All multiple pregnancies pose a risk to both mother and offspring. Pregnancy induced maternal complications such as miscarriage, pre-eclampsia, antepartum and post-partum hemorrhage become progressively more prevalent the higher the multiple gestation. For the babies, it is an escalating risk of premature birth and intrauterine growth retardation that places the offspring at risk.
While even twin pregnancies increase the risk to mother and babies, it is high-order multiples (triplets or greater) that prove to be most dangerous. In fact, in about 50% of such cases severely premature births that commonly occur in such cases, result in death or severe developmental complications such as cerebral palsy, psychomotor retardation, blindness and mental retardation; conditions which severely compromise the quality of life after birth and lead to devastating financial, social and societal hardship.
Most women going through IVF are desperate to have a baby and many are even willing to cast safety to the wind, abandon all cautions, and virtually do anything it takes to achieve success. Such women are highly vulnerable to the (fortunately) few reckless medical practitioners who might exploit such desperation.
IVF, because of an inclination on the part of many practitioners, to transfer multiple embryos at a time in the hope of improving success rates, has in the past contributed vastly in this regard. However, improving IVF technology and the ability to better identify “competent” embryos for transfer has in recent years resulted in a tendency to transfer only one or two embryos, leading to a significant decline in the incidence of high-order multiple IVF pregnancies. Notwithstanding this, the transfer >2 embryos at a time still takes place far too often and with a few exceptions (e.g. in older women with poorer quality embryos) can no longer be justified in my opinion.
There is undoubtedly a need to better inform IVF consumers regarding the risks associated with the transfer of multiple embryos (especially >2) at a time. In fact, the American Society for Reproductive Medicine (ASRM) has issued specific guidelines and recommendations pertaining to the number of embryos that should be transferred at ba time. In general terms it has been recommended that only a single embryo be transferred in cases associated with highly “competent” embryos, resulting from fertilization of the eggs of younger women and/or PGS-normal blastocysts. This recommendation is supported by data which shows that cumulatively, the number of babies generated is no greater when several embryos are transferred at one time than when only one is transferred at a time. Of course, in the case of the latter, the risk of a multiple pregnancy occurring is very small.
The Hippocratic Oath states the cardinal rule of medicine as “do no harm.” Against this background, the high rate of multiple gestations resulting from IVF is a complex problem that can no longer be justified as an acceptable side effect of treatment. It is imperative that this issue be addressed at multiple levels. This should include educating patients to the risks of high-order multiple gestations, as well as the steps practitioners can take to mitigate those risks, such as tailoring the treatment to the specific needs of each patient and limiting the number of embryos transferred.
IVF Technology is one of the successes of modern medicine. It would be unfortunate if this success were to be overshadowed by the creation of compromised offspring resulting from a growing epidemic of multiple gestations.