Infertility is becoming an increasingly common concern in the United States. More couples are choosing to wait until later in life to have children. While waiting does allow time for the parents to complete their education, pay off debts, or find a good career, it can also mean higher chances of infertility and medical conditions that complicate pregnancy. When simpler treatments and technique have failed, medication-induced ovulation and in-vitro fertilization (IVF) offer new hope for these established couples who are struggling with fertility issues.
While the effectiveness of these interventions is well-publicized, they have also gained a reputation for being too effective, in some cases. Stories of couples who undergo infertility treatments and end up getting more than they expected are rampant. Some outcomes extend beyond twins and triplets and even into quintuplets, sextuplets and other “higher-order” multiples.
While these babies are certainly an overabundance of joy to their families, these stories can leave others who are interested in these treatments wondering why the risk might be greater, or even if these risks can be mitigated.
The risk and reward of multiple eggs
Couples who undergo IVF are determined to overcome the obstacle of infertility, often at great emotional and financial costs. Frequently, infertility patients must weigh the potential success rate of over-stimulating their ovaries and transferring multiple embryos at once (with IVF) against the potential risks of carrying multiples.
The decision isn’t a simple one. Multiples come with a unique set of medical challenges that make both the pregnancy and delivery more complicated for both the mother and the babies.
For many of these couples who have been struggling to conceive, multiples can be a desired outcome and multiple eggs can be extra insurance against failure. However, even couples who chose to take these risks are often not planning to have quadruplets or more.
Ovulation induction is unpredictable
Frequently, prior to IVF, medications like Clomid or Gonal F are used to cause the ovaries to ovulate more effectively. Unfortunately, despite monitoring of estradiol hormone levels and watching the ovaries using ultrasound in order to predict “ovarian hyper stimulation,” sometimes two or three or more eggs slip out. This technique is the most likely to end up in higher-order multiples. In some cases, your doctor will warn you against carrying more than three babies due to the very high risks of quads and more.
Splitting is more likely with IVF
While IVF patients often accept the risk of multiples if they choose to transfer more than one embryo, there’s another hidden risk that can occur after the embryos are transferred. This extra risk for higher-order multiples is due to the same sort of splitting that occurs to create identical twins.
IVF can increase the chances of embryos splitting, so two eggs can quickly become three or four or more. This possibility is sometimes not adequately communicated to IVF patients. Unlike the choice of how many embryos are transferred, splitting is beyond prediction or control of your doctor and of the patient. This is why couples who might have only transferred two eggs can find themselves with triplets or more.
Even electing to use only one egg for IVF doesn’t guarantee against multiples. The elevated risk of splitting still remains, and one egg can become twins or more.
Although the risk of multiples is higher with IVF and other advanced reproductive techniques, for many couples the benefits outweigh the risks. these interventions can overcome the diagnosis of infertility and bring the joy of pregnancy and parenthood to families who desperately want children. If you’re considering infertility treatments, be sure to discuss your concerns with your doctor. Although ovulation induction and IVF are often effective, it’s important to be aware of the potential risks and complications.
Always speak with your doctor if you have any questions or concerns. No pregnancy is perfect, but I hope your pregnancy is the very best it can be.
Be safe, be well and have fun!
David L. Berry, M.D.
Founder and Staff Physician
Austin Perinatal Associates