Multiple births: what's new?

When couples turn to fertility treatments they're looking to add a child to a loving home - not to make headlines.

The controversy in early 2009 with the birth of octuplets in California has raised concerns regarding practices in fertility and brought into question medical standards that fall outside of established guidelines, such as those set by the American Society of Reproductive Medicine (ASRM), the Canadian Fertility and Andrology Society (CFAS), and the Executive and Council of the Society of Obstetricians and Gynaecologists of Canada (SOGC).

The California Medical Board is currently investigating the physician who implanted six embryos into a woman, two of which divided into twins. Dr. Daniel A. Potter, medical director of Huntington Reproductive Center in Southern California, shared his view with the New York Times: "If someone came in and wanted to transfer six embryos in a situation like we're talking about, we have an obligation to protect the patient and not let the patient do things that are unreasonable."

In Canada there are strict CFAS-SOGC guidelines set out for the number of embryos transferred in an IVF (in-vitro fertilization) cycle.

In women under the age of 35, no more than two embryos should be transferred. Women in that same age group who have an excellent prognosis should have one embryo transferred. An excellent prognosis include women going through a first or second cycle of IVF or a cycle immediately after a successful round of IVF, with at least two high-quality embryos available for transfer. A high-quality embryo is an embryo with no or minimal fragments or unevenness.

No more than three embryos should be transferred in women aged 35 to 37. Candidates with high-quality embryos and favourable prognosis can transfer up to two embryos in the first or second round of IVF.

For women aged 38 to 39 years, there should be no more than three embryos transferred in a cycle. Patients with high-quality embryos and favourable prognosis can consider the transfer of two embryos in the first or second round of IVF.

After the age of 39 years, no more than four embryos should be transferred. Women with high-quality embryos should have three embryos transferred, if they're available.

Only in exceptional cases where a woman has had multiple unsuccessful attempts at IVF should transference of more embryos than what's been recommended above be considered.

While general consensus in the past was to implant more embryos to increase the rate of success, recent data has shown that the odds of having a successful pregnancy do not decrease when only two embryos are transferred, which will also reduce the chances of multiple births.

These guidelines clearly outline the goal of Canadian fertility experts - to help patients conceive while avoiding high-risk pregnancies. Your local fertility clinic and the professionals working there strive to ensure that couples have healthy and successful pregnancies. Like you, they know that the gift of a child is truly special. To get the facts, see a fertility specialist in your area.

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