Multiple
Pregnancy
Management
of IVF in Barbados, is characterised by a conservative approach
to embryo transfer, in order to reduce the likelihood of multiple
births. Generally between one to three embryos are transferred
in each attempt, depending on the individual patients history.
Although
the world's first IVF baby was born from a natural cycle with
spontaneous ovulation, controlled ovarian hyperstimulation
is now the norm. Consequently, multiple pregnancy has become
common, and it has been estimated that in total, 45% of IVF
babies born are from multiple pregnancies, with twinning rate
of nearly 25%, triplet rate of 2-3% and quadruplet rate of
0.5% of pregnancies worldwide.
Unfortunately, neonatal and perinatal mortality rates are
3 to 6 times higher for twins when compared to singleton births,
and 5 to 15 times for higher order multiples, and the risk
of cerebral palsy is six times higher for twins, and twenty
times higher for triplets. Multiple pregnancy also places
greater physical strain on the mother, with an increased incidence
of miscarriage, high blood pressure, bleeding during pregnancy,
increased risk of vomiting during pregnancy, and premature
birth.
The complication
of being born prematurely includes difficulty with breathing,
higher incidence of jaundice, and feeding difficulties. Twins
also have a higher incidence of congenital abnormality. Triplets
are almost always delivered by Caesarean section, and twins
far more often. Even if the babies are born normal, caring
for two, three or more babies can be a challenge, with extra
emotional, physical and financial stresses.
To reduce
the risk of multiple pregnancies we have to limit the number
of embryos transferred. In deciding how many embryos are to
be transferred, we need to consider the number of previous
pregnancies, woman's age, the duration of infertility, the
reason for the fertility problem, the number of previous attempts,
the number of fertilised embryos, and the cleavage stage and
quality of embryos replaced. Excess embryos that are of good
quality can be frozen, stored, and used in a subsequent cycle,
if necessary.
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