Shellene and Bruce Berry had the usual worries of expectant parents.
But one of their concerns — that their family would dramatically increase with triplets or more — was resolved because of a new advance for couples who use in-vitro fertilization.
Last year, the Berrys, of Livonia, Mich., were among the first people in metro Detroit to use blastocyst transfer. The technique, which is gaining acceptance at U.S. fertility centers, limits babies born from in-vitro fertilization to single births and twins.
A blastocyst is a fertilized embryo that grows to a few hundred cells by five days after fertilization. It is smaller than the tip of a pin, but it has the vital genetic machinery to allow it to grow and implant itself successfully in the uterine wall.
Last year, 44 couples, including the Berrys, used the procedure at William Beaumont Hospital’s Center for Fertility and Reproductive Endrocrinology. Twenty-eight got pregnant — 10 with twins and 18 with single babies. None had or are expecting triplets or more.
Healthy women capable of producing many eggs are the best candidates. Insurance reimbursement varies widely, and many centers have as little as a year or less experience with the technique.
“I consider blastocyst transfer to be in its early stages,” says Dr. Mostafa Abuzeid, medical director of the Center for Reproductive Medicine in Rochester Hills.
The technique may offer its greatest hope if it can be combined with another called pre-implanation genetic diagnosis.
The pre-implantation test analyzes fertilized embryos in as little as eight hours after an in-vitro procedure, in which the eggs of a woman are fertilized outside the body by the addition of sperm. The test is done to learn whether the fertilized eggs carry genetic defects. Mark Hughes, the Wayne State University geneticist who has helped pioneer the technique, calls it a “molecular spell checker.” It’s available only at a few sites like WSU.
Diamond says one problem is that there’s no way to guarantee single babies or twins from the procedure because blastocysts can divide and “you end up with more babies than embryos.”
Over two decades, multiple births have soared in the United States because of advances in drugs and laboratory techniques.
Births of triplets or more exploded 404 percent between 1980 and 1997, according to a report issued in the fall by the Centers for Disease Control and Prevention.
Some 6,148 triplets were born in 1997 — up from 2,529 in 1989, according to the report. Quadruplets, quintuplets and other higher-order multiples, as triplets or more are called, also jumped.
Michigan is among the states with “significantly higher” rates of triplets or more, according to a report the CDC issued in September. For every 100,000 births in 1995-97, there were 176.2 higher-order multiple births of triplets or more, compared with a national rate of 151.2. No one knows why Michigan has a higher rate.
Authors Joyce Martin and Melissa Park called the national trend a public health concern because multiple births are a risk to mothers and babies.
Babies in multiple births are more likely to be born earlier, smaller and with lifelong disabilities. They have a greater chance of dying in the first year of life.
“We don’t think triplets or more is necessarily a success,” says Dr. William Keye Jr., director of Beaumont’s fertility program.
In November, the American Society for Reproductive Medicine issued new guidelines recommending that only two embryos, when possible, be transferred during in-vitro fertilization.
The goal is more realistic for younger women, who often are better able to produce a number of eggs suitable to be combined in the laboratory with sperm to produce an embryo.
Fertility experts hasten to point out that most multiple births are from fertility drugs, not in-vitro fertilization. Doctors can control how many embryos they transfer back to a woman’s uterus during in-vitro fertilization and freeze the rest.
With fertility drugs alone, there still aren’t good ways to accurately detect the number of fetuses inside a woman.
In-vitro procedures in the past contributed to higher multiple birth rates because many centers transferred three or more fertilized eggs to the uterus to improve a couple’s chance of having a baby. But discussion has been building for years about the societal implications of these extra births.
The Berrys were perfect candidates for blastocyst transfer. She’s 30, a registered nurse and in excellent health. Her husband, a financial adviser, is 28.
When she was 18, she was diagnosed with endometriosis, a disorder in the lining of the uterus. The cause of endometriosis is not known, but it’s believed to occur when fragments of the uterine lining are shed during menstruation but are not discarded with menstrual flow. Instead, they travel to the fallopian tubes and into the pelvic cavity. The displaced tissue continues to respond to hormones that begin subsequent menstrual cycles, so the tissue continues to bleed, then grows and forms cysts that can become the size of a grapefruit. This swelling causes the pain associated with endometriosis.
Berry was told at the time that she should consider having children soon, but she wasn’t even married then.
Last year, she found out that her chances of having a baby without in-vitro fertilization were slim. “I was prepared for it, but it was still pretty upsetting,” she says.
Her husband was exceptionally supportive, she says. “He knew how badly I wanted a baby, and he wanted one, too.”
When she visited Beaumont and learned that her husband would have to give her shots of fertility drugs, she broke down, she says.
She says his response was: “This is no big deal. We can do this.”
And they did.
