The common practice of giving infertile women hormone treatments to increase the chances of pregnancy carries such a high risk of multiple births that doctors should avoid the treatment, researchers conclude in today's New England Journal of Medicine. Dr. Emily Senay talked to us about implications of the study.
Multiple birth babies are frequently premature, low-weight infants in need of expensive, neonatal intensive care. According to the study, of the 441 women who became pregnant, 9% had triplets, quadruplets, quintuplets or sextuplets. The natural rate of such multiple births is 0.01%.
The researchers said a better alternative may be in vitro fertilization because, with the test tube baby technique, doctors can implant just two fertilized eggs at a time, dramatically reducing the risk of a woman having more than twins.
Gonadotropin therapy (or hormone therapy) is "the single most widely used treatment for infertility in the United States and world wide. Although the widespread use of in vitro fertilization would increase health care costs, they said, the costs are also high when a woman becomes pregnant with three or more fetuses and the babies are born prematurely.
The lead author of the study, Dr. Norbert Gleicher, says that he hopes this changes the way fertility specialists treat woman. And his two biggest concerns about media coverage of infertility stories are, the celebration of multiple births and of famous women who have babies in their 40s, both are bad ideas, according to Gleicher.
"When they happen they are hailed as miracles of modern medical science," says Dr. Norbert Gleicher, lead author of the study. "But pregnancies with multiple births can carry big risks including lifelong handicaps as a result of being born prematurely." Gleicher says multiple births should be avoided at all cost.
"The Centers for Disease Control and Preventions (CDC) has declared multiple birth an epidemic," says Gleicher. "I think we are seeing a tremendous increase in multiple births in this country."
Most of these multiple births are the result of standard therapy. Women are given hormones that stimulate the ovaries to produce eggs followed by artificial insemination. The number of eggs produced with this method cannot be controlled so multiple fetuses can result. Doctor Gleicher says fertility specialists should opt for a more expensive technique called in vitro fertilization.
"If we make a decision in a young woman that we will transfer only one or two embryos then the most she'll end up with is twins," says Gleicher.
During in vitro fertilization the eggs are removed and fertilized in the lab. Doctors can then re-implant just two or three eggs. Pascale Karras chose this method instead of standard therapy because she did not want to face a multiple birth pregnancy.
"The problems that these babies have from deafness and blindness, and then problems throughout their lives," says Karras. "It was to me ust a situation that seemed unbearable."
For couples considering treatment they will have to weigh the added cost of in vitro against the risk of having a multiple pregnancy.
Dr. Gleicher says that in vitro cycle also gives you two and a half to three time the pregnancy chance, "so on a per pregnancy basis IVF is not more expensive."
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