Fertility doctors aim to reduce the rate of twins

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. "I n 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. Article: 3rd December 2013 www.huffingtonpost.com

Single embryo IVF with genetic screening has high success rates

The transfer of one pre-screened embryo during IVF leads to birth rates equivalent to transferring two unscreened embryos, indicates new research from the USA. Preliminary results presented at the American College of Obstetricians and Gynecologists Annual Clinical Meeting revealed that single embryo transfer combined with preimplantation genetic screening (PGS) resulted in fewer twin pregnancies and better health outcomes for both mother and child. 'Single embryo transfer with comprehensive chromosome screening has the potential to be paradigm-shifting and revolutionary in the world of IVF', explained lead researcher Dr Eric Forman, of Reproductive Medicine Associates of New Jersey (RMANJ) at the Robert Wood Johnson Medical School. 'Patients can do single embryo transfer and maintain excellent delivery rates while not taking on the treatment-related risk of multiples', he added. Infertility treatment currently accounts for 18 percent of twin deliveries in the USA. However, multiple pregnancies carry increased health risks to the mother and child. In the study 175 women aged 43 or younger received either a single pre-screened chromosomally normal embryo or two unscreened embryos. Results so far indicate equivalent pregnancy rates in the two groups. No twins resulted from single embryo transfers whereas 53 percent of double embryo transfers led to multiple pregnancies. At present only ten percent of women in the USA opt for an elective single embryo transfer. Dr Forman noted that most women choose to have multiple embryos transferred because they feel that this improves their chances of becoming pregnant. However, as more people become aware of the success rates of single embryo transfer, its popularity as a treatment option may increase. 'The technology exists today to make single embryo transfer the standard of care across age groups, eliminating the vast majority of complications stemming from IVF, while maintaining excellent delivery rates for couples who have struggled with infertility', explained Dr Forman. PGS adds an extra cost to fertility treatment in the USA and research is ongoing at RMANJ to establish whether in the USA this cost is offset by the reduced healthcare burden associated with lower risk singleton pregnancies. Article: 13th May 2013 www.bionews.org.uk