An international trend has recently arisen to prevent twin pregnancies through mandatory elective single embryo transfer (sET). The reasoning by the proponents of mandatory sET is that twin pregnancies are an adverse outcome of assisted reproductive technologies (ART). However, literature search via PubMed and MEDLINE to assess maternal and perinatal/neonatal risks as well as cost comparisons for singleton vs. twin pregnancies reveal that twin pregnancies are sometimes a desirable outcome of ART. Most risk assessments of twin pregnancies after fertility treatment have used spontaneous conceptions data, which reflect different treatment paradigms and outcome benefits from pregnancies after fertility treatments. IVF twins demonstrate approximately 40% lower outcome risks than spontaneous twin conceptions. Most risk assessments in the literature are calculated with pregnancy as the primary outcome, but in a fertility-treatment paradigm, where patients want more than one child, the statistically correct risk assessment should refer to born children as the primary reference. If published data are corrected accordingly to achieve statistical commonality of outcome (i.e., one child in singleton versus two children in twins), twin pregnancies no longer demonstrate a significantly increased risk profile and/or higher cost for mothers or individual offspring. For infertile patients who want more than one child, twin deliveries represent a favorable and cost-effective treatment outcome that should be encouraged, in contrast to the current medical consensus.
VIDEO: Norbert Gleicher, MD, FACOG
Recorded on: December 10, 2011