Think hard about ART

Thanks to science, those who would have
previously been written off as barren are
now able to have babies.

By Adrian Koh

The sheer number of TV shows featuring couples with multiples these days is just amazing. We’re not just talking twins or triplets here, but six, seven, eight babies at one go, which really puts these mothers on par with the best brood animals. The common denominator – assisted reproduction.

Perhaps one of your new year’s resolutions is to start a family. If you’re lucky like most people, you’d be able to get pregnant the good old fashioned way. If, however, you’ve been trying for several months now without any success, you might be thinking of consulting a fertility doctor. But before you do, there are things to keep in mind about assisted reproduction – not least the fact that recent research shows that babies conceived through in vitro fertilization (IVF) are two to four times more likely to have birth defects. Oh, and did we mention multiples?

The risks of assisted reproduction

Thanks to science, those who would have previously been written off as barren are now able to have babies. Apart from IVF, other assisted reproductive techniques (ART) include artificial insemination, gamete intrafallopian transfer where a mixture of sperm and eggs is placed directly into the woman’s fallopian tubes using laparoscopy, and the controversial preimplantation genetic diagnosis which involves the identification of genetically abnormal embryos for healthy outcomes.

Although these measures have made deliriously happy parents of many an infertile couple, it’s not all sweetness and light. A study from the US-based Centers for Disease Control and Prevention found that babies conceived through in vitro fertilization are two to four times more likely to have birth defects than children conceived naturally.

The study involved 281 ART births and over 14,000 naturally conceived births, with controls for factors such as maternal age, smoking, race and ethnicity. It found that ART was associated with four times the risk of gastrointestinal defects and twice the risks of some types of heart defects, compared with babies who were conceived naturally. The risk of cleft lip with or without a palate was also more than twice as high.

This has serious implications. Are you prepared for the possibility of having a child with birth defects? Would you keep the child and go through the ups and downs of parenting him, or would you choose the equally painful decision to terminate the pregnancy? The good news is, only a tiny minority of babies conceived through ART suffer from birth defects. What you should be more concerned about, if you ask me, is the possibility of conceiving more than one baby.

The ART of multiples

The likelihood of a multiple-birth pregnancy is higher with ART simply because the usual practice – not just in kiasu Singapore but worldwide – is to transfer several embryos at a time to increase the chances of implantation. In fact, ART is said to be responsible for a 100-fold rise in multiple-infant births in the last 20 years with a whopping one in four IVF pregnancies being a multiple.

While the idea of quadruplets might seem a charming one (think four bubs all cooing at you while wearing matching clothes), a multiple-birth pregnancy carries several complications for both mother and baby. Risks include higher miscarriage rates, anaemia, high blood pressure and organ damage, bleeding, placenta problems and more. The babies are also at risk of being born prematurely, which could lead to complications such as vision problems, hearing loss and development disabilities and delays.

Once you’ve gotten past the drama of the pregnancy and birth, it’s on to parenting. Having just one baby is tough, so you can imagine what caring for multiples entails. You can expect challenges in the form of sleep deprivation, having to split your time between equally demanding children, doing loads of baby laundry and spending tons of money on diapers, not forgetting the housework, spouse and your own personal needs. You’ll probably ask yourself if the nonstop frenzy of baby activity will ever calm down, or if your eyebags will ever go away. You might even consider putting your sprogs up for adoption.

If the idea of a large brood scares you, there is the option of single embryo transfer (SET), which is recommended for women aged below 35 and some older women, who have good quality eggs. As the name implies, only one embryo will be transferred for implantation at a time. Doctors say this does not significantly reduce a woman’s chances of having a baby while avoiding the risks associated with multiple pregnancies, making it a very viable option for those who’d prefer to the assurance of a singleton pregnancy.

Ultimately, the dream of starting a family of your own might far outweigh your fears and the risks of ART. Just be sure you do your homework first. Happy babymaking!