In many cases, Ory says, diligent monitoring of a patient taking fertility drugs can help prevent a multiple gestation pregnancy. If an exam shows that the woman may be producing too many eggs, the cycle can be stopped before conception. "In some cases, the patients have not been monitored as closely as is recommended," Ory says.
But reproductive medicine still produces occasional surprises. Dr. David A. Grainger, president of the Society for Assisted Reproductive Technology, says he once used fertility drugs and artificial insemination to help an infertile woman become pregnant, and she gave birth to a healthy baby. Two years later, doctor and patient agreed to the same course of treatment. The patient conceived six babies.
"I would never have predicted that," says Grainger, of Wichita, Kan. "I think there are some of these cases that absolutely catch clinicians by surprise. Fortunately, they are rare."
The use of fertility drugs has a place in treatment, says Dr. Eric Surrey, medical director of the Colorado Center for Reproductive Medicine. "Many women don't ovulate. There is no reason to go straight to IVF if we can stimulate ovulation with medication."
Most often, doctors try to stimulate ovulation with a drug called clomiphene citrate, which carries about an 8% chance of producing twins but a very low risk of higher-order multiples. Drugs called gonadotropins, however, are more powerful and produce a higher risk of multiple births, Surrey says.
"The percent of patients we administer those to with artificial insemination is very low," Surrey says of gonadotropins. "The reason is that multiple pregnancy rates can't be controlled very well. And the pregnancy rates aren't very good."
Some doctors refuse to use gonadotropins and artificial insemination in younger women because of the unpredictable outcome, Ory says.
In his editorial in the March issue of Fertility and Sterility, Jones noted that no national organization "has been bold enough to offer guidelines attempting to control and monitor multiple pregnancies because of ovulation induction and ovulation enhancement."
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Price factors in
The cost of treatment often persuades couples to try infertility drugs instead of opting for the more predictable IVF, Grainger says. One cycle of IVF can cost $10,000 while fertility drugs can cost a few hundred dollars.
