Julie: There has been a lot of discussion and debate about multiple births through infertility treatments. Talk a little bit about that.
Dr. Lucidi: Sure. The treatment options we use most frequently are the oral medications. With those drugs, things like Clomiphene, there is a slightly increased risk of twins. With those drugs, triplets and higher are almost unheard of, that is, the “lower tech” treatments. It is the higher tech treatment options where we often get into the multiple births. With the injectable drugs, if we stimulate the ovaries and make a lot of eggs and then do something like have the couple have intercourse or do an insemination, then we have no control over how many of those eggs will fertilize and implant in her uterus. It is because of that that we keep a very close eye on her, when we are doing this type of stimulation, and if she has more than 3 or 4 follicles, 3 or 4 eggs in her ovaries, we will cancel the cycle at that point and tell her “Don’t even think about getting pregnant until your next menstrual period”. The other thing is that with in vitro fertilization we now have the embryos in our laboratory in the incubator and we can control how many embryos go back into her uterus. So most of the higher order multiples that you hear about in the news are not with in vitro fertilization and they are not with the conservative oral medications, they are with that “in between”, and it is that in between area that there is a lot of effort going on into being more conservative and reducing the risks of higher order of multiples.
Julie: I didn’t realize that. I thought they were IVF cases. How do you decide how many embryos to implant when you are in that IVF case? Does that depend on the case?
Dr. Lucidi: It depends on a number of different factors, including the woman’s age. The older she is, the lower her pregnancy rate is going to be. All of these factors are designed, or, all of these factors will determine the risk of multiple pregnancy and the chance of pregnancy, and our goal is to maximize the chance of pregnancy while still minimizing the risk of multiple pregnancy. So, the woman’s age is one factor we consider; so is the age of the embryo. If the embryo has been cultured for three days versus if the embryo has been cultured for five days-- a five day old embryo has a slightly better chance of causing a pregnancy. Also, how the embryo looks-- if the embryo is kind of falling apart, and doesn’t look like it is a very good quality embryo, it has a lower chance of causing a pregnancy than one that looks like it is ready to be put in a textbook as one of the photos. Other things to consider are her history, if she has done IVF multiple times before without success, we might get a little more extra aggressive with an extra embryo, but in general, somebody who is young, less than 35, with good quality day five embryos, we want to put in one embryo, a single embryo transfer. In somebody who is over 42, with poor quality embryos, who has failed IVF multiple times before, in that case we may put in 4 or 5, but in no case would we put in 8 and cause an "Octomom".
Julie: So really the goal is that one healthy embryo that implants. The goal isn’t ever for triplets or twins.
Dr. Lucidi: No, I tell my patients my goal is to get you as many babies as you want, one at a time.