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Past Article of the Month Originally Published 05/08/2009
When One More is Too Much: The Risks of Having Multiples

The birth of octoplets in the United States made headline news and elicited many reactions. As remarkable as this event has been, it has also raised an alarm causing many to question the ethics, and need for regulation, of assisted reproductive technology (ART). Although the American Society for Reproductive Medicine (ASRM) suggests guidelines in the use of ART, there are currently no laws controlling this industry. A survey of patients who were undergoing infertility treatment found that 41% thought that having a multiple would be ideal; the longer they were in treatment without success, the more desirable it became. This is entirely understandable given that the medical and emotional price tag of infertility treatment is so high. While creating an instant family may seem like a good solution, the complications associated with having two (or more) can be significant. There are considerable health threats to both the mother and the infants. Multiples are at higher risk for prematurity and low-birth weight. Compared with singleton births, for example, cerebral palsy was found to be 4 times greater for twins; for triplets or higher, the risk was 17 times greater. The cost, both emotionally and financially, for the treatment of children with major handicaps, can be an onerous responsibility for the family as well as society. For mothers, the medical risks associated with multiples can include: gestational diabetes, hypertensive disorders, pre-eclampsia, placenta abruption, preterm labor, pulmonary problems and caesarian births. It is not uncommon for a woman carrying more than one baby to be put on bed rest for a significant part of her pregnancy. Thus there may be a loss of wages, increased feelings of isolation and/or depression, and an extra burden on other family members to pick up the slack. The accepted wisdom is that the odds of having at least one embryo take will be higher with the transfer of multiple embryos. Thoughts on this logic are changing, however, with more doctors opting to transfer only one embryo, especially in women under 35, specifically because of the dangers involved. If you are over 35 years old, and have been trying for a long time, the physical, emotional and financial fatigue from numerous failed attempts may be enough reason to transfer more than one embryo. It is crucial, however, for you to have a clear understanding of all the issues at hand. While success is often measured by a positive pregnancy test, it does not take into account all the potential traumas that may occur with multiple gestations. Before proceeding with any ART we recommend that you do a cost to risk analysis, with the help of your medical doctor and mental health professional. Being as informed as possible will allow you to weigh the plusses and minuses, and move forward with building your family in the best possible way. * Back
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