Photo by Flickr user netdance (CC BY-NC-ND 2.0)

When Michelle was preparing for in vitro fertilization (IVF), her doctor told her that he wanted to transfer three to five embryos. Her response: “Absolutely not.” She told him that she wanted only one baby. They settled on two embryos, and the result was a twin pregnancy. At 32 weeks, she delivered the boys, who weighed only four pounds each. They went straight to the neonatal intensive care unit, where they were fed through a tube in their nose. It was a month before she could bring them home.

Michelle shared her experience for a new CDC video that promotes single embryo transfer.

“What the public doesn’t really understand, and even physicians, I think, don’t appreciate to some degree, is even twin pregnancies do have a much higher chance of all kinds of complications,” Dr. James Goldfarb, the current president of the Society for Assisted Reproductive Technology, said in the video posted on the CDC’s website. “And really, the goal is to have one healthy baby.”

It is still too early to tell whether such messages are making an impact on younger couples considering IVF. But it is clear that many infertile couples in the U.S. are still willing to risk having twins. For many, the reasons are emotional. After trying for so long to have a baby, many couples want children so badly that they would happily take on all the sleepless nights and double expenses that come with twins.

But one of the biggest obstacles for many couples is financial. Only a handful of states require insurance companies to pay for IVF treatment, so in most places, couples have to pay the entire cost themselves. The typical price for IVF is $10,000 per cycle – or more. So if the single embryo transfer doesn’t result in a pregnancy the first month, the couple will have to pay more money (although usually less than the full price) to try with another embryo following month.

Some experts say that public service announcements aren’t enough. In order to reduce the number of multiples and resulting complications, they say it will take a nationwide policy change. In places like Quebec and Sweden that have achieved low rates of multiple pregnancies, the government pays for treatment, so couples do not risk thousands of dollars if they don’t get pregnant the first month. Although treatment carries a high price tag, those countries save money by preventing preterm birth.

A study published this month estimated that preterm delivery resulting from fertility treatment cost the U.S. healthcare system $1 billion per year. According to the CDC (see graph at right), among babies conceived by assisted reproductive technology, 63.3 percent of twins and 95.3 percent of triplets are delivered preterm. The Board of Health Sciences Policy estimates that each one of those preterm infants costs $51,600.

And those are only the financial costs. No economic analysis can quantify the fear and worry of new parents, already survivors of infertility, as they spend months in the hospital with their tiny babies.

See the CDC videos here: http://www.cdc.gov/art/PreparingForART/index.htm

Bromer JG et al. Preterm deliveries that result from multiple pregnancies associated with assisted reproductive technologies in the USA: a cost analysis. Curr Opin Obstet Gynecol. 2011, 23(3):168-73.