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Fertility doctors aim to lower rate of twin births

December 2nd, 2013 1:10 pm by AP

Fertility doctors aim to lower rate of twin births

Abigail Ernst poses for The Associated Press with her 2-month-old daughter, Lucy, in their Oldwick, N.J. home. Ernst, and her husband, Ken Ernst, conceived Lucy by using only one embryo through in vitro fertilization. With nearly half of all babies born u

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.

In
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
problems.

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.

The
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
womb.

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
doubles.

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.

Chromosome
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
time.


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