Reducing Maternal and Child Morbidity

Canada has one of the highest rates of multiple births following in-vitro fertilization in the world.  Doctors working in Canadian fertility clinics customarily heed the wishes of their clients and routinely transfer more than one embryo at a time during IVF.  They know the high risks this practise poses to women and their unborn babies, but they're giving their paying clients what they demand.

And the clients demand value for their money.  The cost of IVF averages $12,000 per treatment, and it is not always successful.  Many couples, desperate for a child of their own, mortgage their homes to pay for that cost.  And in doing so they fixate on maximizing the success of a single cycle of IVF.  For them that means increasing the potential of success by transferring more embryos.

For the women who engage in this kind of risky practise, what may occur to them as a result can be miscarriage, high blood pressure, kidney damage and postpartum hemorrhage serious enough to require life-saving transfusions.  For babies born by this practise, the risks include prematurity, low birth weight, respiratory distress, infections, hearing and vision problems or cerebral palsy as well as other types of irreversible neurological damage.

None of these risks represent anything to minimize in the impact on mother and child.  They are all serious byproducts of a formula that dangles the hope of motherhood at one end, with the risk of severe health impairment on the other, with the impetus toward either hanging on the thread of an expensive treatment to aid fertility.

What too commonly results is multiple births.  Twins are six times more likely to die in their first year of life than are single children.  The risk of death increases twelve-fold for triplets.  Twins are four to six times more likely than single babies to suffer from cerebral palsy. 

There are no winners in this risky lottery with life.  But counselling couples of the risks inherent in transplanting multiple embryos doesn't seem to influence their decision-making.

With this knowledge and experience readily available, clinics in Canada continue to transfer two, three or more embryos at a time.  While fertility specialists claim their only goal is to achieve a healthy single pregnancy and live birth, this is not what is occurring.  Canada's 28 private fertility clinics reported 1,274 multiple pregnancies in 2010, including 1,193 twins, 76 triplets and five quadruplets.

Evidently, there is a solution.  General society must be agreeable to funding the IVF procedure through the public purse.  "The Quebec experience is an ideal example of the impact that funding can have on the establishment of a successful (elective single embryo transfer) program and concomitant reduction in the multiple pregnancy rate."

While Quebec funds IVF, it does so under the understanding that only one embryo should be transferred.  "If you take away the financial component, like what's happening in Quebec and many other places in the world where it's legislated and paid for, then you get multiple pregnancy rates decreasing significantly", according to Dr. Jon Barrett, chief of maternal-fetal medicine at Toronto's Sunnybrook Health Sciences Centre.

To many people it represents an unpalatable solution, to fund a couple's fertility program to enable that couple to have children with their own DNA.  An unfair burden on the rest of society. But the outcome of cost to society in caring medically for a woman whose multiple-birth experience has left her with lingering health problems, let alone the costly care required by her affected offspring turns out to be far more expensive.

On the one hand, it is understandable that many of us would balk at paying through a common purse to enable a couple to have a family.  You want them, you pay for them; it's logical.  On the other hand, people fall victim to their own lack of intelligent planning, their intelligent choices hampered by their emotional turmoil regarding the subject.

Perhaps, all that being so, we might be persuaded to invest up front in funding IVF for those who qualify, if the result would be far fewer twins in neonatal intensive care units in our hospitals.