The world’s first test-tube baby, Louise Brown, will celebrate her 40th birthday this year 2018. A mother of two naturally conceived children herself, Louise Brown was a revolution in medical science when she was born and, as the first of a generation, her success still gives inspiration to the medical community to this day.
Since Louise Brown’s birth it is estimated that 5 million babies were conceived through IVF methods, the efficiency and sophistication of which have evolved tremendously over the decades. While Louise Brown’s life has seen success after success, IVF treatment is often associated with a range of complications for both mothers and children. But these concerns can all be pushed to the background when a couple is struggling to conceive.
Indeed, one of the biggest challenges any young couple could face is that of having children.
Difficulty conceiving can become one of the major hurdles a man and a woman face in the beginnings of their relationship and this problem has a major impact on both parties, in some cases leading to depression and strain on the marital relationship.
Thankfully, through in vitro fertilization treatment, many couples that once struggled to have children are now able to have children.
In fact, not only are these couples able to start a family, but also they are doing so with multiple new members. And this is a trend that is worrying for many doctors.
A widespread phenomenon documented by research is that couples that tend to have IVF treatment have a greater chance of twins. Now there is evidence that couples may be seeking in vitro fertilization treatments simply for this reason.
So families struggling to have even one child could end up with two in the process. While that might sound like a great situation, it often is a medically complex one that is fraught with potential problems.
Statistics from Ireland show that the number of twins born in the country has doubled while the overall birth rate itself has declined. According to The Times, Ireland’s Central Statistics Office recorded a near 80% increase in twin births between 1985 and 2015, rising from 10.5 per 1000 to 18.6 in 2015.
Patients are increasingly aware of this trend and some are even seeking IVF treatments to possibly conceive twins. More than 40% of all IVF treatments in the United States result in twin births according to the New York Times. This number would give hope to parents wanting to jumpstart their family and make IVF an appealing way to accomplish this. One of the more common explanations for this phenomenon is that doctors often transfer multiple fertilized eggs to the womb in the hopes of success. Often this results in multiple conceptions or twins, even triplets.
Medical professionals, however, caution against using this approach as a way to increase the chances of having a multiple birth. Other fertility organizations are joining physicians in this recommendation and are even backing up their calls with research and documented case studies about the impact of multiple pregnancies on both mothers and children.
One of the major hurdles to IVF treatments are the costs associated. Some patients consider the cost of IVF treatment with the potential of having twins as a fair tradeoff to make to expand one’s family. Doctors warn patients looking to specifically have twins that IVF treatment is not a guaranteed process.
Doctors say the phenomenon of IVF patients expressing a desire for twins is common, but physicians counsel against this being the goal and purpose of IVF treatment.
This is in addition to the fact that mothers who have multiple births are more likely to face complications, including death. Low weight and birth defects are also more common with multiple births. These aspects of twin pregnancies rarely factor into the calculus of families trying to conceive even one child but doctors say patients looking to IVF to merely increase their chances of having twins are looking at the treatment through a flawed lens.
This especially becomes noticeable when taking into account the broad range of outcomes for both mother and children. Low birth weight and other conditions at birth can sometimes impact a child throughout life. Doctors also cite the increased likelihood of a newborn from a multiple pregnancy requiring neonatal intensive care units or with lasting physical and mental scars like cerebral palsy. Mothers are likely to develop high-blood pressure, gestational diabetes, preeclampsia, premature labor, placental abnormalities, cesarean delivery, and prolonged hospitalization. Multiple births increase this likelihood.
Another less scrupulous factor that may contribute to the boom in twin births through IVF is IVF and fertility clinics who, in the goal of promoting the successes of their treatments, often tout multiple births. This has the effect of enticing consumers looking for not only one child but two and gives the false impression that IVF treatment and a subsequent multiple pregnancy are not serious matters to consider but rather the results of an abundantly successful treatment. It is not difficult to see, especially when thousands upon thousands of dollars are involved, how patients and doctors could be aiming at cross purposes with this marketing tactic.
This has led to many doctors and fertility organizations recommending that treatments now only transfer one fertilized embryo rather than multiple embryos in the hopes of dissuading consumers from pursuing IVF in the hopes of having twins.
Issuing this advice has led to the decrease in IVF multiple births from 50% in 2009 to 22 percent in 2015 according to the New York Times.
In August 2016 the American College of Obstetricians and Gynecologists said that the method of transferring just one fertilized embryo at a time not only resulted in successful pregnancies but also decreased the risks associated with multiple births dramatically.
IVF treatments in the United States, in particular, can be quite expensive for patients – often starting at $20,000 a cycle. Most health insurers in the USA do not cover IVF treatments, leaving patients to fend for themselves. This has the market effect of IVF patients in the United States being from markedly more affluent backgrounds than in any other countries where IVF may be covered by a national health insurance scheme.
What you have operating in the United States, a market-driven, consumer oriented IVF market with a consumer base that is mainly affluent and, in some cases, desperate, is a cocktail for abuse of the system. Making the treatment both successful and cost effective means taking into account how IVF is currently perceived in the marketplace. Most physicians turn to patient educational outreach as one of the biggest ways to discourage people from seeking multiple pregnancies.
Often when faced with the myriad of complications that can result from multiple pregnancies, patients demur and choose to perhaps only transfer one fertilized egg at a time.
Education will help consumers distinguish between solid, necessary medical treatment and a slick a marketing campaign. Clinics are incentivized to show off their successes and have little reason to brag about complications; however, it is incumbent upon both patient and doctor to pursue the procedure involving the least medical risk to both patient and a potential child. When couched in this language, IVF treatment becomes a necessary step towards having a child, not a shortcut to having an instant family.
In fact, a cursory search of Google and IVF related terms will quickly uncover common search results like “IVF twins success stories” and other such related terms which would indicate that IVF, at least in the US consumer market, is definitely regarded as a means for securing a multiple birth if a patient is so inclined.
For its part, the March of Dimes organization is advocating for a wholesale reform of the IVF industry, advocating for single-embryo transfer and better patient educational efforts. In addition, the March of Dimes wants fertility clinics to become more considerate in how they market their materials and to head off attempts by patients to unnecessarily seek IVF treatment in the hopes of having twins.
IVF is an amazingly revolutionary treatment for couples experiencing difficulties conceiving and, while an old procedure at this point, it is far from a perfect process. Patients should seek the options best available to them given their health status and should discuss any treatments with their physician prior to undergoing an IVF procedure.
Article exclusively provided for AskTheDoctor.com by Keith Lutz