Ethical guidelines in the prevention of iatrogenic multiple pregnancy

Abstract

1.In recent years there has been a dramatic increase in multiple pregnancies throughout the world. For example, some countries have reported a doubling of twin pregnancies and the quadrupling of triplets over the last 20 years. The relative increase in higher order pregnancy has been even greater.2.Undoubtedly, the main factor has been the use of ovulation inducing drugs and of multiple embryo transfer in the treatment of infertility. The increase in twin pregnancies may also be attributed in part to a trend towards increased maternal age at conception.3.The need for infertility treatment has also been rising sharply due to factors which include the trend towards pregnancy at later ages, and the impact of sexually transmitted diseases.4.Multiple pregnancy has very serious implications for the mother and her offspring, for the family and the community, and for health service resources. To give examples, the maternal mortality may be increased three-fold for twin pregnancy and even more for triplet pregnancies; with triplets as compared with singletons the incidence of birth weight <1.5kg has been reported to be increased 75-fold, the perinatal mortality raised nine-fold, and the incidence of cerebral palsy 16-fold. The parenting required for triplets has been estimated at 197h per week. The resulting physical and emotional stress commonly leads to psychological problems within the family. In addition the financial cost to the health service and community, as well as to the family may be 100–200 times greater than with a singleton pregnancy.