Multiple Births: The More the Merrier?

Gambling on Nature

The two most commonly employed assisted-reproduction techniques today are fertility drugs and in vitro fertilization (IVF). Synthetic hormones like Clomid and Serophene are generally the first line of treatment for infertile couples. By stimulating a woman's ovaries to release eggs, they make it more likely she'll conceive naturally. If that fails, IVF requires using the same drugs to provoke the release of eggs, which can then be harvested and fertilized outside the woman's body. The resulting embryos are allowed to develop for a few days in a culture medium, then placed in her uterus in the hope that at least one will implant there and begin a pregnancy.

Both methods assume that most of the eggs a woman releases won't be fertilized, or if they are, that most will not successfully implant and continue growing into a fetus. Even so, responsible doctors usually hedge against the possibility of high-order multiples by closely monitoring women only taking drugs. If ultrasound reveals that too many eggs are present, the couple is advised to abstain from trying to conceive during that cycle.

IVF guidelines recommend for women under 35 that no more than three embryos be placed in the uterus during a single cycle, and no more than four for a woman over 35. There is no U.S. law regulating the number of embryos transferred, but in Europe, laws do limit IVF practitioners to placing only two embryos per cycle.

Still, betting that most attempts are likely to fail leads to surprising payoffs like Jody's after she underwent IVF at age 34. "They put back three embryos," she recalls, "One was great, one was good, and one was okay—that was how they said it—and I said, 'alright, let's just hope one of them takes,' and they all took!"

Economics also propel some couples to take the chance of having multiples by allowing as many as seven IVF-created embryos to be introduced into to the uterus at once. According to Dr. Daniel Kenigsberg, Co-Director of Long Island IVF at Mather Hospital in New York, "Some couples are more anxious than others to be aggressive. There is a big push by the patients to maximize their chance of pregnancy in just one try because oftentimes these procedures are not covered by insurance and are expensive to the tune of $8,000 to $10,000 per procedure."

Insurance coverage for IVF is mandated in only a handful of states: Arkansas, Hawaii, Illinois, Maryland, Massachusetts, Montana, and Rhode Island.

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