Eight is Too Much

I am a child of the '80s. I still listen to Fleetwood Mac (yeah I know they really are a '70s band) and Supertramp. I like the Back to the Future movies and I still remember how I felt when Darth told Luke he was his father...whoa! I never really liked the TV show "Eight is Enough" and clearly the recent events on the Left Coast have those of us who practice reproductive medicine scratching our heads.

My patients know that I am not a big fan of twins. The problem with twins is the risk of preterm labor, preterm delivery and prematurity. Although many patients brought the recent NY Times article about birth defects and IVF to my attention, nearly all of them went on to state how wonderful twins would be...."two for one deal....buy one get one free..." This line of thinking ignores the forest for the trees as the biggest risks facing IVF babies are not those from birth defects but the risks from prematurity... and almost all of the prematurity is from multiple gestations. Of course, it follows that the multiples come from replacing >1 embryo in an effort to improve the pregnancy rate.

As one would expect, there are now cries calling for more regulation of the IVF "industry." We are already extremely regulated. Clinics have to undergo inspections, the FDA is involved in donor egg, donor sperm, donor embryo and all gestational carrier cases and our own professional associations publish clear practice guidelines. However, this does not mean that certain individuals cannot practice in ways that are beyond the norm.

Ultimately, a physician should aim to follow the dictum of Sir William Osler of "First do no harm." Whenever I go into the room to perform an embryo transfer I ask the couple how they feel about twins. If twins are not desired then they get a single embryo back. The possible situation where the government legislates the number of embryos to be replaced eliminates any consideration of an individual patient's clinical history. However, I agree that if the government agrees to pay for all IVF cycles then they can determine the number of embryos to transfer. Until that time, we should not make sweeping changes in the practice of reproductive medicine because of the events in Beverly Hills.

Remember that you can always ask for a single embryo transfer or consider Natural Cycle IVF where there is only one available for transfer. If you get twins with a single embryo back...well, I can't be blamed for those twins as no one has yet been able to transfer <1 embryo!

So how do all of you feel about the octuplets....freak show or medical miracle? You know where I stand.

DrG