Our national fascination with Nadya Suleman (aka “Octomom”) continues. I think we are drawn to all multiple births, so I guess it’s logical that we’d be more engrossed in the ultimate of all multiple births—octuplets. This fascination is fueled by the tinge of horror because Suleman actively attempted to have eight children by having eight (or six embryos as she claimed in the past) embryos transferred. All the other cases of super multiples (6+) that I know of were the unintended consequence of taking ovulatory stimulating injectible drugs with IUIs (artificial insemination).
I read an article recently that asserted that one consequence of our national fascination with Octomom is the increased awareness of the risks of multiple births and an increase in patients opting for single embryo transfer. Oh, if only it were true!!
The CDC reports that the twin birth rate rose 76 percent from 1980 to 2009, while triplets and higher-order multiple births rose a staggering 315 percent. Certainly there has been increased awareness that the ultimate goal of infertility treatment is one healthy baby, but I’m not so sure that we’ve convinced most patients that their best chance of success is with single embryo transfer. The risk associated with twin births is totally downplayed in our society. Few people know that 60% of twins are born premature, with an increased risk of death, cerebral palsy, mental retardation, lung problems, eye and ear impairments, and learning disabilities. Or maybe the real truth is that most people “know” the risk on some level, but believe that it won’t happen to them. They want to believe that they will somehow be able to control their pregnancy by eating just right, moving just right, sleeping just right, and thinking just right so that they and their children will be in the 40%. The problem, of course, is almost 100% of moms pregnant with twins from fertility treatment believe this, and only 4 out of 10 will be right.
We have a solution to this problem of twin births from IVF, especially for younger women (35 and under)–single embryo transfer. The problem is that only around seven percent of women under 35 choose an elective single-embryo transfer. I see this in the people I talk with in our large online community as well. The problem is multifaceted…the desperation to get pregnant, the perception of decreased success rate when using only one embryo, plus the ever present issue of cost.
Most patients by the time they reach the infertility clinic for IVF are emotionally and financially tapped out. They just want to be parents. Period. It’s a hard sell to get them to transfer only one embryo when they can up their odds by transferring two and have an instant family. So, what are the odds of getting a baby when only one embryo is transferred?
Three recent metal analyses found that birth rates after fresh embryo transfer of one cleavage stage (day 3) embryo were 26% compared to 43% for double fresh embryo transfer. When blastocyst stage (day 5) embryos were used, one study found that the ongoing pregnancy rate for single fresh embryo transfer was 61% versus 76% for double fresh embryo blastocyst transfer. The twin rate, however, for these double blastocyst transfers was a frightening 47%, while none of the single blastocyst transfers resulted in twins.
The problem with most studies of single embryo transfer is that they only look at the first fresh transfer. Assuming that most people electing to transfer one embryo have frozen embryos remaining, it is important to assess the birth rate after one fresh and one frozen cycle. In other words compare the results from transferring two embryos at two different times versus transferring two embryos at one time. In one well designed double-blind, randomized multi-center study of 661 patients under age 36, the birth rate of cleavage stage (day 3) embryos did not differ significantly between two single embryo transfers (one fresh, followed by one frozen) and one double embryo transfer. Of course, the cost of one fresh and one frozen transfer is usually more than the cost of one double transfer, but not significantly more at most clinics.
As much as I want to believe that there is an upside to Octomom, I’m not so sure that it is happening. As I said above the vast majority of patients do not elect to transfer only one embryo unless it is strongly encouraged by their infertility clinic, and the sad fact is that only about 100 existing clinics in the US and Canada are making this push. Anecdotally, I hear that the clinics that require patients to watch a video on the risks of twin pregnancies have a much greater success with patients choosing the more conservative single embryo transfer. It would also help if fertility clinics would make the cost of two single embryo transfers (one fresh and one frozen) the same as one double embryo transfer.Image credit: NY Daily News