The last 30 years have seen a dramatic increase in the incidence of twin and triplet pregnancies in the United States. Fertility doctors have been largely responsible. 1 in every 30 infants born in 2009 was a twin; double that of 30 years ago. The serious risks of triplet pregnancies are generally well understood. Most people, however, believe that twins do great. Surprisingly, 25% of twins require neonatal intensive care hospitalization, and the risk of cerebral palsy and even death are higher for twins compared to a single baby.

RMA is committed to decreasing the likelihood of twin pregnancies. A simple strategy is to use Femara (letrozole) rather than Clomid, coupled with intrauterine insemination. A recent National Institutes of Health sponsored randomized trial showed higher pregnancy rates with Femara compared to Clomid with fewer twins. Femara is not FDA approved for helping women conceive, and we have a detailed informed consent to answer any questions you may have about this medication. Feel free to discuss it with your RMA physician as well.

The use of Follicle Stimulating Hormone (FSH) injections (Gonal-F, Follistim, Menopur) coupled with intrauterine insemination has been decreasing in the United due to the risk of multiple births and the awareness that it is only marginally more effective than Femara and Clomid. If injectable gonadotropins are going to be used, lower dosages have been associated with a lower incidence of triplets, but not twins.

In vitro fertilization involves removal of eggs and fertilization outside the body. The last 10 years have seen a dramatic decrease in the incidence of triplets from IVF as fewer embryos are being put into the Mother’s  uterus. More and more patients- particularly those under age 35 are requesting a single embryo transfer which is wonderful news! Our pregnancy rates for young women have been nearly as high with elective single embryo transfer compared to a two embryo transfer.

As women pass their mid-30’s, single embryo transfer is not as effective as a two embryo transfer. The recent introduction of embryo biopsy with comprehensive chromosomal screening has allowed for transfer of a single embryo with normal genetics – achieving the same extraordinary pregnancy rates without the risk of twins. This technology is especially well-suited for women as they go through their late 30s and early 40s. You should discuss this ground-breaking technology with your RMA physician.

As I like to say, “Bartender, make mine a single!”

By Art Castelbaum, MD