I've just been reading about a "miracle" birth in the States, where a woman has given birth to quintuplets after fertility treatment. The tiny babies were born at 28 weeks and are apparently "critical but stable". It is so very sad that anyone who has had to go through the traumas of not being able to conceive should then have the further trauma of premature babies spending weeks if not months in intensive care in hospital. The babies are in an intensive care unit that has just recently been caring for sextuplets, born to a couple who had IUI.
No reputable fertility professional should be putting the lives of babies and mothers at risk by carrying out treatment which results in the conception of five or six babies at once. We are only hearing about the babies which make it as far as being born, albeit prematurely, but it would be far more common to miscarry when so many embryos implant at the same time.
In the early days of fertility treatments, when specialists were still unsure quite how women's bodies would react to fertility drugs, such multiple conceptions may have been more understandable, but there is no need for anyone to take such risks any more - and any fertility specialist who boasts sextuplets or quintuplets on their CV should be avoided as they certainly don't have their patient's best interests at heart.
Showing posts with label multiple births. Show all posts
Showing posts with label multiple births. Show all posts
Tuesday, 18 September 2012
Thursday, 16 February 2012
Triplets
How many embryos should you transfer during fertility treatment? It has been the subject of much debate recently, and I find the argument used by some medical professionals that they can do nothing to prevent their patients opting for multiple embryo transfers is fascinating. Consultants are hardly known for their inability to tell their patients what is good for them, and yet when it comes to multiple embryo transfers many are suddenly unable to overrule patients making decisions that they know very well could lead to serious medical issues.
In the UK, the Human Fertilisation and Embryology Authority is monitoring the situation and setting targets for clinics to cut their multiple pregnancy rates. Successful clinics are reducing their multiple pregnancy rate without slashing their success rates by carefully selecting the patients who are most at risk of multiple pregnancy. Some other countries, such as Sweden and Belgium, have already taken these steps but others are way behind; for example, in the United States, many clinics transfer three or more embryos.
When you are trying to get pregnant, it is easy to imagine that triplets would be a marvellous outcome - three babies all at once, an instant family and no need for any more treatment. The reality is often very far from this perfect vision. The problem with fertility consultants is that their job stops with the positive pregnancy test. They don't see the babies born very prematurely and then spending weeks in special baby care units, they don't have to witness the long term health problems or the financial and emotional impact on the parents. Of course, it is not impossible to have healthy triplets, but the risks are high.
My views on this have been swayed by interviews I've done over the years with women who've faced huge problems after multiple embryo transfers. For my very first book, In Pursuit of Parenthood, I interviewed a woman who'd had three embryos transfered and who had been overjoyed when she discovered she was pregnant with triplets. She went into labour very early and gave birth to three tiny babies. She then had to live through a horrendous week, as her three children died one after another. "We'd gone into hospital happy, pregnant with three children, come out and we were arranging three funerals. It was as simple as that", she said. She went on to have a family after more fertility treatment, but having cope with such a terrible experience convinced her, and me, that it was far better to have embryos transfered one at a time.
If you are thinking of having treatment overseas, do ask the clinic about their policy on multiple embryo transfers. I spoke to someone a while ago who was planning to go to a particular clinic overseas because they would transfer five embryos. She assumed this meant that they had her best interests at heart as she felt they were willing to take a risk in order to help her get pregnant. This is far from the case. Clinics should not need to transfer five embryos and if they do, it shows a cavalier attitude to your health and your future children's. Remember, the risks associated with multiple birth are created by the decision to put back more embryos - it's an active choice to gamble with your own future children's health. Of course, multiple pregnancies don't always end in disaster, but I think for too long fertility patients have had to suffer because some fertility consultants have not been mindful of the problems they are creating for their patients.
In the UK, the Human Fertilisation and Embryology Authority is monitoring the situation and setting targets for clinics to cut their multiple pregnancy rates. Successful clinics are reducing their multiple pregnancy rate without slashing their success rates by carefully selecting the patients who are most at risk of multiple pregnancy. Some other countries, such as Sweden and Belgium, have already taken these steps but others are way behind; for example, in the United States, many clinics transfer three or more embryos.
When you are trying to get pregnant, it is easy to imagine that triplets would be a marvellous outcome - three babies all at once, an instant family and no need for any more treatment. The reality is often very far from this perfect vision. The problem with fertility consultants is that their job stops with the positive pregnancy test. They don't see the babies born very prematurely and then spending weeks in special baby care units, they don't have to witness the long term health problems or the financial and emotional impact on the parents. Of course, it is not impossible to have healthy triplets, but the risks are high.
My views on this have been swayed by interviews I've done over the years with women who've faced huge problems after multiple embryo transfers. For my very first book, In Pursuit of Parenthood, I interviewed a woman who'd had three embryos transfered and who had been overjoyed when she discovered she was pregnant with triplets. She went into labour very early and gave birth to three tiny babies. She then had to live through a horrendous week, as her three children died one after another. "We'd gone into hospital happy, pregnant with three children, come out and we were arranging three funerals. It was as simple as that", she said. She went on to have a family after more fertility treatment, but having cope with such a terrible experience convinced her, and me, that it was far better to have embryos transfered one at a time.
If you are thinking of having treatment overseas, do ask the clinic about their policy on multiple embryo transfers. I spoke to someone a while ago who was planning to go to a particular clinic overseas because they would transfer five embryos. She assumed this meant that they had her best interests at heart as she felt they were willing to take a risk in order to help her get pregnant. This is far from the case. Clinics should not need to transfer five embryos and if they do, it shows a cavalier attitude to your health and your future children's. Remember, the risks associated with multiple birth are created by the decision to put back more embryos - it's an active choice to gamble with your own future children's health. Of course, multiple pregnancies don't always end in disaster, but I think for too long fertility patients have had to suffer because some fertility consultants have not been mindful of the problems they are creating for their patients.
Thursday, 22 September 2011
Warning over dangers of multiple births from Canada...
News from Canada of an expert in multiple births who has accused the IVF industry of "creating a population of sick babies", and has demanded to know why fertilty experts continue to put back more than one embryo.
The multiple birth rate had surged in Canada, and there had been more and more babies born prematurely with low birth weights who were at risk of long-term health problems. Although the number of twins and triplets born after fertility treatment in Canada had dropped a little more recently, it is still around 25%.
In Quebec, treatment is paid for by the state but in the majority of cases only one embryo is transferred at a time, and the multiple rate has dropped to around 5%, but in other parts of the country it's still fairly routine to put back two or more embryos.
Here in the UK, there has been considerable pressure on fertility clinics to reduce the number of multiple pregnancies and many are making great strides to achieve this. Unfortunately others are happy to continue to blame patient pressure for their decision to keep transferring two embryos even where patients are at high risk of a multiple pregnancy.
One consultant told me recently that of the couples they'd advised to have a single embryo transfer who had ignored the advice, every single one had ended up with a multiple pregnancy. The important thing to remember is that if you were going to get pregnant with twins, you will still get pregnant but with one baby who is far less likely to have health problems.
I know it can be difficult to accept single embryo transfer but that's partly because of the way the IVF industry works in this country. For too long, fertility patients have had to take risks with their future children's health and it is important to understand that by having a single embryo transferred you are not being penalised, but are being offered a greater chance of having a healthy baby - it's not always appreciated that multiple birth poses the biggest health risk to children born after fertility treatment.
For more information about single embryo transfer, go to www.oneatatime.org.uk
The multiple birth rate had surged in Canada, and there had been more and more babies born prematurely with low birth weights who were at risk of long-term health problems. Although the number of twins and triplets born after fertility treatment in Canada had dropped a little more recently, it is still around 25%.
In Quebec, treatment is paid for by the state but in the majority of cases only one embryo is transferred at a time, and the multiple rate has dropped to around 5%, but in other parts of the country it's still fairly routine to put back two or more embryos.
Here in the UK, there has been considerable pressure on fertility clinics to reduce the number of multiple pregnancies and many are making great strides to achieve this. Unfortunately others are happy to continue to blame patient pressure for their decision to keep transferring two embryos even where patients are at high risk of a multiple pregnancy.
One consultant told me recently that of the couples they'd advised to have a single embryo transfer who had ignored the advice, every single one had ended up with a multiple pregnancy. The important thing to remember is that if you were going to get pregnant with twins, you will still get pregnant but with one baby who is far less likely to have health problems.
I know it can be difficult to accept single embryo transfer but that's partly because of the way the IVF industry works in this country. For too long, fertility patients have had to take risks with their future children's health and it is important to understand that by having a single embryo transferred you are not being penalised, but are being offered a greater chance of having a healthy baby - it's not always appreciated that multiple birth poses the biggest health risk to children born after fertility treatment.
For more information about single embryo transfer, go to www.oneatatime.org.uk
Friday, 15 April 2011
Canadian study shows costs of IVF multiples
Anyone who has qualms about the aim to reduce the number of multiple births after assisted conception in the UK should look at a new study from Canada published in The Journal of Pediatrics which analyses the admissions to neonatal intensive care of IVF babies.
The research shows that a hefty 17% of the newborn babies in intensive care were the result of multiple pregnancies after assisted conception, and that a policy of single embryo transfer could save 30-40 deaths across Canada each year, not to mention many serious complications.
The researchers studied a database from one hospital over a period of some years to check for significant complications, and extrapolated those findings to the whole country. They found that twins were more likely to be premature, were more likely to be admitted to intensive care and were also more likely to have other complications. They say that although fertility specialists are aware of the risks of multiple pregnancy, they are still willing to continue with procedures that carry risks for mothers and their babies and that this is partly due to the fact that people are usually paying for their treatment. The couples are therefore willing to attempt anything that might mean paying for fewer cycles, while clinics are pressured for higher "success" rates. The researchers make it clear that they feel the medical system "sometimes has the responsibility to refuse to offer interventions that increase morbidity when there are equally effective alternatives available, which lead to lower morbidity; especially when the large part of the morbidity is suffered by another individual, in this case, the baby." They call for a system where treatment costs are reimbursed and where IVF is regulated in order to save lives and long-term additional expenses.
You can read the report in full at www.jpeds.com
The research shows that a hefty 17% of the newborn babies in intensive care were the result of multiple pregnancies after assisted conception, and that a policy of single embryo transfer could save 30-40 deaths across Canada each year, not to mention many serious complications.
The researchers studied a database from one hospital over a period of some years to check for significant complications, and extrapolated those findings to the whole country. They found that twins were more likely to be premature, were more likely to be admitted to intensive care and were also more likely to have other complications. They say that although fertility specialists are aware of the risks of multiple pregnancy, they are still willing to continue with procedures that carry risks for mothers and their babies and that this is partly due to the fact that people are usually paying for their treatment. The couples are therefore willing to attempt anything that might mean paying for fewer cycles, while clinics are pressured for higher "success" rates. The researchers make it clear that they feel the medical system "sometimes has the responsibility to refuse to offer interventions that increase morbidity when there are equally effective alternatives available, which lead to lower morbidity; especially when the large part of the morbidity is suffered by another individual, in this case, the baby." They call for a system where treatment costs are reimbursed and where IVF is regulated in order to save lives and long-term additional expenses.
You can read the report in full at www.jpeds.com
Tuesday, 15 June 2010
Indian triplets for 66-year old mother
I've just been reading about the triplets born to a woman of 66 in Northern India. Her doctor seems rather proud to announce that she is the oldest woman in the world to give birth to triplets. This was apparently her third attempt at IVF and she had three embryos transferred as the two embryos put back in the earlier cycles had failed to implant. The three babies are now in intensive care as they are very underweight.
The treatment was carried out at the same clinic in Haryana where a woman of 70 who became the world's oldest mother was treated. The clinic seems to specialise in treating pensioners and the website is quite bizarre, featuring pictures of elderly couples next to tiny babies. In India, the average age expectancy for a woman is 66 and it's even younger for a man, so the clinic are helping to create babies whose parents are highly unlikely to live past their first few years. And surely carrying three babies and then having a Caesarean at 66 is hardly going to increase your life expectancy...
It's stories like these that have to make you glad that we have such a highly regulated system in the UK, and that our fertility doctors consider what is right for potential parents and children when they are making decisions about treatment, rather than the desire to break new ground in totally unethical territory.
The treatment was carried out at the same clinic in Haryana where a woman of 70 who became the world's oldest mother was treated. The clinic seems to specialise in treating pensioners and the website is quite bizarre, featuring pictures of elderly couples next to tiny babies. In India, the average age expectancy for a woman is 66 and it's even younger for a man, so the clinic are helping to create babies whose parents are highly unlikely to live past their first few years. And surely carrying three babies and then having a Caesarean at 66 is hardly going to increase your life expectancy...
It's stories like these that have to make you glad that we have such a highly regulated system in the UK, and that our fertility doctors consider what is right for potential parents and children when they are making decisions about treatment, rather than the desire to break new ground in totally unethical territory.
Thursday, 16 April 2009
Post-natal depression and multiple pregnancy
When you're trying hard to get pregnant, it's easy to assume that having two or three babies in one go would be the ideal solution to your problem, giving you an instant family. The fact that there are medical risks attached to multiple pregnancy is well-documented, but a new study from the States has found that mothers of twins and triplets are 43% more likely to suffer post-natal depression.
More than seven thousand mothers took part in the study and the researchers found that those who had been through the stress of a higher risk multiple pregnancy and delivery were far more likely to become depressed. It was also thought to be partly due to the exhaustion they experienced caring for more than one baby. The research is published in the April edition of Pediatrics, the journal of the American Academy of Pediatrics. You can find more at www.aap.org
More than seven thousand mothers took part in the study and the researchers found that those who had been through the stress of a higher risk multiple pregnancy and delivery were far more likely to become depressed. It was also thought to be partly due to the exhaustion they experienced caring for more than one baby. The research is published in the April edition of Pediatrics, the journal of the American Academy of Pediatrics. You can find more at www.aap.org
Friday, 27 February 2009
US clinics ignoring guidelines on embryos
I've just been reading an alarming story explaining how many clinics in the US completely ignore professional guidelines on the number of embryos that should be transferred during IVF for younger women. Here in the UK, a maximum of two embryos would be used and many women under 35 are now choosing to have one embryo put back at a time to reduce the risk of multiple pregnancy.
Apparently 80% of clinics in the US regularly transfer more that the recommended number of embryos, with some routinely transferring four embryos for women who are under the age of 35. Of course, many blame "pressure from patients", which clearly indicates that they haven't made any attempt to warn their patients of the often tragic consequences of high order multiple pregnancies. What's more likely to be the cause is their own lack of awareness of the risks they are taking with the lives of these future children and their mothers - and perhaps their own inadequacies as fertility specialists, as any consultant worth his or her salt should be aiming for success without needing to transfer four embryos.
These statistics were highlighted by the recent case of octuplets in the States. In that case, the doctor claimed to have transferred just six embryos, but even six is probably five too many in a younger women who'd already had a number of successful IVF pregnancies. You can read more about the findings here
Apparently 80% of clinics in the US regularly transfer more that the recommended number of embryos, with some routinely transferring four embryos for women who are under the age of 35. Of course, many blame "pressure from patients", which clearly indicates that they haven't made any attempt to warn their patients of the often tragic consequences of high order multiple pregnancies. What's more likely to be the cause is their own lack of awareness of the risks they are taking with the lives of these future children and their mothers - and perhaps their own inadequacies as fertility specialists, as any consultant worth his or her salt should be aiming for success without needing to transfer four embryos.
These statistics were highlighted by the recent case of octuplets in the States. In that case, the doctor claimed to have transferred just six embryos, but even six is probably five too many in a younger women who'd already had a number of successful IVF pregnancies. You can read more about the findings here
Tuesday, 8 July 2008
The truth about IVF twin risks
You're probably aware of the controversy over moves to reduce the number of multiple births after IVF, but now the deep disagreements on the subject have been highlighted at a European fertility conference in Barcelona.
An American fertility specialist, Norbert Gleicher, claimed that doctors have been exaggerating the risks of twin pregnancies to try to mislead patients who will end up having more treatment if they put back one embryo at a time. His speech at the conference was immediately condemned by many leading fertility specialists, including the chair of the European conference, who are adamant that the claims are at odds with all the evidence.
Here, the Human Fertilisation and Embryology Authority has called on clinics to cut the twin rate in order to ensure babies, and mothers, do not face unnecessary risks. One of the problems with trying to do this successfully is that not all fertility doctors are behind the move and some, like Norbert Gleicher, believe the dangers are not so great.
For most patients, it is difficult to assess what any of this means in relation to your individual situation and how many embryos you should be choosing to put back in an IVF cycle. The reality is that single embryo transfer is never going to be the right thing for everyone, but for women who have a high chance of having a twin pregnancy, it can cut out the risks without having a great impact on the chances of success. How we view the risks as patients may be largely governed by how our doctors see them and if you're treated by Norbert Gleicher you're unlikely to be insisting on a single embryo transfer. If your doctor spends time explaining what the risks might mean for you, you may be happy to give it a go. If you want to find out more about single embryo transfer, there's lots of information on the oneatatime.org,uk website.
An American fertility specialist, Norbert Gleicher, claimed that doctors have been exaggerating the risks of twin pregnancies to try to mislead patients who will end up having more treatment if they put back one embryo at a time. His speech at the conference was immediately condemned by many leading fertility specialists, including the chair of the European conference, who are adamant that the claims are at odds with all the evidence.
Here, the Human Fertilisation and Embryology Authority has called on clinics to cut the twin rate in order to ensure babies, and mothers, do not face unnecessary risks. One of the problems with trying to do this successfully is that not all fertility doctors are behind the move and some, like Norbert Gleicher, believe the dangers are not so great.
For most patients, it is difficult to assess what any of this means in relation to your individual situation and how many embryos you should be choosing to put back in an IVF cycle. The reality is that single embryo transfer is never going to be the right thing for everyone, but for women who have a high chance of having a twin pregnancy, it can cut out the risks without having a great impact on the chances of success. How we view the risks as patients may be largely governed by how our doctors see them and if you're treated by Norbert Gleicher you're unlikely to be insisting on a single embryo transfer. If your doctor spends time explaining what the risks might mean for you, you may be happy to give it a go. If you want to find out more about single embryo transfer, there's lots of information on the oneatatime.org,uk website.
Thursday, 21 February 2008
Single embryo success
Doctors at a London hospital have proved that putting back just one embryo during IVF doesn't have to reduce your chances of getting pregnant.
The team at Guys and St Thomas' managed to increase their pregnancy rate from 27% to 32%, whilst cutting their multiple birth rate in half. They did this by using more developed embryos, or blastocysts, and their newly published research shows that putting just one back at a time really does work.
For too long, the risks involved in multiple pregnancies have been played down by many fertility doctors, who don't have to see the pain and anguish of miscarriage, of premature, sick babies or of children who will have health problems for the rest of their lives. Of course, not every multiple pregnancy is problematic, but the Human Fertilisation and Embryology Authority has estimated that more than a hundred IVF babies die every year as a result of multiple embryo transfers, and this is not a risk patients should have to take.
The new research shows that fertility clinics can move to single embryo transfer without cutting the chances of success, and others should be encouraged to follow this lead so that fertility patients no longer have to take unnecessary risks with their own health, and that of their future children.
You can read a report on the study, published in the British Journal of Obstetrics and Gynaecology, in The Independent
The team at Guys and St Thomas' managed to increase their pregnancy rate from 27% to 32%, whilst cutting their multiple birth rate in half. They did this by using more developed embryos, or blastocysts, and their newly published research shows that putting just one back at a time really does work.
For too long, the risks involved in multiple pregnancies have been played down by many fertility doctors, who don't have to see the pain and anguish of miscarriage, of premature, sick babies or of children who will have health problems for the rest of their lives. Of course, not every multiple pregnancy is problematic, but the Human Fertilisation and Embryology Authority has estimated that more than a hundred IVF babies die every year as a result of multiple embryo transfers, and this is not a risk patients should have to take.
The new research shows that fertility clinics can move to single embryo transfer without cutting the chances of success, and others should be encouraged to follow this lead so that fertility patients no longer have to take unnecessary risks with their own health, and that of their future children.
You can read a report on the study, published in the British Journal of Obstetrics and Gynaecology, in The Independent
Tuesday, 4 December 2007
HFEA acts to reduce multiple births
The Human Fertilisation and Embryology Authority has finally come up with a long-awaited policy to reduce multiple births after IVF, and is calling for a professionally-led national strategy to cut the twin rate to 10% over a period of three years.
Patients are often unaware of the real risks they are taking with their children's health when it comes to multiple births, and fertility clinics have not always acted in their best interests on this front. The biggest danger to the health of children conceived by IVF in the UK is multiple birth, and the HFEA estimates that around 126 IVF babies die every year purely as a result of being multiples. For many others, being a twin or triplet may mean being born prematurely and suffering life-long health problems as a result of this.
To have one healthy child at a time should be the ideal outcome of fertility treatment, but the patchy and inadequate funding for IVF and fierce commercial competition between clinics has not encouraged joined-up thinking on this matter. For too long, patients have been penalised by a system which encourages some of them to take unnecessary risks.
We must now hope that the HFEA's strategy really does make a difference, and warmly welcome the fact that the Interim Chair of the Authority, Walter Merricks, has written to the Health Minister to explain the link between patient concerns about single embryo transfer and the lack of funding for IVF treatment. Maybe now, finally, we will see a move towards the government's broken promises on this issue.
You can see the HFEA press release here
Patients are often unaware of the real risks they are taking with their children's health when it comes to multiple births, and fertility clinics have not always acted in their best interests on this front. The biggest danger to the health of children conceived by IVF in the UK is multiple birth, and the HFEA estimates that around 126 IVF babies die every year purely as a result of being multiples. For many others, being a twin or triplet may mean being born prematurely and suffering life-long health problems as a result of this.
To have one healthy child at a time should be the ideal outcome of fertility treatment, but the patchy and inadequate funding for IVF and fierce commercial competition between clinics has not encouraged joined-up thinking on this matter. For too long, patients have been penalised by a system which encourages some of them to take unnecessary risks.
We must now hope that the HFEA's strategy really does make a difference, and warmly welcome the fact that the Interim Chair of the Authority, Walter Merricks, has written to the Health Minister to explain the link between patient concerns about single embryo transfer and the lack of funding for IVF treatment. Maybe now, finally, we will see a move towards the government's broken promises on this issue.
You can see the HFEA press release here
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