December 2, 2013

Fertility doctors aim to slow epidemic of twins

Twins aren’t always twice as nice; they have much higher risks of serious health problems. Now fertility experts are pushing a new goal: One.

By Marilynn Marchione
The Associated Press

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The American Society for Reproductive Medicine has issued new guidelines that 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.

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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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