IVF and Multiples By Sonja Kristiansen, MD on September 05, 2013

The massive disappointment, heartbreak, and frustration of failed cycle after failed cycle can leave couples feeling like their dream of parenthood will forever remain a dream. Assisted reproductive technology (ART) has allowed patients suffering from male factor infertility and female factor infertility to overcome their obstacles and realize their dreams of parenthood.

With the new hope that assisted reproductive technology brings, there are also risks to consider. One of the most common risks associated with ART is multiple pregnancy. The specialists at Houston Fertility Center counsel patients on the risks of multiples with IVF. Twins, triplets, and higher-order pregnancies carry additional risks than singleton pregnancies. One way in which the risk of multiples can be lowered is by limiting the amount of embryos transferred during an IVF cycle.

IVF and Multiples: The Financial Cost

IVF is not an inexpensive treatment. The procedure as well as the additional costs associated with IVF adds up to thousands of dollars per cycle. The overwhelming expense of treatment may lead patients to make decisions that are not in their best interest. If a patient can only afford one cycle, she may choose to transfer a larger number of embryos than is recommended to try to increase her chances of a successful outcome. It is easy to say that expense should not play a role in determining how many embryos to transfer, but it does. Even patients that understand the medical risks associated with multiples can still feel pressure to make health decisions that are based on their financial circumstances.

What should also be considered are the additional costs that come with a twin pregnancy including the medical expenses. One of the biggest medical expenses associated with twin pregnancies is the cost of delivery. Cesarean sections are extremely common with twin pregnancies. More than half of twins are delivered prematurely. A baby born prematurely will likely require a long stay in the neonatal intensive care unit (NICU). A stay in the NICU can cost tens of thousands of dollars.

Risks of Multiples

There are many health risks for the mother and baby in a twin pregnancy, including:

Twin-to-twin transfusion syndrome (TTTS): One of the scariest complications that can occur during a twin pregnancy is twin-to-twin transfusion syndrome. Twin-to-twin transfusion syndrome affects approximately 10 percent of identical twins. In TTTS the blood vessels within the placenta that provide blood flow to the babies causes one baby to receive too much blood flow and for the other baby to receive too little blood flow. TTTS can be life threatening to both babies.
Premature birth: Premature delivery is common with twins. About 60 percent of twins are born prematurely.
Low birthweight: Premature birth results in low birthweight. Over half of twins are born weighing less than 5 ½ pounds.
Pre-eclampsia: The risk of developing pre-eclampsia is double for women pregnant with twins than for women pregnant with only one baby. Pre-eclampsia is extremely dangerous for both the mother and the baby. Pre-eclampsia is marked by high blood pressure, swelling of the legs, and protein in the urine.

Minimizing the Risk of Multiples

Advances in assisted reproductive technology have allowed for higher pregnancy rates while minimizing the risk of multiples. One of the most effective and successful methods is through blastocyst culture and transfer. In blastocyst culture and transfer, embryos are grown for five days instead of the traditional three. This allows for the fertility specialist to select the most promising and healthiest embryos to transfer. For many patients this means that fewer embryos need to be transferred, yet the pregnancy rate virtually remains the same.

Many women under the age of 35 do not benefit from transferring more than one embryo. For a patient with a favorable prognosis transferring two or more embryos only increases the risk of multiples. The best way to reduce a patient’s risk of multiple pregnancy is to consider all factors including her age, her prognosis, and the stage of embryo development. Day three vs. day five can change the course of treatment drastically. At day three two embryos may be recommended, when at day five only one is recommended.