In Vitro Fertilization and Multiple Birth Risk - Essay Example

In Vitro Fertilization and Multiple Birth Risk Hypothesis: In Vitro Fertilization poses high risk of multiple birth during fertility treatment.A multiple pregnancy is a pregnancy involving more than one fetus. Though twins are the most common type of multiple pregnancy, the largest multiple pregnancy recorded till date involves birth of nine offspring. In the United States, the incidence of higher-order multiple pregnancies (triplets or greater) has increased 100-fold whereas births of single individuals (singletons) rose only six percent in that same time period. The incidence of multiple pregnancies of all types has been increasing worldwide as advanced types of infertility treatment have become more common. (http://www.womenshealthchannel.com/multiplepregnancies/index.shtml) There are many infertility treatments in practice, In Vitro Fertilization being the most common one. In Vitro Fertilization Pre-Embryo Transfer (IVF-ET) is a fertility procedure which first succeeded as recently as 1978 by Dr. Edwards (an embryologist) and Dr. Steptoe (a gynecologist) in England. Since then the technology has been further refined and developed by physicians and embryologists. Since its introduction in the US in 1981, more than 114,000 babies have been born as a result of IVF. In fact, 32% of IVF-assisted births result in twins, and 5% result in triplets and higher. During the procedure, a man's sperm and a woman's eggs are combined outside of the body in a laboratory dish. If fertilization occurs, the resulting embryos are transferred to the woman's uterus, where one or more may implant in the uterine lining and develop. With the introduction of more than one fertilized egg, the chances of multiple births are increased. (http://www.ivf.com/ivffaq.html) (http://www.mbmc.org/healthgate/GetHGContent.aspxtoken=9c315661-83b7-472d-a7ab-bc8582171f86&chunkiid=88288) In 1993, Swedish physicians voluntarily reduced the number of transferred embryos from three to two, which virtually eliminated the conception of triplets in that country. However, IVF-assisted birth rates stayed constant, as did the rate of twin births. A study published in the December 2, 2004 issue of the New England Journal of Medicine looked at how transferring a single embryo, as compared to two, affects the rates of single and multiple births. The findings of the study was that transferring a single-fresh-embryo resulted in 91 (27.6%) live births. This rate of live births was significantly lower than the double-embryo-transfer group, in which 142 (42.9%) live births were recorded. Although this still was a lower success rate than the double-embryo group, it was certainly comparable. The 142 live births in the double-embryo transfer group resulted in 46 pairs of twins and one set of triplets. In comparison, only one pair of twins resulted from 128 live births in the single-embryo transfer group. The study's authors concluded that a single fresh-embryo transfer, followed by single frozen-and-thawed embryo if necessary, resulted in a marked decrease in the rate of multiple births, but not a substantial reduction in the rate of successful pregnancies. (http://www.mbmc.org/healthgate/GetHGContent.aspxtoken=9c315661-83b7-472d-a7ab-bc8582171f86&chunkiid=88288) Multiple pregnancies are associated with a higher risk of premature birth, low birth weight and complications such as cerebral palsy. For the mother, there is a higher risk of pregnancy-related high blood pressure, postpartum depression and other problems. Due to these reasons, Britain, Germany, Sweden, Switzerland and other European countries have banned putting more than three embryos in women undergoing IVF. Doctors who break the rules can lose their licenses, pay fines or face incarceration. The U.S. has only voluntary guidelines. In 1999 the American Society for Reproductive Medicine recommended that no more than two embryos should be placed in women under 35 undergoing IVF who produce healthy embryos. Those women who produce poor embryos could get three. Older women could get more. The voluntary guidelines were further tightened in 2004. They now state that women under 35 with a good prognosis should consider only one embryo and that no more than two should be transferred in this age group except under extraordinary circumstances. The new guidelines also say women between 35 and 37 should get only two embryos if they have a good prognosis. If they don't, they should get three but no more. A study published last year in the New England Journal of Medicine suggests the 1999 guidelines resulted in a slight overall drop in the number of embryos used in IVF treatment in the U.S. The average number of embryos per IVF cycle in the U.S. declined to 3.2 from 3.6 right after the guidelines were issued. Nonetheless, many fertility doctors say the guidelines continue to be sidestepped. A review by The Wall Street Journal of CDC records for 2002 showed that 130 of 391 clinics, or 33%, still placed on average more than three embryos in women younger than 35. (http://www.mindfully.org/Health/2005/Multiple-Births-Risks7oct05.htm) The increase of multiple births is also age related. According to the National Center for Health Statistics, over the last 20 years, multiple pregnancies in the United States have increased 400% among women in their 30s and 1000% in women in their 40s. This trend is due in part to the fact that older women are less able to get pregnant naturally and are more likely to undergo infertility treatment. A study conducted to examine multiple birth rates stratified by maternal age showed that the number of embryos needed to achieve maximum live birth rates varied by age. Among women 20 to 29 years and 30 to 34 years of age, maximum live-birth rates of 43% and 36% respectively were achieved when two embryos were transferred. The corresponding rate for women 35 years and above was less than 12%. (http://www.womenshealthchannel.com/multiplepregnancies/index.shtml) (http://jama.ama-assn.org/cgi/reprint/282/19/1832.pdf) Couples considering IVF can best evaluate and compare in vitro fertilization clinics when they have a thorough understanding of the outcome results of the program. Some IVF centers have very low pregnancy success rates and some others have high rates. All couples considering IVF treatment should get a written statement of their clinic's recent success rates and evaluate them in relation to other clinics. The biggest variables affecting a program's IVF success rates are quality of the laboratory environment, skill and experience of the embryology staff, skill and experience of fertility specialists, and the average number of embryos transferred per procedure. (http://www.advancedfertility.com/ivf-pregnancy-rates.htm) Fertility treatments are no doubt a boon to those infertile couples who are desperately looking forward to having children of their own. However, in my opinion, fertility treatments like IVF procedures have inherent risks such as the risk of multiple births. Doctors, with an intention to fulfill the demands of patients desperate to get pregnant as well as to meet competition in the field by achieving higher success rates, are disregarding ethical practices and also the safety and well being of their clients. I think fertility treatments can prove to be highly helpful if they are practiced with more stringent compulsory rules in the background, rather than mere recomendatory rules. Bibliography "Multiple Pregnancy - Overview, Multiple Pregnancy and Infertility Treatment". Swierzewski, Stanley J. 04 Dec 2007. 01 Apr 2009. "In Vitro Fertilization (IVF-ET)". Georgia Reproductive Specialists. 01 Apr 2009. "Single-Embryo Transfer in In-vitro Fertilization". Calvagna, Mary. 01 Apr 2009. "Baby Boom: Multiple Births Persist as Doctors Buck Guidelines". Westphal, Sylvia Pagan. 01 Apr 2009. "Live-Birth Rates and Multiple-Birth Risk Using In Vitro Fertilization" Schieve, Laura. Peterson, Herbert. Meikle, Susan. Jeng, Gary. Danel, Isabella. Burnett, Nancy. Wilcox, Lynne. 01 Apr 2009. "IVF Pregnancy Success Rates: Why do they differ so much between clinics, and what do they mean". Gurnee & Crystal Lake. The Advanced Fertility Center of Chicago. 01 Apr 2009. Read More