The third session of Double Take: Twins in Genetics and Fertility Treatment covered a broad range of opinions and specialties. There was discussion of patient choice over embryo transfer, talk of treatment access and decisions over genetic testing. The session was skilfully chaired by Jane Denton, director of The Multiple Births Foundation.
The three speakers all gave their own unique take on multiple births resulting from IVF.
Dr Yacoub Khalaf, director and person responsible at Guy's Hospital Assisted Conception Unit and senior lecturer in reproductive medicine at King's College London, opened the session. His talk asked whether IVF twins were 'fulfilling dreams or turning them into a nightmare'.
As those that have heard Dr Khalaf speak before would expect, he was engaging and humorous, masterfully outlining the difficulties of multiple births. He incorporated some rather memorable visual aids which drew upon the stories of Celine Dion and the Bush Twins. He expertly demystified a recent Daily Mail story about IVF twins being born nearly three years apart.
Dr Khalaf spoke of the occasional clash between the perception and reality of having twins. Patients may look at twins as a positive outcome - a sort of 'buy one get one free' pregnancy - but while many healthy twins are born every year, all the risks of pregnancy are increased. And then there are not just medical difficulties but financial and emotional ones as well.
The take-home message was that multiple births are the single biggest risk to the health and welfare of a child born from IVF. And twins are more likely to be born prematurely, which itself carries high risk of complications, some of which can last a lifetime.
Next, Dr Nicky Hudson, senior research fellow and leader of the Reproductive Research Group at De Montfort University, spoke about her research looking at patients who travel abroad for treatment.
Her talk drew on her findings from a study group of 51 people: 41 women and ten men, including one lesbian couple and eight single women.
Dr Hudson said those interviewed were more likely to view twins as a positive outcome and this view intensified the longer they had been trying and the more complex their fertility problems.
Those interviewed didn't necessarily go outside of the UK just so that they could have multiple embryo transfer. All the same, 70 percent of those seeking treatment in Spain (a popular destination) had double embryo transfer.
Dr Hudson said that participants felt more involved in their treatment when they went abroad than they had done in the UK. Participants spoke about both the medical and psychological risks, but often the biggest risk they perceived was that of not getting pregnant at all.
Jane Fisher, director of Antenatal Results and Choices (ARC), gave the session's final talk, 'Multiple Dilemmas: The Implications of Prenatal Diagnosis in Twin Pregnancies'. She spoke from the perspective of the expectant parent. ARC offers specialised support for as long as needed when expecting parents receive a worrying screening result or when a fetal anomaly is diagnosed.
Ms Fisher spoke about the difficulty of prenatal screening of twins compared to singleton pregnancies. Down's syndrome testing was given as an example. Non-invasive prenatal testing, which uses a maternal blood test, may yet prove preferable to current scanning techniques but is still being trialled for use on the NHS.
Ms Fisher also spoke about the difficulties of selective reduction, particularly later on in a pregnancy.
Interestingly, she said that for parents who have conceived via IVF there was often a stigma attached to testing. She told the story of one patient who had been asked outright by her midwife why she was requesting a test given that the fetus has been conceived via IVF - surely the parents couldn't ever consider terminating?
The questions from the audience were varied, as always at Progress events. There was a particularly intriguing question from Jane Denton when she wondered aloud if couples would be more willing to accept single embryo transfer if they could be promised three cycles of IVF in accordance with the National Institute for Health and Care Excellence recommendations (see BioNews 694).
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