Multiple implants in IVF women ‘irresponsible’

Implanting more than two embryos in a woman undergoing in vitro fertilisation is “irresponsible and unacceptable”, according to leading consultant paediatrician Simon Attard Montalto.

“The risks to the infants increase exponentially according to the number in utero (implanted). It has been clearly documented for several decades that twins have significantly greater risks than singletons but that the risks are far greater for triplets, even worse for quads…,” he said.

“The most important determinant for this risk… is premature delivery and this occurs earlier the greater the number of infants,” he said, adding that, given such well-documented facts, implanting more than two embryos was not accepted in countries where IVF and other forms of assisted procreation were regulated.

Prof. Attard Montalto and his colleague, Paul Soler, said there was urgent need to regulate assisted procreation in Malta.

Mater Dei Hospital’s premature babies ward – the Neonatal Paediatric Intensive Care Unit – is overcrowded due to multiple births resulting from IVF.

Over the past few weeks, five women gave birth to four sets of triplets and a pair of twins. Another mother is expected to deliver a fifth set of triplets in the coming days.

Agreeing with Prof. Attard Montalto, Dr Soler said implanting more than two embryos was an irresponsible practice.

“A multi-foetal pregnancy… increases the risk of death for the babies by a factor of 10 to 14 times that of a single baby,” he said.

Dr Soler, who heads the NPICU, said the four sets of triplets and the twins born between December 21 and January 29 were “all very sick premature babies” of 30 weeks gestation or less and all weighing under 1.5 kilogrammes. All 14 babies were born following IVF treatment, he said.

As a result of these sudden births, there are 28 babies at NPICU, which has a bed capacity of 18.

An inquiry has been launched into the way the ward is being run after two newborns, from a set of triplets, died from an infection contracted from their mother during birth.

The problem of multiple implantations has been compounded by the fact that a foreign embryologist comes to Malta every three months and implants women in batches. This means they then give birth at the same time, running the risk of clogging the hospital’s maternity wards.

Asked about this, Prof. Attard Montalto said: “Whatever the mechanism and whoever is the orchestrator, there is no doubt that IVF in Malta is batched in cycles and implantation of at least three embryos is employed routinely, a practice that goes against established protocols in numerous other countries.”

So what should be done?

Prof. Attard Montalto said there was an urgent need to regulate IVF and include mandatory capping of no more than two embryos per cycle. Fertility treatment should be considered a specialist domain and should be restricted to those appropriately qualified. There had to be better communication between private clinics and the hospital and couples had to be counselled on the risks of multiple pregnancies.

“From the paediatric aspect – and this is based on direct consultation with numerous couples within our own unit – parents are not sufficiently informed of the risks of high order (multiple) pregnancies, prematurity and its potential consequences,” he said.

Parent support

A support group for parents of premature babies believes the strict regulation of IVF, in accordance with the country’s resources, will help alleviate the burden in the hospital ward that looks after these newborns.

Tiny Infants Parents Support, or Tips, said the overcrowding in NPICU, and the recent death of two babies in the ward, could have given people a wrong impression and inevitably brought to light the possible downsides to IVF.

“Many couples who are fortunate enough to conceive naturally may not realise how miraculous the treatment is. IVF may also bring misfortunes, which are sometimes ignored, in the desperation of those longing to have a child, such as multiple pregnancies resulting in premature births or even neonatal death. I, for one, unsuccessfully underwent this treatment in the hope of having another child,” Tips secretary Didi Busietta said, adding very few babies were lost at NPICU.

Tips is a support group within the Cana Movement founded by Janice Buttigieg, Louise Farrugia and Ms Busietta.

Tips can be contacted through Cana on 2123 8942/2123 8068.