Why one baby at a time?
Some very simple basic reasons.
Why am I talking about this?
Because once again, I spoke to a patient who was hoping for twins. One boy, one girl. Done.
I get it.
Never have to go through fertility treatment again?
I get it.
We all get it, actually.
Your doctors, your nurses, your medical staff, they get it too.
But we also get how much more challenging a pregnancy is with more than one baby.
We want you to have the healthiest possible outcome.
We all see multiple pregnancies that are healthy and uncomplicated.
We also see babies that have serious health problems and mothers that are on bedrest for months at a time, often with their own health problems.
We try to avoid this. We are encouraged to avoid this. Both SART (Society for Assisted Reproductive Technologies) and ASRM (American Society for Reproductive Medicine), the two professional organizations dedicated to reproductive medicine, ask us too. Tell us to, actually.
There are guidelines that infertility programs in the United States are supposed to follow. the guidelines dictate how many embryos are transferred in an IVF cycle. The amount of embryos depend mainly on diagnosis and age of mother.
Most infertility programs follow these guideline. Check. Ask. If your program does not follow these guidelines, you may want to consider a different program.
Yes, we do get it. Creating a family via fertility treatment is very challenging and stressful. Not to mention time consuming and financially difficult.
Having the chance to do it all at once is tempting. Very, very tempting.
We want to support you having as healthy a family as possible.
That's our job.
IVF. In vitro fertilization. Stimulating a woman’s ovaries to produce more than one egg, removing the eggs, and fertilizing the egg and embryo in the laboratory. ESET. Elective Single Embryo Transfer. Simply put, regardless of how many embryos are created, only one, in any given cycle is transferred to the uterus.
An international study just released is showing that a woman with an ESET is five times more likely to carry a baby to term.
This is the news of the day. Japan, Ireland, Britain, the United States and Scotland and many other countries all over the world are all ready talking about it.
A telling quote, “As a result, many clinics in Europe -- but few in the U.S. -- have begun transferring single embryos to reduce multiple births.”
"Considering the apparent advantages of single embryo transfer, Allan Templeton, MD, also of the University of Aberdeen, questioned why the practice is not used more extensively in the U.K. and U.S."
Many patients in the United States, at least, can answer that question easily enough, as does Dr. Templeton in his later comments:
"Many point out that Sweden, the Netherlands, Belgium, and Finland have adequate public funding of infertility treatment, whereas in the U.K. and even more so the United States, couples often have to find the funding themselves," Templeton wrote in an accompanying BMJ editorial.”
Certainly we do know that paying for fertility treatment in the United States can be a significant burden. Mandated coverage for fertility treatment varies from one state to another. Different insurance policies cover some things and not others. It is the unusual person in the United States who does not have to factor in financial cost for fertility coverage.
Perhaps the news in this article to consider most carefully:
"Couples in this situation will want to maximize the outcome from one procedure, even though the extra costs of cryopreservation and transfer in an unstimulated cycle are minimal and, in most hands, the procedure is very effective," he commented.”
RMACT is one of those fertility programs in the United States that actively encourages ESET and has had tremendous success to show for it. The above statement by Dr. Templeton can be seen as a way to minimize the financial burden for the patient. The single biggest reason that patients would prefer a double embryo transfer (or more) is for their chances of pregnancy to be increased, with less IVF procedures and therefore, less financial cost.
If in fact, we can see that from one IVF cycle, that multiple FET (frozen embryo transfer) cycles are possible, at less cost financially, as well as being less invasive (an unmedicated intrauterine insemination (IUI) cycle), then perhaps we can approach patients about ESET as an effective way of preventing multiple births as well as being financially sound.
If one looks at the cost of one IVF cycle and several FET cycles, that would be considerably less than several IVF cycles. Then factor in that carrying multiple pregnancies comes with risk, including financial risk. It’s possible, at the very least, that there will be more time missed from work due to more complications with the pregnancy. It’s also very possible that there will be a more complicated birth, often lower birthweights for multiples, and sometimes significant health issues for both the babies and the mother.
It’s very gratifying to read this study and the comments being made about it all over the world and knowing that right here, in our own corner of the world, we’re already on board. This study confirms that our own practice here at RMACT is healthier on all fronts for babies and mothers, as well as showing that it can be even more financially feasible for patients than just avoiding multiple IVF cycles.