Assisted reproduction and risks of multiples

There are numerous concerns in assisted reproduction. One of the biggest concern and most known to the general public is the risk of multiples or 2 or more fetuses in one pregnancy. By the time a women is using assisted reproduction, she has gone through great disappointment through trying for several cycles (as, on average, it takes a women 1-12 months to become pregnant once beginning to try) without a successful pregnancy, some have suffered miscarriages, and invasive and expensive tests to determine the cause infertility. These women are desperate for a baby and want to utilize all possibilities to have baby. Therefore, many women will agree to transfer several embryos, with the hope that at least one will implant into their uterus and continue on to a successful pregnancy. Although there are many times when none of the implanted embryos attach to the uterus, there are also several times when 2-6 embryos implant, and the women is faced with a multiple pregnancy.

The greatest risk in a multiple pregnancy is premature delivery, which causes other serious complications. While a full term pregnancy is considered 37 to 42 weeks, twin pregnancies deliver at an average of 35 weeks, triplets average 33 weeks, and quadruplets average 29 weeks. The risk of premature delivery is 50% for twins, 90% for triplets, and 100% in quadruplets and higher multiples.1

Prematurity first leads to respiratory distress syndrome as the baby’s lungs are often not developed enough to breathe without assistance until 37 weeks. Infections and damage to other organs are also prevalent. Death is also a greater possibility as are development problems, such as cerebral palsy.1

To avoid the risks of multiple pregnancies, patients and doctors will perform a “selective reduction” if more than two embryos implant into the uterus. The doctor will perform an abortion on the fetus or fetuses that are selected to be “reduced.” However, women who have gone through so much to get pregnant and have a successful pregnancy are hesitate to abort some of their babies. However, reports show a risk of 4-6% and higher that an entire pregnancy will be lost after a selective reduction. In addition, these higher multiples are often only reduced to a twin pregnancy; therefore, the risks associated with a multiple pregnancy, thought reduced, still apply as the pregnancy is still considered a multiple pregnancy.2

The media has fueled the idea that multiples of assisted reproduction is safe. The country was awed by the birth of America’s first surviving sextuplets, the Dilleys, born in 1993. While I don’t remember the full extent of the coverage, Diane Sawyer of ABC visited the family each year on the sextuplets’ birthday to see how they were developing and growing. Though I cannot find any specific details, I believe one or two of the Dilley sextuplets suffer from mild cerebral palsy. More recently, Discover Health has given a reality TV show to a couple who had twins and sextuplets through assisted reproduction (Jon and Kate plus 8). This set of sextuplets have no medical consequences, though as they enter school, learning disabilities may present themselves. These two cases are media-worthy because they are remarkable and miraculous because the medical consequences have been so minimal compared to what the risks are.

However, a more recent birth again highlights the ethical concerns and very real risks of high order multiples. Ryan and Brianna Morrison had sextuplets on June 10, 2007, 4 ½ months early. Four of the 6 Morisson sextuplets died within a week, with a fifth baby dying in July.3 Mom was also treated for heart failure.4 The Morrisons were offered selective reduction but declined.4

While medical ethics have approved various methods of assisted reproduction, there are many very negative consequences to multiple pregnancies, which are often considered a guarantee of assisted reproduction. Therefore, perhaps the more ethical method would be to limit the number of embryos transferred. If only 2 embryos were transferred, at the most, a woman and her doctor is only looking at a twin pregnancy, which has a much greater risk of a successful, term pregnancy without disastrous consequences to mom and babies.

1. American College of Obstetrics and Gynecology and March of Dimes. Multiple pregnancy and birth: considering fertility treatments. Available at: http://www.acog.org/departments/resourceCenter/2006ModAcogAsrmMultiplePregnancyAndBirth.pdf. Accessed on October 14, 2007.
2. ACOG Committee on Ethics. Multifetal pregnancy reduction. Available at: http://www.acog.org/from_home/publications/ethics/co369.pdf. Accessed October 14, 2007.
3. 5th Minnesota sextuplet dies. Available at: http://wcco.com/topstories/local_story_204133943.html. Accessed October 14, 2007.
4. Minnesota sextuplets highlight risks of multiple births. Fox News. Available at: http://www.foxnews.com/story/0,2933,286889,00.html. Accessed October 14, 2007.