“One baby at a time”

Women who undergo infertility treatment are no longer at risk of giving birth to five or six infants. But twins are still common, and twin births are often premature births—potentially causing costly stays in intensive-care units and neurological abnormalities.

Pasquale Patrizio, director of the Yale Fertility Center and a professor in the Yale School of Medicine’s Department of Obstetrics, Gynecology, and Reproductive Sciences, believes in “one baby at a time.” He has published a study in the April online issue of Fertility and Sterility in which he recommends major changes that he says could significantly lower the instances of multiple births.

Topping his list: improving doctor-patient communication—patients need a better understanding of the risks of having twins, he says—and expanding insurance coverage for in vitro fertilization (IVF).

IVF begins with a round of hormones that hyper-stimulate a woman’s ovaries to produce mature eggs. The eggs are then retrieved and fertilized by sperm in the lab before being implanted in the woman’s uterus. Without insurance, the process can cost more than $10,000 per cycle, so many patients try to maximize their pregnancy chances by implanting multiple embryos at once. Therefore, one way to minimize the risk of multiple pregnancy is to redefine an IVF “cycle.” Instead of one round of egg retrieval and one round of implantation—the current insurance company definition—a cycle, Patrizio says, should be one round of egg retrieval and as many separate implantations as necessary, so that “the cycle isn’t exhausted until all the embryos are utilized” or pregnancy is achieved.

With more chances at implantation, Patrizio argues, would-be parents would be more likely to choose the safer route for their future children: one embryo at a time.