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Fertility doctors aim to lower rate of twin births

AP • Dec 2, 2013 at 1:12 PM

BOSTON — Doctors are

reporting an epidemic — of twins. Nearly half of all babies born with

advanced fertility help are multiple births, new federal numbers show.


the five years since the "Octomom" case, big multiple births have gone

way down but the twin rate has barely budged. Twins aren't always twice

as nice; they have much higher risks of prematurity and serious health


Now fertility experts are pushing a new goal: One. A

growing number of couples are attempting pregnancy with just a single

embryo, helped by new ways to pick the ones most likely to succeed. New

guidelines urge doctors to stress this approach.

Abigail and Ken

Ernst of Oldwick, N.J., did this to conceive Lucy, a daughter born in

September. Using one embryo at a time "just seemed the most normal, the

most natural way" to conceive and avoid a high-risk twin pregnancy, the

new mom said.

Not all couples feel that way, though. Some can only

afford one try with in vitro fertilization, or IVF, so they insist that

at least two embryos be used to boost their odds, and view twins as two

for the price of one.

Many patients "are telling their physicians

'I want twins,'" said Barbara Collura, president of Resolve, a support

and advocacy group. "We as a society think twins are healthy and always

come out great. There's very little reality" about the increased

medical risks for babies and moms, she said.

The Centers for

Disease Control and Prevention's most recent numbers show that 46

percent of IVF babies are multiples — mostly twins — and 37 percent are

born premature. By comparison, only 3 percent of babies born without

fertility help are twins and about 12 percent are preterm.

It's mostly an American problem — some European countries that pay for fertility treatments require using one embryo at a time.


American Society for Reproductive Medicine is trying to make it the

norm in the U.S., too. Its guidelines, updated earlier this year, say

that for women with reasonable medical odds of success, those under 35

should be offered single embryo transfer and no more than two at a time.

The number rises with age, to two or three embryos for women up to 40,

since older women have more trouble conceiving.

To add heft to the

advice, the guidelines say women should be counseled on the risks of

multiple births and embryo transfers and that this discussion should be

noted in their medical records.

"In 2014, our goal is really to

minimize twins," said Dr. Alan Copperman, medical director of

Reproductive Medicine Associates of New York, a Manhattan fertility

clinic. "This year I'm talking about two versus one. Several years ago I

was talking about three versus two" embryos.

The one-at-a-time

idea is catching on. Only 4 percent of women under 35 used single

embryos in 2007 but nearly 12 percent did in 2011. It's less common

among older women, who account for fewer IVF pregnancies, but it is

gaining among them, too.

"Patients don't really want multiples.

What they want is high delivery rates," said Dr. Richard T. Scott Jr.,

scientific director for Reproductive Medicine Associates of New Jersey,

which has seven clinics in that state.

Better ways to screen

embryos can make success rates for single embryos nearly as good as when

two or more are used, he contends. The new techniques include maturing

the embryos a few days longer. That improves viability and allows cells

to be sampled for chromosome screening. Embryos can be frozen to allow

test results to come back and more precisely time the transfer to the


Taking these steps with single embryos results in fewer

miscarriages and tubal pregnancies, healthier babies with fewer genetic

defects and lower hospital bills from birth complications, many

fertility specialists say.

Multiple studies back this up. In May,

doctors from the New Jersey clinics did the kind of research considered a

gold standard. They randomly assigned 175 women to have either a single

embryo transferred after chromosome screening or two embryos with no

screening, as is done in most IVF attempts now. Delivery rates were

roughly equivalent — 61 percent with single embryos and 65 percent with


More than half of the double transfers produced twins but

none of the single ones did. Babies from double transfers were more

likely to be premature; more than one-third spent time in a neonatal

intensive care unit versus 8 percent of the others.


testing and freezing embryos adds about $4,000 to the roughly $14,000

cost for IVF, "but the pregnancy rates go up dramatically," and that

saves money because fewer IVF attempts are needed, Scott said. Using two

or more embryos carries a much higher risk of twins and much higher

rates of cerebral palsy and other disorders.

After explaining the

risks, "this is the easiest thing in the world to convince patients to

do," Scott said of screening and using single embryos.

But Dr.

Fady Sharara of the Virginia Center for Reproductive Medicine in Reston,

Va., found otherwise. For a study, he offered 48 couples free

medications and embryo freezing if they would agree to transfer one at a

time instead of two. Eighteen couples refused, including one-quarter of

those whose insurance was covering the treatment. Some who refused said

they viewed twins as two for the price of one.

"I tell my

patients twins are not twice the fun," Shahara said. "One is hard

enough. Two at a time is a killer for some people. Some marriages don't

survive this."

The New Jersey couple who had a daughter using a

single embryo has eight more frozen embryos. When it's time to try

again, Abigail Ernst said, "we would do the same thing" and use one at a


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