- The Washington Times - Tuesday, June 22, 2004

The pitter-patter of six little feet is noticeably louder than two, but Laurena Mayne Davis wouldn’t have it any other way. Her 6-year-old triplets — Isabel, Chance and Piper — are triple the pleasure.After failing to become pregnant, Mrs. Davis and her husband, Scott, of Grand Junction, Colo., turned to in vitro fertilization. Although the birth of multiple babies was never the couple’s plan, they thought it was a risk worth taking for the chance to have even one child.

Now, fertility specialists are trying to minimize the risk of multiple births associated with the procedure. Women undergoing in vitro fertilization soon will face new guidelines lowering the number of fertilized eggs used in the process.

The Society for Assisted Reproductive Technology (SART), a sister organization to the American Society for Reproductive Medicine (ASRM), is finalizing guidelines to reduce the number of embryos planted in the womb during in vitro to two instead of three or more. The guidelines, which are approved by ASRM, will be published in the society’s journal Fertility and Sterility.

“We have had guidelines of numbers transferred for a number of years,” said Sean Tipton, press representative for SART. “It looked as if we could recommend a further reduction in the number of embryos transferred that we hoped would reduce the number of multiple births possible without reducing the pregnancy rate.”

Dr. Mark Fritz, chairman of the practice committee for ASRM, helped to review and approve the new guidelines.

“There is a distinctly more conservative recommendation simply because of continuing advancements and improvements in the outcomes in reproductive technology. As those outcomes continue to improve, the guidelines for numbers to transfer are reduced,” he said.

Statistics used to form the guidelines are based on the most recent report on fertility treatment centers.

The 2001 report, published by the Centers for Disease Control and Prevention, compiles data from the reports of 384 fertility clinics across the country.

Of the 26,550 pregnancies that resulted from assisted reproductive technology (ART) cycles using fresh non-donor eggs or embryos, 58 percent resulted in single pregnancies. Twin pregnancies accounted for 29 percent, and 7 percent of pregnancies were triplets or greater. About 5 percent of the pregnancies resulted in miscarriages in which the number of fetuses could not be determined accurately.

“Our goal is to maximize success responsibly, while also minimizing multiple births,” Dr. Fritz said. “There’s no better outcome than a singleton, normal, healthy pregnancy.”

Because would-be parents are emotionally desperate to have a family, any restrictions must come from the doctor, Mrs. Davis said.

“Potential parents are not going to say, ‘Only plant two eggs,’” the Colorado mother said. “The burden should be on the medical community to limit themselves.”

More than one in three ART procedures transfer three embryos to the womb. Another 32 percent of procedures involve the transfer of four or more.

According to the 2001 report, when two embryos were transferred, 66.5 percent of procedures resulted in a live single birth. Almost 33 percent resulted in the birth of twins.

With the transfer of five or more embryos, the percent of twin births stayed at close to 33 percent, while the percent of triplet or more births increased from 0.9 percent to 4.9 percent.

Pro-life activists question the morality of in vitro fertilization.

“Let’s begin with the truth — in vitro is immoral,” said American Life League President Judie Brown. “Anytime that a man interferes with the procreative process in a way the separates the union of a couple, it’s going to raise ethical problems.

“I just don’t see any reason for technology to replace human procreation at this point.”

Infertility, Mrs. Brown said, should be treated by means other than in vitro fertilization, which can result in the destruction of embryos. These destroyed or unused embryos are wasted life, she said.

Mrs. Brown also noted that in some extreme cases, women who become pregnant with multiples might be asked to undergo fetal reduction, the selective abortion of one or more of the fetuses, to offer increased chances of survival for the remaining fetuses.

Processes such as in vitro inevitably will lead to a greater tolerance for stem-cell research and perhaps even human cloning, she said.

“For us, the goal would be to stop in vitro permanently,” Mrs. Brown said.

For the Davis family, three healthy children are nothing short of a blessing.

“We were so fortunate in a lot of ways. Some we controlled, some we didn’t,” Mrs. Davis said. “As it turns out, I wouldn’t do anything different.”

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