Octuplets Could Have Been Prevented

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Medical Contribution By Dr. Roberta Stillmn

The birth of Los Angeles octuplets is big news. Fortunately -- incredibly -- the babies and mother are doing relatively well. Sadly, we are learning as of this writing (Feb 2, 2009) that the eight children born from one pregnancy in California last week were indeed the result of in vitro fertilization (IVF).

This story is not typical of ethical fertility treatment. It is a departure from the norm for virtually every other woman and man who are considering the use of assisted reproductive technology (ART) to build their families.

IVF is one of the most controllable and successful forms of ART. The proper use of IVF, per the guidelines of the American Society for Reproductive Medicine and other expert groups, has as its primary goal a singleton pregnancy and birth of a healthy child. Because of advances in the science and practice of ART, elective Single Embryo Transfer (eSET) is a viable option for many patients who need IVF to conceive.

Study after study of virtually all parameters -- physical, developmental, social, financial -- tell us that the mothers of multiples, and especially “high-order multiples” (three or more babies), are endangered during pregnancy, and the impact on the babies is a cascade of potentially life-threatening or altering conditions.

With eSET, the risks of multiple pregnancy are eliminated. Fertility patients, however, may be worried that IVF with eSET will result in lower chances at a baby per cycle. A retrospective review of over 15,000 IVF cycles performed by Shady Grove Fertility physicians reveals significantly positive news for patients about eSET and an appeal for insurance providers to reconsider their thinking that IVF is the treatment of last resort.

“This was the largest eSET study yet conducted,” says Dr. Roberta Stillmn, Medical Director of Shady Grove Fertility. “Importantly, we demonstrated that eSET can be used successfully without compromising pregnancy rates and that patients who tend to use eSET are more aware of the risks for multiples. We also learned that the more a patient has to pay for their IVF cycle out of pocket, the less likely they are to choose eSET, along with the inverse.”

In short, the study exposes the role that insurance, or the lack thereof, plays in any continuing possibility of multiple babies from assisted reproductive technology.

“This was powerful data supporting that insurance coverage of IVF will lead to more patients electing to transfer only one embryo,” Stillman emphasizes. “It would accordingly result in lower costs to the insurance company by way of reducing the far greater neonatal intensive care expenses that often come with twins and invariably with high-order multiples.”

“In the past, when intrauterine insemination (IUI) and IVF rates were similar regarding chances of getting pregnant per cycle, it made sense to utilize IVF only as a last resort,” says Stillman. “Now, the benefits of IVF over IUI are dramatic. However, insurance companies are often bringing up the rear in that regards. We have many patients who need to bypass IUI -- there’s demonstrably lower chances that they’ll conceive with it versus IVF; yet their insurance company may require they go the IUI route first before even considering IVF, if they’ll cover it at all.”

Patients who need IVF may overlook the inherent risks of multiple pregnancy, but not because they really want to have a high-risk situation for themselves and their babies. As the study concludes, patients are more likely to choose eSET when they feel freed from financial constraints and resulting pressures to transfer more embryos in each IVF cycle.

Dr. Stillman and the rest of the Shady Grove Fertility’s physicians understand patients’ reasons for hesitance toward eSET. He says they have “perfectly legitimate reasons, coupled with the misunderstanding about the health and development risks of multiples. They also worry about having to pay for additional IVF cycles. Sometimes, they want to complete their family with one pregnancy, especially if they’ve been struggling with trying for awhile.”

So Stillman sees the patients’ perspective and requires they receive full and up-to-date education prior to their final choices. Very importantly, the Shady Grove Fertility study showed that “good-prognosis patients” can significantly reduce twin pregnancies without compromising pregnancy rates by using eSET.

“It’s our responsibility as professionals to provide all sides of this equation,” elaborates Dr. Stillman, “that is, the risks of multiple pregnancy and their chances of conception per cycle. We found that when patients fully understand the real potential for dangers to the mother and infants with multiples, their interest in transferring more embryos subsides considerably.”
 

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