Fertility experts are increasingly advocating a different approach to in vitro fertilization that could reduce the birth rate of twins and create the best chance for healthy babies. They say transferring only a single embryo during in vitro procedures can boost the rates of healthy births and reduce pre-term labor and other pregnancy-related health problems.
"Our goal is not just to get the patient pregnant but to have a healthy live birth," says Dr. John Zhang, a board-certified OB-GYN at New Hope Fertility Center in New York City. "Multiple embryo transfers increase the rate of twins, which many times come with complications, such as preterm birth. We have to consider the strain this puts on the baby, mother and even the healthcare system."
Some potential parents may balk at this more conservative approach to infertility treatment. After all, in vitro fertilization is an expensive procedure that's often used by frustrated couples looking to ensure success by having multiple embryos transferred.
But Dr. Zhang, a pioneer in minimally invasive fertility care, explains that some patients have misconceptions about multiple-embryo procedures. Zhang has performed elective single embryo transfers as standard practice since 2005 and routinely fights the mistaken beliefs regarding what method achieves the greatest IVF success.
"Transferring a single embryo does not decrease the patients' odds of getting pregnant, and transferring two embryos does not double their chances," Zhang says. "The risks of transferring multiple embryos certainly do not outweigh the benefits of single-embryo transfers."
According to Zhang, data shows that 20 to 30 percent of embryo transfers with more than one embryo result in twin pregnancies.
Why should the birth rate of twins be reduced? It's easy to see why triplets or quads could be difficult to carry and the rate of unhealthy babies in such pregnancies would be high. But with modern technology, the idea of carrying two babies doesn't seem as life-threatening to mother and babies.
"Twin pregnancies have a higher incidence of complications resulting in C-section, which does not come without risks to the mother," Zhang says. "Although the long-term effects of twins are overall lower than triplets or quads, it is a well-known fact that 11 percent of children with cerebral palsy were from a multiple birth. This and other complications, such as pre-term birth, require babies to be hospitalized at birth and spend time in the neonatal ICU, significantly affecting healthcare costs."
Zhang says people often think about the "happy, healthy" twins. Unfortunately, many forget or choose not to consider the complications that may arise, such as unhealthy twins.
"Although for many in the U.S. this is a new concept, this has been standard practice for us since we first opened, and in some European countries, it is mandatory," Zhang says. "We have to consider the strain this puts on the baby, mother and even the healthcare system."
Though Zhang advocates his conservative in vitro fertilization approach, each infertility treatment is dealt with on a patient-by-patient basis. The key to fighting misconceptions is educating infertility patients seeking treatment.
"We focus on educating the patient and encourage autonomy in the decision," Zhang says. "We ensure that the patient understands not just the process but the risks and benefits of the treatment, regardless of their preference."