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No More High Order Multiple Birth Disasters -or- Being The Change We Seek

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You might have noticed that there is a lot of breaking fertility news this week. That's because ESHRE is taking place in Amsterdam and everyone is publishing their scientific papers and sending out press releases.

So, once again there are articles in the press that are grabbing for attention. Some are things that we have known for years but are written with a new slant. We are reading once again about why laptops reduce male fertility (it's the heat dummy!), or why bicycle riding is bad for sperm production, or my personal favorite of this week's fertility news - daily sex improves sperm quality! I don't know if it does or doesn't - but if the men can't play with their computers, or ride their bikes - they might as well do something constructive with their time! Right?

So, in this sea of press releases, today, Dr. David Kreiner (the doctor that I work with), a nationally renowned Long Island reproductive specialist, has decided to take on the long-standing moral and medical dilemma of multiples with a unique approach to IVF designed to make single embryo transfer (SET) the standard of care available to everyone.

Dr. Kreiner’s East Coast Fertility center offers a critical twist on routine IVF services. With the new Single Embryo Incentive Program, East Coast Fertility will freeze all viable, unused embryos retrieved from a single IVF cycle and transfer them at the patient’s discretion – one embryo at a time – at no extra cost.

“We’ve reduced the sticker shock of IVF so dramatically by absorbing the fees associated with cryopreservation and subsequent transfers, that we’re providing a financial incentive for patients to do the right thing for themselves, their marriages, their financial futures and, most important, any babies they may have,” Kreiner said. “Our goal is to help people already under the stress of infertility, choose the possibility of one healthy child with each pregnancy.”

Recent headline-grabbing cases, such as the public dissolution of Jon and Kate Gosselin’s marriage, underscore the spectrum of perils associated with high order multiples. They range from infant mortality and disability to parental depression, divorce and economic disaster. The Single Embryo Incentive Program is the first financial package from a fertility center in this country that defrays the economic risk of using one embryo at a time.

I have to admit that I am incredibly proud to work with a guy who has come up with a program that takes on this issue in such a personal way. The high order multiple birth problem has been the fertility field's dirty laundry, so many people pay lip service to this issue without really doing much about it. Oh - there are guidelines - and high order multiple births are down. But there are still far too many high order multiple births in this country.

We as a field have gotten better about talking about the collateral damage of multiples but few have come up with a solution. Most American couples are uninsured for fertility treatment. They can barely scrape together payment for a single round of IVF and so they feel compelled to put in as many embryos as they can, hoping one will take. Unfortunately, their best intentions boomerang and the result is a medical tragedy that, often, is worse than the underlying infertility. In many European countries where fertility treatment is covered, single embryo transfer is the law.

Dr. Kreiner, a pioneer in the field who trained under legendary IVF innovators Drs. Howard and Georgianna Jones, vowed to bring an end to the heartache and ruin that comes with high order multiples.

“I take this personally, “ said Kreiner. “Over the years, I’ve become close with so many of my patients and have lived through their high-risk pregnancies, the surgeries on tiny infants and the collapse of many marriages under the strain. We doctors must do more than advise people that single embryo transfer is the prudent choice. We must make it possible for patients to make this choice and avoid the lifetime complications of high order multiples. That means shouldering some of the economic burden, especially for the uninsured and cash-strapped.

“East Coast Fertility certainly makes less on the Single Embryo Incentive Program. But I feel it is our moral obligation to insure that money doesn’t stop people from making the right decision.”

So, I think that this is a great news story. But I don't know if a doctor stepping up and saying that he was a part of creating the multiple birth mess and now he is going to be a part of the solution by developing an innovative program to reduce high order multiple births can compete with laptops, bicycles and daily sex. We will see.

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EmpowHER Guest

I totally believe in Single Embryo Transfer for IVF. In order to improve and maximize the chances for implantation we must be sure that we place the single embryo at the "Maximal Implantation Potential (MIP) Point". This requires an upgrade of the ultrasound guidance to "3D/4D Ultrasound Guided Embryo Transfer". Using this new technique could increase pregnancy rates by more than 10%. This way we can reasure our patients and ourselves that we did the best we could.

July 7, 2009 - 5:25pm

Dear Pamela,

Fascinating article. Thank you for your insight.

I wonder if this article, "Judging Octomom" has anything to do with the Amsterdam conference.


It's the first non hoopla article I've read that explores intelligently and dispassionately the issues raised by the birth eight babies to on welfare mother, Nadya Suleman, who already had six IVF children.

You are in such a complex and emotionally volatile field, Pamela. I very much respect your efforts to bring information and clarity to us.

warm regards,


July 7, 2009 - 3:22pm
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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.

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