Ask the Expert : Will IVF Cause a Multiple Pregnancy?

Assisted conception or rather IVF accounts for about 2% of all births in developed countries, and this rate is rising in developing countries.

Since the birth of the first test-tube baby in 1978, the technology has evolved to become much safer and more successful. There are various complications associated with assisted conception, but most are rare and easily circumvented. One controversial complication is multiple pregnancies (twins or more). All pregnancy-related risks are increased with multiple pregnancies, including risks of miscarriage and premature delivery. Premature babies may need prolonged intensive care, and some suffer long term handicaps. The cost of their care may run into millions.

Fertility experts are therefore wary of multiple pregnancies, but patients perceive it differently. “We’d rather have two at ago, to compensate for time spent trying to conceive,” said the Lutoyes. We were discussing the strategies we employ to reduce multiple pregnancies, as they were about to start IVF treatment. “We should put one embryo (fertilized egg) into your womb and freeze the rest” I advised. The strategy would maintain her success rates, with a dramatic reduction in the chances of multiple pregnancies.

Patient choice predominates in contemporary medical practice, and we acceded to the Lutoyes’ request to put two embryos into her womb. I scanned her a several weeks later, “you are carrying triplets” I announced as I turned the ultrasound monitor to them. “Can’t be, you only put in two embryos!” they said in disbelief.

One of the embryos had split into two, resulting in triplets. This is a rare occurrence, with a multiplication of potential risks. “The choice is to carry all three, or reduce them to two,” I said referring to a technique called Fetal Reduction. This involves selectively terminating one fetus, converting the pregnancy from triplets to twins, and lessening the pregnancy risks.

Such decisions are difficult to make, and complications may result in the loss of all the fetuses. After several consultations and at an appropriate time, we successfully reduced their pregnancy to twins.

Her subsequent care was smooth, till 26 weeks into the pregnancy. On a routine visit, we confirmed one of the twins was dead. It was devastating. After determining the still-living twin was not in immediate danger, we allowed the pregnancy to continue, but with strict monitoring. This allowed the remaining twin to mature further, and have better chances of survival. “It’s odd carrying one dead and another live baby in the same womb” Ms Lutoye would lament.

The patience paid off. After several weeks, we delivered a healthy baby girl and removed the dead one. They gave them the same name, Shakila, and took several mementoes before arranging a special burial. “The mementoes will remind Shakila of the twin sister she never met.” Mr Lutoye said. The experience has changed the Lutoyes’ perception of multiple pregnancies. They fully support a Charity called “One at a time”, dedicated to the reduction of fertility treatment-related multiple births.

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