Fertility Treatment Advances Increase Risks Of Multiple Births, Newsweek Opinion Piece Says

"Overlooked in the happy news" that more than two million women worldwide have been able to give birth after in vitro fertilization are the "troubling surges in neonatal deaths, developmental disabilities and other long-term problems," Mark Evans, director of Comprehensive Genetics in New York City, writes in an opinion piece that will appear in Newsweek's March 2 issue. Evans, who describes himself as an "obstetrician and medical geneticist who specializes in developing new prenatal screening and diagnostic tests," writes that he performed the first selective-reduction abortion procedure more than 20 years ago. He writes that he "couldn't believe" the news that 33-year-old Nadya Suleman gave birth to octuplets conceived through IVF. He added that although the high cost of IVF places "enormous pressure to get patients pregnant -- fast," most physicians "prefer to avoid multiple births" because of the increased risks to the health of the woman and infant.

Evans writes that he is "one of a small cadre of experienced, high-risk obstetricians who now offer selective reduction for higher-order multiples," which is "accomplished -- usually at about three months of gestation -- by reducing the number of fetuses down to a manageable number, usually two." To determine which fetuses to reduce, most patients undergo genetic testing the day before the procedure "so we get back significant information about the pregnancy," Evans says. The "first priority is if there is a confirmed abnormality," followed by any other "suspicious" findings, such as indications of Down syndrome or other conditions, he writes. "Finally, if nothing else matters, we can take into account gender preferences if the couple has them," Evans says.

Reproductive medicine in the U.S. "has mostly been a political exercise hijacked by conservatives to promote a 'right to life' agenda and not patient welfare," Evans writes, adding that if "fertility doctors don't want government to step in, they've got to find ways to enforce their own guidelines and crack down on egregious behavior, such as the conduct that gave us the octuplets." Current guidelines from the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology state that only one or two embryos should be transferred into a woman younger than age 35. However, an average of 2.4 embryos are transferred in the U.S., and one-third of such transfers result in twins, and 4.3% result in triplets or more, according to Evans. In women older than age 35, the overall pregnancy rate declines dramatically, while the proportion of multiple births rises, he notes.

Selective reduction "can be an agonizing decision for a parent, but most of the couples who come to me have had a longstanding infertility problem," and selective reduction is "just one more hurdle to deal with," according to Evans. He continues that couples are "better able to cope when they know the facts: a woman with a quadruple pregnancy has about a 25% chance of losing all four babies, but she can decrease the loss rate to about 5% by reducing to twins." The "risks of prematurity, cerebral palsy and genetic abnormalities (if tested) are all reduced, too," he adds.














Evans writes that selective reduction "will always be controversial." He continues, "A woman has an abortion because she wants -- for whatever reason -- to not have a child. But women who have reductions are often desperate to have children." Reduction "may be the best way -- sometimes the only way -- for that to happen" in high-risk situations, Evans says, adding that he "realize[s] that in the minds of pro-lifers, this reasoning is flawed." However, "if performing this procedure means that couples who have suffered years of anguish can have their own healthy children, I'll take all the criticism I get," he concludes (Evans, Newsweek, 3/2).


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