Three strategies to minimize multiple pregnancies with IVF treatment

Having twin pregnancy has become almost synonymous with undergoing the IVF treatment. And, my patients often ask me if they can conceive only twins with IVF? Here I share what are the best practices to optimize the outcome of IVF treatment and minimize the incidence of twin pregnancies.

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With rising incidence of infertility, IVF treatment becoming more commonly available and all the technological innovations with IVF procedure, there is an ever growing focus on minimizing the complications associated with IVF treatment. One of the common risks associated with IVF, which is also a major cause of distress among couples preparing to start IVF treatment, is the risk of multiple pregnancies. In fact, having twin pregnancy has become almost synonymous with undergoing the IVF treatment. And, my patients often ask me if they can conceive only twins with IVF? In reality about 1 in every 4-5 pregnancies resulting from ART are twins, a rate much greater than in the general population (1 in 80 pregnancies). The incidence of triplets and quadruplets is also higher among women undergoing ART. However, the majority of ART pregnancies (about 70%) are singletons.

The risk of multiple pregnancy in IVF cycle exists primarily because of the tendency to transfer more than one embryo inside the uterus to increase the chances of pregnancy. This is done as there are no tests or procedures which can assure us of pregnancy after IVF. The process of implantation of an embryo in the womb is a complicated one, and what  transpires between the embryo and the womb that results in positive or negative pregnancy outcome is not fully understood. Therefore, in order to increase the chances of transferring an appropriate embryo, more embryos are transferred at a time. But, this puts the woman at risk of multiple pregnancy. But this does not mean that in the pregnancy rates increase proportionately to the number of embryos transferred. In fact, rather that increasing the overall pregnancy rates, transferring more than one embryos in one cycle actually increases the risk of multiple pregnancies, as more than one embryo may implant at a time.

Having twins may actually even sound tempting to many patients who have struggled to have a baby for long, but it is not as good as it sounds. Multiple pregnancy is associated with a higher rate of maternal, fetal and neonatal complications and is now considered as the single biggest risk of fertility treatment. Good practice in IVF aims to reduce risk of multiples in an IVF, whilst maintaining the overall chances of becoming pregnant. This is achieved by proper patient selection and counselling. I follow these three simple strategies to achieve the best clinical outcome from IVF procedure –

  1. Young women who have the best chance of conception also have the highest chance of conceiving multiples, so I prefer to do single embryo transfer in these patients. The remaining embryos can be frozen and preserved for later use
  2. An extended culture of embryos up to the day 5, called as blastocyst culture, allows us to select the best embryo for transfer, thereby improving the chance of pregnancy with single embryo transfer.
  3. For carefully selected set of women, who have had multiple IVF failures and who are not fit or willing for blastocyst culture, I transfer two high quality embryos, which gives the best possible chance of pregnancy with minimum possible risk of multiple pregnancies.

To sum it up, we need to counsel all our patients that only success parameter in any IVF cycle is a healthy baby born to a healthy mother, and reducing the number of embryos transferred in a cycle is a significant step in achieving this objective. Patients should be counselled about the risks associated with transferring many embryos and also explained the option to freeze the spare embryos, if any. If needed, subsequent cycles with both fresh and frozen embryos would give them even better cumulative pregnancy outcome than putting in several embryos in one cycle itself.

Do write to me at ivfgurgaon@gmail.com if you have any questions about IVF.

 

IVF treatment and twins – role of multiple embryo transfer

One of my patients whom I was counselling for IVF treatment for her primary infertility recently asked me a very basic question about the procedure and its outcome. She asked me – “Doctor, can I conceive only twins with IVF?”. This again prompted me to think about this very important aspect of fertility treatment – the risk of multiple pregnancy resulting from multiple embryo transfers. Some big celebrities like Celine Dion, Julia Bradbury and Jennifer Aniston and our own Farah Khan have been in news for conceiving multiple babies with IVF and that somehow makes many women undergoing IVF treatment to think that IVF produces multiple pregnancy only.  In this post, I  will try to explain the reasons for multiple pregnancies resulting from IVF treatment and how can this be avoided.

According to global evidence, approximately 25% of total births resulting from ART treatment are twins, a rate much greater than in the general population (approximately one in 80 births). The incidence of triplets and quadruplets is also high among pregnancies resulting from IVF treatment. However, the majority (approx. 70%) of pregnancies resulting from IVF treatment are singletons. With an ever increasing focus on optimizing treatment outcome and reducing complications associated with IVF treatment, the risk of multiple pregnancies with IVF has become  one of the most important considerations while planning the IVF cycle.

The process of implantation of an embryo in the womb is a complicated one and we still do not know what transpires between the embryo and the uterus when they come in contact with each other, and therefore, we do not completely understand the reasons for a positive or negative pregnancy outcome also. Since there is no test or procedure that can assure pregnancy with IVF – an expensive treatment not generally covered by insurance policies – the physicians naturally want to enhance the probability of pregnancy and consider putting in more than one embryos. The risk of multiple pregnancy in IVF cycle derives from this tendency among treating physicians to transfer more than one embryos inside the uterus in order to increase the odds of pregnancy.

Pregnancy rates with IVF treatment appear to peak with transfer of three or four embryos. However, the risk of multiple pregnancy also increases at the same time. Multiple pregnancy is associated with   a higher rate of maternal, fetal and neonatal complications and is considered as the single biggest risk or complication of fertility treatment.

Good practice in IVF treatment aims to reduce the risk of multiple pregnancy whilst maximizing the overall chances of conception. This is achieved by proper patient selection and counselling.

  1. Young women who have the best chance of conception, also have the highest chance of conceiving multiples. Therefore, I always offer them a single embryo transfer at a time and freeze the rest of the good quality embryos for later use.
  2. An extended culture of embryos up to the day 5, called as blastocyst culture, helps in better embryo selection for transfer into the uterus. I advise blastocyst culture for patients with more than 3 good quality embryos and transfer a single blastocyst in such patients.

I also believe that treating physicians should counsel the patients that only success parameter in any IVF cycle is a healthy baby born to a healthy mother and reducing the number of embryos transferred in a cycle is a significant step to achieve that goal. Patients should be counselled about the risk associated with transferring many embryos and also explained that freezing the spare embryos and transferring them in subsequent cycles if needed  would give them even better cumulative pregnancy outcome than putting back many embryos in one embryos transfer.

Please contact me at ivfgurgaon@gmail.com for any queries related to IVF or any aspect related to infertility treatment.