Multiple Births

Twins: Conception of a twin gestation is a possible outcome of almost every treatment involving assisted reproductive technology, including IVF. Approximately one third of RMA IVF conceptions result in a twin birth. Many of our IVF patients consider a twin pregnancy a very desirable success. While we are constantly attempting to refine and improve IVF technology to reduce the risk of multiple gestation, we recognize that there will likely always be some chance of conceiving a twin pregnancy through IVF - and our patients should realize this as well. Techniques of blastocyst culture and transfer practiced at RMA have substantially reduced the chances of multiple conception, without sacrificing a patient's overall chance of pregnancy. In selected cases, RMA has performed single-blastocyst embryo transfers for patients in whom a twin gestation might pose a significant medical risk.

High Order Multiples: A high-order multiple pregnancy is a conception consisting of 3 or more fetuses. While the rare successful delivery of very high-order multiple pregnancies might receive international attention in the press, it is important to remember that most high-order gestations end in premature delivery. Prematurity carries a significant risk of complications for both mother and babies. When deciding on the number of embryos to recommend for transfer, our team of embryologists and physicians carefully weighs all factors with the goal of offering each patient the highest chance of pregnancy with the lowest possible risk of a high-order multiple gestation. Blastocyst culture and transfer has brought about a dramatic reduction in the incidence of high-order multiple pregnancy at RMA, and our ultimate goal is to reduce this incidence to zero. We at RMA are proud of the work we have done, and continue to do to substantially reduce the risk of conceiving high-order multiple pregnancies in our IVF program.

Multifetal Reduction: Multifetal reduction (or selective fetal reduction) is a technique developed as a possible alternative method of managing the risks associated with high-order multiple gestation. It is known that twins carry a lower risk of premature delivery than triplets or quadruplets. Selectively reducing the number of viable fetuses carried down to two has been shown in some studies to reduce the risk of premature delivery, and thus fetal complications related to prematurity. The procedure is performed by a perinatologist (high-risk obstetrician) at approximately 12 weeks gestational age (beyond the usual time of spontaneous pregnancy loss). The multifetal reduction procedure itself carries some risk of complication that may result in the loss of the entire pregnancy, and does not provide a guarantee of full term delivery. While high-order multiple pregnancies are not a common outcome of IVF at RMA, multifetal reduction can be considered as an option for patients who find themselves in this unexpected position. The issues surrounding this procedure are complex; our physicians and nurses can provide information regarding the procedure, but patients considering this option will be referred for the more detailed, expert counseling that can only be provided by a perinatologist experienced in both selective reduction and management of high-order multiple gestations. This counseling can provide the balanced information necessary for each patient to make the appropriate decision for her individual case.