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All About IVF

Monday, 9 March 2009

Nadia Suleman controversially gave birth to Octuplets on the 26th of January 2009. This Friday RTE will be showing a documentary filmed after the births. Last Friday we showed the practicalities of having 14 children in your home and today we're going to be discussing IVF, its ethics and also its use in Ireland.

The documentary, "Octuplets Mum - Her Story" will be shown on RTE One this Friday at 8pm.

Professor Robert Harrison
Professor Robert Harrison is now semi retired and lectures on IVF treatment. He is the pioneer of IVF in Ireland since 1985 and set up Human Assisted Reproduction Ireland (HARI) in the Rotunda Hospital in 1989.

"This Friday an exclusive documentary, "Octuplets Mum - Her Story" will be shown on RTE One. Last Friday we spoke about the practicalities of having 14 children, the cost implications, and the day to day running a single mother faces raising a 14 children family."

Today we're discussing the science behind IVF, and we're joined by Professor Richard Harrison who'll be telling us exactly how Nadia Suleman came to have Octuplets. "

What is IVF?
In Vitro Fertilisation (IVF) involves removing the woman's eggs from the ovary and fertilising them outside her body. The fertilised egg (embryo) is then put into the uterus. IVF is one of several assisted conception techniques used to help people with fertility problems to have a baby.

Costs for first cycle IVF can be anything from €4000+.

How did the Octuplet birth happen? Did this woman want eight babies?
In this case 6 embryos were implanted in the mother (Nadia Suleman) She has spoken about how she only wanted one child however some of them split and she eventually ended up with 8 fetuses. In Nadias case 6 embryos were regularly transferred which is considered unethical.

Over the last 20 years there have been two other births of Octuplets. These cases, in 1998 seven of the eight babies born survived. In 1996 all eight of the babies died before birth.


What risks would be associated with their birth?
There are many risks associated with multiple births.

For the mother
. Increased risk of miscarriage
. The risk of gestational diabetes is two to three times (12%) that of a single pregnancy (4%). I f a woman is over 30, overweight or has a family history of diabetes, the risk is even greater.
. In 20% of multiple pregnancies, the woman will develop high blood pressure.
. Rates of pre - eclampsia (PET) are three times higher in twin pregnancies (30%) compared with singletons (10%). This can be very serious and result in emerngy delivery by caesarean section.
. Though the risk of maternal death during pregnancy and delivery is generally low, it is twice as likely to occur with a multiple pregnancy compared to a singleton.
. There is an increases risk of hermorrhage after delivery.
. Half (50%) of twin pregnancies are delivered by caesarean section.

Risks for the infant
. Twins grow slower than singletons during pregnancy and have lower birthweights at the time of delivery.
. Half of twins are born prematurely (before 37 weeks gestation)
. Between 40 - 60% of IVF twins are admitted to intensive care units (twice the rate of singletons)
. Twins not only have a higher chance of dying during pregnancy, their risk of death prior to delivery and in the first week of life is 3 - 6 times greater than singletons.
. In the long term, twins are 4x likely as singletons to have cerebal palsy. Twins more frequently have behavioural, language, visual and auditory impairments - oncluding mental retardation.

All of the above risks were accentuated because of the amount of babies she carried.

With the above risks in mind there is currently a huge push on to try and get couples using IVF to go for single embryo transfer. This is when one single embryo is transferred into the uterus. This will significantly reduce the chances of multiple births and will in turn reduce the risk factors listed above.

Professor Harrison would also like to point out that many people are giving birth as a result of taking fertility drugs so IVF is not always the way to go for some couples.

Was the Octuplet IVF unethical?

Yes it was. Too many embryos were transferred at any one time. The ethical guidelines for transfer of embryos in Nadias case would have been two as she is under 35. The doctor who performed Nadias IVF is currently under investigation by the California Medical Board. Nadia used the same doctor for all of her previous pregnancies so even though this doctor knew she had already had six children he still transferred 6 embryos knowing that there could be a risk of multiple births.

The following are the recommended limits on the numbers of embryos to transfer by the American Society for Reproductive Medicine
Aged below 35, 1 to 2
Aged 35 - 37, 2
Aged 38 - 40, 3
Aged 40+, 4

Could this have happened in Ireland?
Yes it could have happened anywhere in the world. It all depends on the doctor who is performing the IVF and the laws and guidelines of the country. Professor Harrison thinks it is unlikely it would as IVF clinics in Ireland have a high standard of good practice. There is only one country (Belgium) where the number of embryos transferred is controlled by law to single embryo transfer for the first cycle.

IVF in Ireland
IVF in Ireland is up to standard with our European counterparts. It's estimated that in Ireland 1 to 2 % of our population has been born through IVF. 30% of twins / multiples born in Ireland are born due to IVF.

The following are the recommended limits on the numbers of embryos to transfer in Ireland:
Under 30 - 1
Up to 40 - 2
Aged 40+ - 3

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