Infertility treatments cause rise in multiple births

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Birth rates for twins, quadruplets and higher-order multiples have soared in the past three decades, an increase that's been linked to the number of women using infertility treatments. Drugs used to stimulate ovulation have been blamed for the vast majority, according to the American Society for Reproductive Medicine.

In the United States, in vitro fertilization treatment is at a record high. More than 61,000 babies were born through in vitro in 2012, the latest data available show.

Dr. John Elliott has been involved with caring for more than 101 sets of quadruplets since 1984. He's an authority in perinatal services and is the medical director of Valley Perinatal Services in the Phoenix region.

Assisted reproductive technology accounts for more than 95 percent of all high order multiple pregnancies, according to his office. Under Dr. Elliott's care, mothers of quadruplets carry almost 33 weeks, compared to the average of about 30 weeks, greatly reducing the risks for developmental delays.

He instructs mothers to follow a high-protein diet, bed rest at about 18 weeks, at-home contraction monitoring and aggressively uses drugs to stop early labor. While he's widely published his results, he said there is still a prevailing attitude among doctors that a woman should try to selectively abort quads instead of carrying them. He said there are also risks to selective reduction, or choosing which fetuses to abort.

"Everybody is piling it on you that you must reduce in order to have any chance of having healthy babies," Elliott said. "I'm not a religious zealot at all but I do believe in the right to have informed consent. There are very good chances that you can be successful carrying a quadruplet or quintuplet pregnancy."

Still, over the past decade, the Society for Assisted Reproductive Technology and its affiliate, American Society for Reproductive Medicine, have focused on ways to reduce multiple births. The Society for Assisted Reproductive Technology's report released earlier this year showed fewer embryos are being transferred at one time and more people are choosing to transfer a single embryo at time.

This led to the reduction of the number of twin and triplet births.

"Even when a woman is older, we try to transfer as few as possible," said Dr. Charles Coddington III, president of the Society for Assisted Reproductive Technology, which represents almost 400 clinics, or most American facilities and a professor at Mayo Medical School in Rochester, Minn.

Still, it's not an exact science and there's no guarantee against multiples. Two to three embryos are often placed at a time.

Dr. Craig Sweet, Specialists in Reproductive Medicine & Surgery in south Fort Myers, has found that few patients wish to transfer only one embryo, which may or may not become a pregnancy.

"Unfortunately, in America, a lot of people like a two-for-one sale and it is difficult to explain to patients what the potential consequences are of a twin pregnancy."

In the United States, the doctor and the patient decide the number transferred, though there are recommended guidelines. Doctors factor in a woman's age and whether the embryos are fresh or frozen, which have lower implantation rates. The practice differs in other countries. In Italy, for example, doctors are only able to create the number of embryos they are able to place, Coddington said, noting that Italian doctors have been vital in teaching lessons about freezing eggs.

In 2012, the American Society for Reproductive Medicine lifted the label of "experimental" from the practice of freezing eggs and it's now considered a standard part of the practice.

Historically, success with frozen eggs has been lower, but the technology for freezing eggs has improved in the past decade, said Dr. Paula Amato, chairwoman of the American Society for Reproductive Medicine's ethics committee and an associate professor at Oregon Health & Science University in Portland.

If people didn't want many excess frozen embryos left over due to religious and ethical concerns, doctors could offer to leave half of the eggs unfertilized so they'd be dealing with frozen eggs rather than frozen embryos, she said.

Sweet still normally tries to fertilize as many eggs as possible because just one of three will become healthy embryos and less than half of those embryos will become a pregnancy. Technology has improved, but only about 60 percent of frozen eggs survive thawing, he said.

In his experience, trying to restrain the number of embryos created adds cost and decreases the odds for the desired result: a baby.

"When I have tried to play these games in the past, the patient almost always loses."