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Monday 3rd May, 2004
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Multiple-infant pregnancies are associated with complications for both the
mother and her baby.
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In a study published in the latest edition of The New England
Journal of Medicine, a group of researchers from Boston evaluated the
incidence of multiple-infant pregnancies (pregnancies involving three or
more fetuses) in infertile women treated with assisted reproduction
techniques (ART).
Assisted reproduction techniques, which have been around since the
70s, involve union of the egg and sperm in the lab, then placing a
number of fertilized eggs back into the women. To increase the chance of
implantation several embryos are transferred at once. This comes at a
price however, as it also increases the risk of multiple-infant
pregnancies.
Multiple-infant pregnancies are associated with complications for both
the mother and her baby, including much higher rates of miscarriage,
premature birth, higher need for cesarean delivery, birth defects, and
higher rates of infant death. Assisted reproduction techniques are
responsible for a 100-fold increase in the occurrence of multiple-infant
births over the past two decades.
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Study details
Tarun Jain et al. from Boston's Brigham and Women's Hospital analyzed
data on assisted reproductive techniques from 1995 until 2001 by
fertility clinics in the U.S. They found a decline in the incidence of
pregnancies three or more fetuses by 4% in 2001. This decline reflects
better technique in particular decreasing the number of transferred
embryos. They also found that the pregnancy rates in those undergoing
ART were on the increase which strengthens the notion that decreasing
the number of transferred embryos does not affect overall pregnancy
rates.
Current guidelines call for a maximum of two embryos transferred per
attempt at assisted reproduction for infertile women with the most
favorable prognoses for becoming pregnant. These women are usually under
35 years old. In women with a below average chance of becoming pregnant
with assisted reproduction techniques, a maximum of five embryos are
transferred. These are women who are 45 and older and who have had
numerous failed attempts at assisted reproduction.
The study also reviewed figures on the rates of twin pregnancies in
the U.S. from 1980-2001. They found, however, that the rates of twin
pregnancies did not improve which may require further tightening the
guidelines by decreasing the number of embryos transferred per attempt.
Like higher-order births, twin births are associated with greater
obstetrical and neonatal morbidity and mortality.
References
Tarun Jain, M.D., Stacey A. Missmer, Sc.D., and Mark D. Hornstein,
M.D. Trends in Embryo-Transfer Practice and in Outcomes of the Use of
Assisted Reproductive Technology in the United States. NEJM, Volume
350:1639-1645.
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