Should there be restrictions on the number of embryos implanted into a woman's uterus

Should the number of fetuses implanted into a woman's uterus and fallopian tubes, through In Vitro Fertilization, be regulated, in order to reduce the risk of multiple births?  

One in every twelve couples, or 8.5%, are involuntarily infertile; they have unsuccessfully been trying to conceive, without the use of contraceptives, for over a year (Sher). This leads couples to increase the chance of successfully becoming pregnant, through fertility techniques, such as In Vitro Fertilization (IVF).

In Vitro Fertilization is an assisted reproductive technique (ART), which extracts eggs from the woman's ovaries and fertilizes them with her partner's sperm outside the uterus. The fertilized eggs are then allowed to develop in a special nurturing culture for one to three days, depending on the woman's situation. Then five or more embryos are implanted into the woman's uterus, or fallopian tubes, depending on the age of the embryo, and the need of the patient. At the follow up visit a pregnancy test and ultra sound are performed to confirm if the fertilized eggs did indeed survive or not. Along with the option of IVF, come several risks, including the possibility of multiple fetuses.

Over the years, the once uncommon sets of twins or triplets were a novelty to many. Now not only are twins and triplets becoming very common, but we are now seeing and almost expecting them, along with the higher gestation, such as septuplet and octuplet pregnancies, occurring. Two years ago, the McCaugheys, an Iowa couple, gave birth to septuplets, and shortly after them, a Texas woman, Chukwa, gave birth to octuplets, the tiniest baby, weighing 10 ounces, died 7 days after birth, and the fate of the other 7 babies is undetermined.

In Vitro Fertilization increases the risk of multiple births, which in turn increases the risks of premature delivery, and the ethical and moral decisions of selective reduction. Women implanted with fewer embryos had fewer multiple births, but patients pressure the doctor to maximize the chances of a successful pregnancy, which means implanting several embryos at a time ("ART into Science..."). If pressure from the patients weren't enough, pressure from for higher pregnancy rates from the fertility clinics also pushes the doctor to implant more embryos. The higher the success rates, the more patients are attracted to that particular clinic (Allen), and the rates are startling. Linda Osborn produced 13 embryos, and had her doctor implant nine of them; five of them survived (Allen). "35.9% of all In Vitro Fertilization births, in particular, are twins, triplets, or more" (Neus). Most women can tolerate twin pregnancies, but greater gestations then put the mother and her babies at risk. The higher the number of fetuses, the greater the risks (Sher). Chukwa was placed in the hospital with her bed tilted head down, at a 45-degree angle, to help prevent the babies from crushing each other and to keep from going into premature labor (Emanuel). Multiple gestation pregnancies clearly increase the woman's risk of premature labor and delivery, with 53% of twins and 92% of triplet pregnancies ending in premature delivery (Nathan); giving birth before 37 weeks gestation ("A Primer..."). Some risks that premature delivery bring to the newborn includes illnesses and death. "Premature delivery is the single most important cause for the increased mortality and illness among newborn twins" (Nathan). Chukwa delivered her set of octuplets, 13 weeks prematurely, at 28 weeks gestation ("Question Time") while Bobbie McCaughey had her septuplets ten weeks early at 30 weeks gestation (Allen). If multiple births survive, more often they have serious health problems, and are almost always born prematurely (Neus) like Chukwa's and the McCaughey's. There are several common health concerns that premature infants face, which include apnea (breathing disorder, during sleep), anemia (low iron in the blood), hyperglycemia (jaundice), low blood pressure, respiratory distress syndrome (RDS), Bronchopilmonary Dysplia (BPD), infection, patent ductus arteriousus, and retinopathy of prematurity. Often these common concerns can turn fatal ("A Primer..."), or leave life long brain damage, cerebral palsy, lung damage, retardation, and learning disabilities (Allen). Alexis and Nathan McCaughey, both have developmental problems at age two, and neither can sit up on their own without assistance, and Alexis and Natalie both need to be fed through tubes in their stomach because of digestive problems caused by acid reflux (Allen).

Another risk multiple fetus pregnancies face, is selective reduction. The potential parents are forced to decide if they should abort one or more fetuses in order to safely carry the rest to term (Sher). This can be a very trying and traumatic experience for the pregnant couple, and some just refuse to have selectively reduced at all. Regulating the number of embryos allowed to be implanted, will reduce the number couples faced with that decision.

Placing a limit on the number of embryos implanted also decreases the risks of multiple birth. Women implanted with two embryos instead of three or more, had fewer multiple births ("Two embryos are better…"). "'Fertilizing a greater number of embryos, enables the doctor to have more selectivity,' says co-author Allan Templeton, an obstetric gynecologist at Aberdeen University." That way the doctor can implant the best embryos, and fewer of them" ("Two Embryos are better…"). The best embryos are the larger ones that are dividing at a good rate.

A new IVF technique has been developed to help reduce the risks of multiple gestations ("Fertilization Technique..."). This new technique uses a culture than can nourish the developing embryos in the lab for five days, instead of one to three. At that point, they choose the larger embryos, which are most likely to survive. This decreases the need to implant several embryos and also reduces the risk of multiple births ("Fertilization Technique…").

"Because these 'runners' have shown more ability than three-day-old embryos to make it to birth, researchers can get decent odds on a pregnancy by implanting one or two blyocysts instead of four to six younger embryos. That eliminates the chances of producing quadruplets, or more" explains Schrof. "It also means that the difficult and ethical questions of selective abortions can be avoided."

This miracle technique doesn't come without its flaws though. Only 20%-50% of all day two embryos survives to day five. Another reason is that not all patients benefit from the older embryos. Some couples have better chances with day one to two embryos, while for other couples, the average patients, two to three day embryos are best, and five-day embryos are still better yet for other patients, Silber explains. He continues to say that yet another problem with extended culture is that there may be a loss of viable embryos that might have survived, if they were implanted earlier. In other words, many embryos do not survive to day five, but might have survived if they would have been implanted at a younger gestation in the natural environment of the uterus or fallopian tubes. Over all two to three day embryos have the same pregnancy success rate as the five-day embryos (Silber).