Fertility doctors don’t always tell couples these unpleasant truths–and they don’t have to deal with the sometimes-traumatic consequences of their work. Often, those tasks fall to another kind of doctor, the high-risk-pregnancy specialist. Some of these obstetricians resent their role as overseers of what they consider to be unnecessarily dangerous pregnancies. “I find myself the guy with the wet blanket,” says Dr. Peter Heyl, a maternal-fetal specialist at Eastern Virginia Medical School in Norfolk. “Champagne has been uncorked at the fertility clinic. And then I have to say, " “Hey, don’t forget, we may have premature kids that are damaged.’ They don’t want to hear that.”
For 15 years, IVF and its several offspring have proliferated without monitoring or regulation. And multiple births have soared, especially “supertwins” (three babies or more). The incidence of triplets, for example, rose seven times faster than single births between 1973 and 1990. The fertility field has become so competitive – and lucrative–that some facilities will do almost anything to increase success rates, including the implantation of as many as eight embryos during IVF to increase the chances of conception. Now, the American Society for Reproductive Medicine has decided it’s time to do a little self-policing. NEWSWEEK has learned that the group will issue new IVF guidelines within six months, limiting the number of embryos implanted during IVF to three or four. (In Great Britain, a doctor can lose her license if she implants more than three.) The goal, says Dr. Alan DeCherney, chief of obstetrics and gynecology at Tufts University, is to produce no quadruplets at all, and to reduce triplets from 5 percent to 1 or 2 percent of “assisted” pregnancies.
Many fertility doctors support such limitations and acknowledge that the criticism by high-risk pregnancy specialists has been justified. Dr. Fady Sharara, a reproductive endocrinologist at Chicago’s Michael Reese Hospital, writes letters introducing his successful fertility patients to their obstetricians. “We’re sorry to put you in this conundrum of dealing with a patient pregnant with triplets,” he writes. He sends the letters, he explains, because, “this is totally a problem that we have caused. We feel awful, because we helped the patient get pregnant, but everything that goes on in the course of the pregnancy is in the hands of another doctor.”
Patients bear some responsibility for their high rate of multiple births. In IVF, some beg doctors to implant lots of fertilized embryos, especially if they’re over 35, with declining odds of achieving pregnancy. Choosing whether to implant a few or many embryos is like deciding whether to drive at 40 miles per hour or 100, says Dr. Peter Stillman, director of IVF at George Washington University. “The faster you go in an automobile, the greater the risks. But you get there more quickly.” To him, three or four embryos would be an acceptable guideline.
IVF is not the only fertility treatment that causes multiple births. The drugs Clomid and Pergonal, commonly the first treatment given to infertile couples, stimulate ovulation and cause the release of multiple eggs in a single cycle. Often more than one is fertilized. The new ASRM guidelines don’t address these drug-induced multiple births. But the recommendations should still have important and far-reaching benefits. For one, fewer multiple births will spare mothers some of the risks they face, such as Caesarean deliveries, anemia, hypertension and post-partum hemorrhage. Couples and their high-risk pregnancy doctors also wouldn’t have to face the sober ethical dilemma of “selective reduction” (aborting some of the multiple fetuses) nearly so often. The parents of twins and supertwins frequently have marital difficulties that lead to divorce, presumably due to the medical problems of premature babies, financial strain and sheer exhaustion. So reforms in the fertility field may even save some marriages. And if insurance providers don’t have to consider the high cost of treating the preemies that result from multiple births (triplets cost about $64,000, compared with $5,000 for a single birth), they may be more willing to cover IVF. And that could turn many more infertile couples into parents.
