe and Mail article that there has been a 300% increase in the incidence of twins and triplets in the past 10 years, largely due to fertility medications. And the emotional cost of multiple births is high.

Parents suffer with their children as they face increased birth defects, cognitive development challenges, and childhood hospitalizations and surgeries. The unpublicized side of multiple births also takes a devastating toll on the family as parents cope with the multiplied demands of parenting, extreme fatigue, and 24-hour child care. Even the strongest of families feel unrelenting stress and pressure, which can escalate into marital discord and severe financial hardships.

The Ontario government stopped funding IVF in the late 1980s, and some see this as having been the start of the boom in multiple births in that province. At $10,000 per IVF cycle and without financial assistance from the government, couples want to get the most out of their money, knowing that double embryo transfers result in higher live birth rates compared to single embryo transfers.

There may be an answer to the dilemma of multiple births. A recent study showed eSET (elective single embryo transfer) was actually preferred and chosen by patients when they were freed from financial pressure.

Ontario is not alone in its stance on the issue of public funding for fertility treatments. Addressing the need for publically funded IVF, the joint SOGC-CFAS guidelines state that funding of IVF would limit the number of embryos transferred. This reduction would lower health care costs by reducing the number of multiple births and the resulting complications.

A fertility specialist can help you sort through the multiple facts and see how relevant they are for you. Your local fertility clinic will welcome any inquiries you may have.  

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