‘Blessed Event’ Times 3 or 4 or 5

Though the percentage of multiple births--triplets or more--has been climbing steadily in America ever since in vitro fertilization was introduced almost 20 years ago, the growing popularity of fertility drugs has significantly steepened that ascent. Now, the fact that at least half of infants conceived through “assisted-reproduction” procedures suffer serious problems ranging from premature birth to cerebral palsy has led many medical ethicists, doctors and insurance companies to call for a crackdown in what has become known as the “Wild West era” of infertility treatment.

The American Society for Reproductive Medicine has taken a sensible first step. Its newly issued “practice guidelines” suggest limiting to four the number of embryos transferred to women age 34 and younger after in vitro fertilization. Such guidelines have already been formalized as law in Japan and throughout much of Europe. The society’s guidelines, however, are unlikely to address the cost concerns of HMOs or the ethical dilemma of physicians because premature births are due not only to in vitro fertilization but to the common use of such fertility drugs as Pergonal, which has a 5% to 20% chance of causing multiple births.

Physicians are in a bind: If they refuse to prescribe the new drugs, they may deny patients their only chance of having a child; if they distribute the drugs liberally, they risk being dropped by insurance providers, who are reeling from the costs associated with infertility treatment. In 1991, for example, the average cost for a single baby delivery was $9,845; for triplets, $109,765.

Medical research may resolve some of the physicians’ problems. Labs are working on a method to allow an embryo to develop more fully before it is transferred to the uterus. If they succeed in creating a growth medium in which a single embryo can develop reliably to the blastocyst stage (50 to 100 cells), they will give it a much better chance of survival.

In the meantime, however, baby boomers hungering for medical miracles need to be reminded that despite the bullish marketing techniques of the $2-billion fertility industry, science has its limitations. After noting that success rates for assisted reproduction are only slightly over 20% per treatment cycle and that the reasons for the 50% rate of premature births are not yet understood, Canadian obstetrics professor John A. Collins lamented, “Our ability to diagnose infertility is still stuck in the 19th century.”