The objective of infertility treatment should be the birth of a single, healthy child. Many of the treatment options presented to infertile couples, however, are associated with high risks of multiple gestations. Moreover, many couples view multiple gestations (twins) as desirable and are unaware of the risks they pose to both mother and babies. Couples should understand these potential risks before starting treatment.
The ability to limit the number of embryos or eggs transferred is an effective approach to limit multiple pregnancies. The Society for Assisted Reproductive Technology (SART) and the American Society for Reproductive Medicine (ASRM) have published guidelines recommending an optimal number of embryos for transfer based on patient age, embryo quality, and other criteria.
In the United States, the decision regarding the number of embryos to transfer is made jointly by the physician and the patients. This decision should be based upon the best interests of the patient and the future offspring. However, ART is centrally regulated in England, and no more than three embryos on Day 3, or two on Day 5, may be transferred in most circumstances.
The ultimate goal is to achieve a high pregnancy rate while transferring a single embryo. Recent laboratory improvements have allowed programs to transfer two embryos while maintaining acceptable pregnancy rates. Eventually, the transfer of one embryo will resolve the issues surrounding multiple pregnancies.
At IVF Phoenix, we see more than the average number of patients with difficult infertility problems, such as advanced maternal age or low AMH (<1.0). Some clinics are not willing to offer ART to those who have a low probability of success and encourage them to use donor eggs, a practice that results in higher success rates among older women. At IVF Phoenix, we have been focusing on low AMH patients and are seeing a 30% on-going pregnancy rate in low AMH patients, (<0.5) under age 40. Unfortunately, this does not apply to a woman 40 and older with low AMH.