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10/26/2006

The first person to complain about "implant" gets it

Two news items of interest, ruthlessly excerpted:

IVF experts advise limits on embryo transfers

Medical groups representing U.S. fertility experts, alarmed by rising numbers of multiple births, on Tuesday advised limiting the number of embryos implanted in women undergoing in-vitro fertilization.

The new recommendations (PDF, 56KB) to fertility specialists, which are not enforceable, call for transfer of no more than two embryos for women under age 35, and say the transfer of a single embryo should be considered.  For women aged 35 to 37, no more than two later-stage or three earlier-stage embryos should be transferred, according to the new guidelines.  The recommendation rises to as many as four embryos for patients aged 38 to 40 and to five embryos for women over the ago of 40.

(Yes.  Yes.  I know Reuters used "implanted" where they should have used "transferred."  I don't much care, and that's not the point.  Keep reading.)

March of Dimes Applauds Effort to Reduce Multiple Births

The March of Dimes applauds new fertility treatment guidelines from the American Society of Reproductive Medicine (ASRM) calling for a limited number of embryos — in some cases only one — to be transferred during in-vitro fertilization procedures.

More than one-third of pregnancies conceived using assisted reproductive therapies (transferring a fertilized egg into a uterus) result in a multiple birth.

The March of Dimes also suggested additional steps, beyond the ASRM guidelines, to help women make informed decisions about fertility treatments:

  • Require informed consent documents include explicit information about the risk of multiples and premature birth.

  • Requires annual review of clinics’ performance and publish a list of those with highest and lowest rates of higher-order multiple births.

Now, a very quick sketch of my initial reactions:

  1. I don't see anything immediately unreasonable about the guidelines.  I once read an article that stated that the goal of IVF should be "a healthy singleton pregnancy," and I am largely in agreement with that statement.
  2. I'm all in favor of single-embryo transfers.  If I ever had more than one good-looking embryo to transfer, I would strongly consider it.  However, and this is a big however, I have a history of getting pregnant, even when I had only one to transfer, and I am not interested in carrying twins.  But my position is almost entirely theoretical; I have never faced the situation of having three pretty embryos — or even three ugly ones — at a clinic whose frozen success rates are low.
  3. Although I've been willing to risk getting pregnant with twins, I never actively desired them, and hoped it wouldn't happen.  But my understanding is that many, many infertile women — most? — do hope to complete their families with a single pregnancy, risks be damned.  If a list were published advising infertile couples on which clinics had the highest rate of ongoing twin pregnancies, I wouldn't be surprised to see those clinics' patient load increase dramatically.
  4. Before we began IVF we were given clear and detailed information on the risks of multiple pregnancy and birth, including prematurity.  I would have thought that was common practice, but the March of Dimes seems to suggest that it's not.

What do you think?  Are these guidelines — which are, as Reuters takes pains to emphasize, unenforceable — reasonable or overly restrictive?  Under what conditions would you consider a single-embryo transfer?  Did your clinic make you aware of the risks of multiple pregnancy?  And when pregnancy itself seemed so remote a chance to begin with, did you care?

Addendum: The ASRM recommendation, linked above and available for a limited time, contains this passage:

Strict limitations on the number of embryos transferred, as required by law in some countries, do not allow treatment plans to be individualized after careful consideration of each patient’s own unique circumstances. Accordingly, these guidelines may be modified, according to individual clinical conditions, including patient age, embryo quality, the opportunity for cryopreservation, and as clinical experience with newer techniques accumulates.

...which makes it that much more reasonable, huh?

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