Multiple births in IVF: Dr Lim Min Yu featured on CNA

Category: Your Fertility
Posted 02 Mar 2018

ACRM’s medical director, Dr Lim Min Yu, was recently featured in a Channel NewsAsia special report by Cheryl Goh about multiple births. You may watch the full video HERE, or jump straight to the section featuring our clinic HERE.

Or see below for a transcript of the CNA interview, as well as what Dr Lim has to add regarding the issue of multiple births due to IVF.

CNA: Doctors say demand for IVF is on the rise. Couples need help to conceive as they start their families later in life. But using IVF may increase the chances of having multiple pregnancies, particularly for older women anxious to increase their prospects of success. This in turn can lead to expensive hospital stays and health problems, so doctors are advocating for single embryo transfers.

Dr Lim Minyu: The simple rule of thumb is that the more embryos you put back, the greater your chance of having a multiple pregnancy. If the patient chooses to have 2 embryos transferred, then the risk of multiple pregnancy is approximately 1 in 4. However, the human body was really designed to carry 1 baby, and if you have a twin pregnancy, then the risk both to the mother and to the babies during pregnancy are greatly increased, the risk is probably 5 times that of a single pregnancy.

Beyond the segment that was aired, Dr Lim adds that these risks include miscarriage, preterm labour leading to premature birth, growth restriction and sudden unexplained death while still in the uterus for the babies, and an increased risk of conditions such as gestational diabetes and pre-eclampsia for the mother.

Dr Lim speaking about multiple births in CNA video
Dilemma of multiple or single embryo transfers

For older women going through IVF, it is not uncommon for them to transfer multiple embryos in order to increase their chances of pregnancy. However, this increases the chances of multiple births, which can have higher risk in older women. To expand on what was covered in the feature, we asked Dr Lim how do we reconcile this dilemma? 

Dr Lim Minyu: Studies have shown that the cumulative live birth rate from transferring one embryo at a time (elective single embryo transfer or eSET), freezing of the remainder of good quality embryos, followed by single embryo transfer of a warmed frozen embryo if the prior embryo transfer is unsuccessful, is no different to the live birth rate with transferring more than one embryo, with much fewer multiple pregnancies. Fertility specialists and patients alike are encouraged to consider the cumulative live birth rate from one cycle of IVF, rather than the birth rates per embryo transfer, when measuring success.

For those mothers who are willing to take the risk of transferring multiple embryos in order to maximise their chances at pregnancy, what can be done to help them prepare for the potential of having multiple births?

Dr Lim Minyu: If couples choose to proceed with multiple embryo transfer having been fully informed of the risks and this results in a multiple pregnancy, the patient would need to have more frequent checkups with her gynaecologist as this would be considered a high risk pregnancy. The chances of delivery by Caesarean Section would be much higher with a multiple pregnancy compared to a single pregnancy.

As part of the process, parents who choose to have multiple embryos implanted will be told of the potential for multiple pregnancies, and given the option of counselling in order for them to prepare for the emotional and financial burdens of having twins or triplets. It is not easy to handle multiple births, and ACRM will help parents learn to prepare for the responsibility so that they are ready for the wonders of having children. 

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