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.

IVF twins risk

New research suggests that twins born after IVF are more likely to be premature and to have health problems than twins conceived naturally. Although it has been known for some time that twin pregnancies carry additional risks for mother and babies, it has often been assumed that these are risks for any twin pregnancy, no matter how it began. Now it seems that the risks are greater for IVF twins although it isn't clear why this should be.

It's yet another argument for moving away from multiple embryo transfers wherever possible - I think that fertility patients have often been misled about the risks of twin pregnancies by consultants who are focused on pregnancy rates. We should be pressing for more affordable and more successful treatment so that single embryo transfer becomes the perfectly acceptable norm for younger women who are deemed to have a good chance of success.

You can read more about the research, which is published in Human Reproduction at http://humrep.oxfordjournals.org

Heart disease in IVF twins

Researchers in the United States have discovered that IVF twins have an increased risk of congenital heart disease, although single IVF babies have no greater risk than the rest of the population.

The team at Yale University say their research suggests that some previous reports of high rates of congenital heart disease in IVF babies may be a result of the high levels of multiple births after IVF rather than anything else.

The study looked at more than 2,000 patients and found the IVF twins had a three-fold increase in rates of congenital heart disease. The research comes as UK clinics are being urged to cut their multiple birth rates, and may be another statistic to take into consideration in the debate about single embryo transfer.

There's more information about the study on the Yale University website.