Standardized Infertility Treatments not only Ensure Maternal-Fetal Health but also Provide Higher Success Rates

In spite of sophisticated development in assisted reproductive techniques (ART) in the past three decades from birth of the first IVF baby, Louise Brown, in 1978, and increase in the success rate of infertility treatment up to 50%–60% in well-designed centers using standard protocols and intensive total quality management , these treatments face a few difficulties including multiple pregnancy and ovarian hyperstimulation syndrome (OHSS) that recently overshadowed the application of these methods. The rate of twin pregnancy is about 1% worldwide, however infertility treatment thorough ART increases its frequency up to 30% depending on the number and quality of transferred embryos, maternal age, quality of endometrium preparation and prenatal care. Multiple pregnancies increase the risk of pregnancy loss, gestational hypertension including pre-eclampsia and eclampsia, gestational diabetes, severe bleeding, forceps delivery and other complications on the maternal side and the risks of prematurity and low birth weight that are accompanied by increased mortality and morbidity or permanent disabilities such as cerebral palsy and restriction of motor and intellectual abilities on the child side. Therefore, neonatal and infant mortality rates of twin to singleton pregnancies increase more than seven times (1). Quality and number of transferred embryos are a key factor in determining the frequency of twin or high order multiple pregnancies. Most studies have shown that increased number of transferred embryos directly increases the rate of multiple pregnancies; however this has not been proportionate with the increase in success rate (2). Consistently over time, infertile couples encounter a great deal of pressures from family, colleagues and community on one hand and high costs of repeating treatment cycles and gradual damage to their marital relationships on the other hand which eventually make them request transfer of higher numbers of embryos in each cycle. Infertile couples always wish to solve their infertility problem in the shortest possible length of time, while they may be less likely to think about the consequences of their request. Therefore, aside from resolving the infertility problem of infertile couples, one of the important roles of the treatment team is to provide a precise and complete consultation on the consequences and problems that they might face during and after of the treatment, especially multiple pregnancies. The other party involved in multiple pregnancies following infertility treatments is the medical team including the gynecologist, infertility specialist and embryologist. Obviously, some treatment teams looking to increase the success rate of their centers …