Dramatic reduction in triplet and higher order births in England and Wales

Abstract

The proportion of multiple births has increased markedly since 1980 in England and Wales. A major contribution to this trend is thought to be the widespread introduction of assisted reproductive technologies. Despite a continuing (but slower) upward trend in twin maternities, analysis of recent data shows that the rate of triplet and higher order births in England and Wales has declined by one‐quarter since 1998. This probably reflects both voluntary and statutory regulation of treatment regimes. This downward trend will help alleviate the high burden of perinatal morbidity and mortality associated with multiple births.

Hippocratic ideal, Faustian bargain and Damocles' sword: erosion of patient autonomy in obstetrics

“…In 2004, 7,275 triplets/+ were born, a drop of 5 percent from the previous year, and the lowest number reported since 1997. Similar trends in twinning and in triplet/+ birth rates have been observed over the last several decades in England and Wales (126).…”

A comparison of the outcomes between twin and reduced twin pregnancies produced through assisted reproduction

“…The fetuses selected for termination were: [1] the smallest fetuses of the cohort, [2] monozygotic twins in HOMP, [3] fetuses with structural defects, or [4] fetuses most easily accessible transabdominally (i.e., located proximal to the uterine fundus). The patients were observed for 1 or more hours after the procedure for uterine contractions, vaginal bleeding, or leakage of amniotic fluid.…”

“…As a result, in recent decades there has been an exponential increase in the number of high-order, multiple pregnancies (HOMP; i.e., more than twins) arising from treatment using assisted reproductive techniques (ART) (1), as well as an increase in the risk of maternal and perinatal complications. Specifically, the major risks associated with HOMP include spontaneous abortions, prematurity, discordant birth weight, pre-eclampsia, severe obstetric hemorrhage, and intrauterine growth retardation (2,3). The HOMP rates have remained high during ART treatment because of the belief that transferring more embryos will improve pregnancy rates (PR).…”

Potential liability of reproductive endocrinologists for high order multiple gestation

“…For example, in an effort to prevent high order gestations and to reduce the number of twin gestations, the U.K. Human Fertilization and Embryology Authority (HFEA) legislation limited the number of embryos that can be transferred during a single ART cycle to a maximum of 2 for women under 40 years and 3 for women 40 years and over. Despite a continuing (but slower) upward trend in twin maternities, analysis of data showed that the rate of triplet and higher order births in England and Wales has declined by one-quarter since 1998 [8]. These strict limitations do not allow treatment plans to be individualized after careful consideration of each patient's own unique circumstances.…”