According to the Human Fertilisation and Embryology Authority, an average one in four IVF pregnancies is a multiple pregnancy compared to one in 80 for women who conceive naturally. Due to the health issues associated with multiple pregnancies, medical professionals regard them as the single biggest risk of fertility treatment but for many families, two, three or even more babies, is a blessing.
Dr. Talha Shawaf, one of Europe s leading fertility and assisted reproduction consultant specialists, says there are three major factors explaining the link between multiple pregnancy and fertility treatment. The first is IVF, Dr Shawaf explains. When more than one embryo is transferred following IVF, each has the potential to implant in the womb, leading to a multiple pregnancy. This accounts for 50% of multiples born following fertility treatment.
Secondly, when women take fertility drugs – such as clomiphene or gonadotrophin – to enhance ovulation or increase the chance of intra uterine insemination it leads to the stimulation of more than one egg follicle. When these eggs are released, they each have the potential to be fertilised, resulting in a multiple pregnancy. This accounts for about 30% of all multiple pregnancies following fertility treatment.
Thirdly, Dr. Shawaf says that the trend of older mothers contributes to the high rate of multiple pregnancies associated with fertility treatment. Before even embarking upon treatment, older women have an increased chance of multiple egg ovulation. Although multiple pregnancies and the resulting readymade family can seem desirable to couples who are desperate to become parents, fertility experts are working towards reducing the number of twins, triplets and higher order babies.
There are many risks associated with multiple pregnancies, says Dr. Shawaf, they include miscarriage, preeclampsia, pre-term labour, gestational diabetes, excess weight gain and delivery via caesarean section. Compared to single pregnancies, twins are 10 times more likely to weigh less than they should for their gestational age and eight times more likely to be born with cerebral palsy.
Triplets are 47 times more likely to have cerebral palsy. All these risk factors increase the burden on couples and their health providers in the short and long term.
The recent case of Vicky and Andy Lamb, the Oxfordshire couple who had sextuplets, has brought the notion of multiple pregnancy back into the forefront of the public attention. The birth weights of all six babies were all under 2lb, and they arrived some 14 weeks early. Sadly, one of the babies, a boy, failed to pull through. Mother Vicky had taken fertility drug Clomid before falling pregnant.
Although Dr. Shawaf agrees that the risk of multiple pregnancies attached to fertility treatment should be reduced, he is cautious about strict legislation. I advocate the open discussion of the issues associated with multiple pregnancy but any legislation needs to sit alongside evidence from the National Institute of Excellence on the advantages of fertility treatment.
We do need to enforce guidelines to reduce multiple pregnancy, but we also have a responsibility to improve our service and continually push fertility providers to enable couples to obtain the best value treatment. It is a delicate balance, but by working closely with other countries, we can learn how to keep a good success rate for fertility treatment whilst reducing the risk of multiple births.
CASE STUDY: The responsibility of triplets is consuming Laura Baker, 33, from Essex is mum to 19-month-old triplets Eddy, Bethan and Cerys.
We d had three failed rounds of IVF in the UK before we travelled to Istanbul for a final try at conceiving a baby. I didn t expect it to work.
At the clinic, they implanted three poor quality embryos. I was prepared for none of them to survive, and had no pregnancy symptoms. But at seven weeks three heartbeats were detected. I was excited and terrified all at once.
I m 5ft 1″, so carrying three babies was very challenging. According to statistics I had a 50% chance of giving birth to three healthy children and was confined to bed rest after the 20th week. I was absolutely elated when my three healthy babies were delivered via caesarean section at 34 weeks.
Eddy was the last of my long-awaited babies to be released from hospital. He came home on New Year s Eve, so we started 2009 with our busy new family complete. I opened the champagne at midnight but one of the babies started crying, setting the other two off. At 5am, when they finally settled, I took my first sip the bubbles had gone flat. We haven t stopped since, but we re used to rushing around. We rarely sit down before 10pm.
I certainly don t have any regrets, but having three babies can be overwhelming. Logistically, things I d taken for granted, like going to the supermarket, are tough. There are only two baby seats in a trolley, so I have to leave one of the triplets with my mum when I go shopping. When we go to baby groups, I can only carry two children at once, so I need someone else to help me unload them from the car.
Triplets can be financially crippling too. Buying brand new cots, mattresses, pushchairs and car seats three times over gets hideously expensive. Our families chipped in to help us prepare for their arrival, but we re still suffering money-wise as I can only work one day a week. Childcare for three babies would be more than my salary.
The responsibility of triplets is consuming but my three children are amazing. They already love playing together and work as a little team; they ve just discovered that if they stand in different when I go shopping. When we go to baby groups, I can only carry two children at once, so I need someone else to help me unload them from the car.
Having three babies still feels surreal at times, and my husband, Tim, and I have been on a massive learning curve. Luckily, we have a Home Start volunteer who comes over for a few hours each week to help out, and at twin and triplet clubs we spend time with families who know exactly what we re going through.
It s already getting easier and other mums with triplets have told me that once they reach the age of four, things get much better. I sometimes feel guilty that the triplets miss out on certain things that other babies get to do, like swimming lessons, but the love and companionship they give each other is worth much more.