How Many Is Too Many?

Risks Spur Effort to Curb Multiple Births

For couples spending thousands -- or tens of thousands -- of dollars trying to conceive, a multiple pregnancy can seem like hitting the jackpot. That's how Lisa Owen of Frederick felt in 2001 when she and her husband, Alex, learned she was carrying triplets.

The couple's initial shock when her sonogram showed three heartbeats quickly turned to enthusiasm. After nine separate insemination attempts (which had produced one son and multiple miscarriages), they'd finally have a big family all at once.

But fertility specialists don't see triplets as a bonus.

Multiple-gestation pregnancies -- even just with twins -- increase the expectant mother's risk of high blood pressure, gestational diabetes, bleeding and cesarean section, according to Resolve, the National Infertility Association.

Babies born of such pregnancies are at higher risk for premature birth, low birth weight, developmental disabilities, respiratory and eye complications, and cerebral palsy. While a single-born U.S. child born in 2001 faced a 6 out of 1,000 chance of dying by its first birthday, according to the Centers for Disease Control and Prevention (CDC), the risk for twins was nearly fives times as great (30 of every 1,000), for triplets 12 times (71 of every 1,000), and for quadruplets 21 times (127 of every 1,000).

As a result, most reproductive endocrinologists now encourage couples attempting to get pregnant to use methods less likely to produce multiples. And next month the Society for Assisted Reproductive Technology (SART), a leading professional group of in vitro fertilization clinics, plans to urge its members to institute new methods to reduce risk of multiple births.

Three's Company

A single, healthy baby is the ideal outcome of fertility treatments, says David Hoffman, a reproductive endocrinologist with IVF Florida Reproductive Associates in Margate, Fla., and past president of SART.

The problem is that since most couples pay out of pocket for fertility treatments, many want to "maximize their pregnancy potential" with each try, Hoffman said. And maximizing potential can translate into taking bigger risks.

Lisa Owen describes her pregnancy and the birth of her triplets as easy. Of course, everything's relative. During her 33 1/2 -week pregnancy (a normal full-term singleton pregnancy is 40 weeks), the 5-foot 6-inch mom ballooned from 125 pounds to 190. The skin across her stomach was pulled so taut that it felt to her like it was burning. She spent the last month on bed rest, hooked up twice a day to a home uterine activity monitor and a pump that injected drugs to halt tiny contractions that were too subtle for her to feel.

After a cesarean delivery, her three baby boys spent the first three weeks of their lives in neonatal intensive care, even though they were large for triplets (two were 5 pounds, 9 ounces, the other 4 pounds, 14 ounces). But by the time they were 2 months old, Tanner, Hunter and Walker Owen were all robust and above the 50th percentile on the infant weight charts for non-premie children.