Octuplets
Octuplets born January 26, 2009.
There has been a great deal of publicity and interest surrounding the birth of the octuplets recently. Initially very little information was available over the treatment, which resulted in the birth. The following are the facts: Nadya Suleman a single unemployed woman delivered on January 26 octuplets in California. Initially the details as to how this pregnancy resulted were very sketchy.
Ms. Suleman has now stated that she conceived by in vitro fertilization, which ironically has the most potential of limiting multiples. She underwent the transfer of 6 embryos. Apparently 2 of the six split generating the octuplets! It is unclear why 6 embryos were transferred. The commonly accepted standard of care is to replace 2 or 3 embryos in women under the age of 35 who are considered to have a good prognosis. Typically 2 embryos are transferred if embryo quality is considered good and 3 if embryo quality is fair or poor. We have some information about the clinic where the octuplets were conceived. It is a very small single physician clinic in Beverly Hills. The last published statistics showed that in 2006 about 50 IVF procedures were performed. This is less than 8% of the yearly volume at IRH. Also the success rates were poor at this clinic. Perhaps this is why such a large number of embryos were transferred.
IVF if used properly is effective and safe. By transferring a small number of high quality embryos we can obtain high pregnancy rates with excellent control over multiples. Most patients at IRH receive 2 or 3 embryos. Additional embryos if available can be frozen to generate future opportunities. The risk of twins with IVF is about 30%. The risk of triplets is concentrated in those smaller number of cases where 3 or more embryos transferred. It is approximately 3-5%. Quadruplet or more pregnancies occur with a frequency much less than 1%. It is important to understand that we never transfer more than one embryo to intentionally increase the odds of a multiple pregnancy. The transfer of more than one embryo is intended solely to improve the odds of pregnancy. As IVF improves we are advancing towards the goal of single embryo transfer.
Ovulation drugs are a more common cause of unexpected high order multiple pregnancies. The irony of this case is that the very technology which can control multiples was used to generate this octuplet case.