In vitro fertilization is often a last resort for couples who want to conceive. While there are other ways to experience parenthood, such as surrogacy or adoption, no other options exist for experiencing pregnancy or birth. For this reason alone, couples may often be more desperate to try any measures possible to conceive. Add in the sheer emotional fatigue, the hormone treatments and the cost, and it isn’t any wonder why so many couples opt for multiple embryo transfers.
“I am 42 and don’t want to wait a year to try again,” stated Celeste, an IVF patient from Folsom, California. “I don’t want to go through an IVF cycle again, including those awful hormones and butt shots. With twins, I get my two babies in one pregnancy, and I’m done.”
Celeste isn’t alone in her views on IVF. Many experts do understand the emotional roller coaster their patients are on, but they are concerned about how those emotions play into the decision about whether to implant more than one embryo at a time and how the decision may impact both the mother and her children.
“Patients are so desperate and so sad they cannot see things objectively,” said Dr. Natalie Cekleniak of the Institute for Reproductive Medicine at Saint Barnabas Medical Center in Livingston, N.J. “All they’re looking for is, ‘Give me my best chance to be pregnant.’ They’re not worried about twins because they don’t see the risks involved.”
Risks involved in giving birth to multiples are many, for both mother and the children she gives birth to. About 60 percent of all twins and 90 percent of all triplets are born prematurely. Premature birth presents a greater risk of death during infancy, stillbirth and health complications that may impact the child’s overall quality of life for the rest of their lives. For mothers, the risk of preeclampsia and gestational diabetes is higher, as is the need for a caesarean birth.
“Probably every other month, we hear of patients who had twins and will come back and say to me, ‘I wish we had listened to you and put in a single embryo. The babies were born at seven months and were put in the NICU,” said Dr. Louis Weckstein, owner of the Reproductive Science Center, a fertility clinic in the San Francisco Bay area. “We educate patients that transferring one embryo in select situations is almost equally as successful as multiple transfers, and there are a number of studies largely confirming this.”
The studies Weckstein is talking about highlight the benefits of growing an embryo for longer periods of time – five to eight days, which is when the embryo reaches the blastocyst stage. It is at this time that IVF specialists can help choose the most viable embryo and implant it. Success rates with this method have been shown to produce the same results as multiple embryo implanting.
“If you transfer a single embryo in women 37 or younger, or with donor eggs, and it’s a high quality embryo, we really do not see significantly different pregnancy rates versus when you transfer two high quality embryos,” Weckstein said.
Unfortunately, not all clinics have access to the same technology needed to carry embryos to the blastocyst stage, nor do they have the expertise to successfully achieve positive outcomes with single-embryo transfers. Because of this, only about 100 clinics are pushing parents to opt for single-embryo transfers.
“Centers that have difficulty growing embryos to the blastocyst stage will often put in more because their embryos don’t grow as well,” Weckstein stated. “So they put in three or four, and they all stick. That’s when disasters happen.”
Nadya Suleman, who had eight embryos transferred. All eight embryos developed and all eight babies survived. A number of complications and a great deal of controversy surrounded the octomom’s pregnancy and birth. Her story, along with the encouragement of the clinics that can successfully reach the blastocyst stage, may explain why some couples are starting to reconsider the idea of single-embryo implantation.
According to a recent study conducted by the CDC, twin births rose 76 percent from 1980 to 2009; triplets and higher-order multiples raised 315 percent during that time period. In Weckstein’s clinic, however, it seems that the trend may be changing.
In just one year, 2009 to 2010, the percentage of elective single-embryo transfers has doubled. It now sits at 30.5 percent. This is also double the national average for single-embryo transfers. So it seems that patient education and better technology is the key.
Carla B., a 33-year-old expectant mother from Calgary, Alberta may be living proof. She says that she chose a single-embryo transfer because of the mandatory video at her regional clinic. The video highlighted the risks of giving birth to multiples.
“We would move mountains to avoid our children having poor health or pain, so the time to start being a parent was before they were born,” Carla stated. “For me, it all boiled down to one question ‘Can I live with any health issues my child may have because of a multiple birth, knowing it was due to my choice to have multiple embryos transferred?’”
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Nadya Suleman at 12 embryos implanted and 8 survived.