The CDC has just issued a report in which it surveyed all the babies born by Assisted Reproductive Technology (ART) in the US in 2009, as part of its “morbidity and mortality” series. So, the title gives us a hint that its focus was not cheery. Indeed, the CDC looked at pre-term deliveries in ART pregnancies (which it limited to non-donor egg situations) and all the complications ensuing therefrom: low birth weight, etc.
First, it reported its factual findings:
- Only 1.4% of US births were the result of ART procedures (as defined by CDC for this study –i.e. excluding the use of donor eggs.)
- States with insurance mandates for fertility tended to have a higher percentage of ART births.
- Elective Single Embryo Transfers accounted for 7% for women less than 35, and they decreased for older women.
- The average number of embryos transferred was 2.1.
- Overall, 32% of ART-conceived infants had low birth weight compared to 8% in the general birth population; and 6% were very low birth weight compared to 1% of the general birth population.
- Infants conceived with ART accounted for 20% of all multiple-birth infants.
- 47% of all ART births were twin births (ranging as high as 60% in Wyoming!), compared with 3% in the general population.
- Overall, 33.4% of ART-conceived infants were born preterm compared to 12.2% of the general population.
Next, the CDC made some conclusions:
- Single embryo transfers should be promoted if feasible – to prevent multiple births, preterm deliveries, and low birth weights.
- However, it went on to admit that, given the small incidence of ART — only 1.4% of all births— that it could not put the blame on ART for the overall prevalence of low birth weight and preterm births in this country.
- Accordingly, the CFC suggested that non-ART causes should be examined.
So, what other causes could there be? Allow me to posit one: The prenatal care of the woman carrying the baby.
The CDC focused only on how the baby was conceived. But what about what kind of prenatal care the mother or carrier received? It is common knowledge that prenatal care affects a baby’s health… and birth weight.
And, given that 47% of the babies were reportedly twins or higher order multiples, does it matter who cares for the pregnant woman? I would say yes. Specifically, if the woman is pregnant with multiples, is she being cared for by a high-risk specialist trained to look for sign of pre-term delivery or risk to the fetus, i.e., a perinatologist?
Case in point: When my law firm, Creative Family Connections LLC (CFC), represents prospective parents and drafts gestational surrogacy agreements, we put a clause in the contract that says that if the surrogate becomes pregnant with multiples, she agrees to supplement her OB visits with visits to a perinatologist.
By requiring this provision, CFC plays the role of the “bad cop.” If a surrogate asks her OB if she has experience with twins, the answer will of course be yes. But Reproductive Endocrinologists have often opined that twins are the highest risk babies precisely because obstetricians do not view them as high risk and requiring a specialist’s care.
We started this perinatologist policy after observing the very different outcome of two surrogates who were carrying twins for parents at the same time. One of those surrogates, Carey, was seeing a perinatologist in addition to her OB, and delivered healthy full-term twins. The other, Tonya, was seeing her OB and, tragically, delivered at only 24 weeks. One baby lived 3 days and the other lived 6. I talked to the babies’ two dads every day. We cried together. The memorial service, which I attended, was gut wrenching. It was not the first preterm death that one of our clients had suffered. But I decided that I really wanted it to be the last.
I thought about all the special tests that Carey had told me her perinatologist performed every time she went to see him…tests to see if the twins were under stress… tests to see if there were signs of preterm labor. We would never know whether Tonya’s preterm delivery could have prevented if she had also been seeing a perinatologist. But we could implement a policy that would leave nothing to chance.
So we implemented our new policy. Given all the effort our parents have gone through to make it just to become pregnant, we knew they would want every effort made to make sure their babies made it full-term. As we expected, the policy was met with grateful appreciation by our intended parents. Our gestational surrogates were cooperative, too. If something happened, they wanted to be able to say that they had done everything they could.
Since then, we have had no more tragic, pre-term deaths.
Surrogates such as Kiona and Brenda have delivered full-term healthy twin pregnancies for their parents.
And when a surrogate shows signs of pre-term labor, she already has a well-established relationship with a perinatologist or high-risk OB – who is immediately consulted. So, for example, when Whitney had pre-term contractions in week 23, she was already a patient of the Johns Hopkins high-risk pre-natal group. Under their care, and through a combination of home and hospitalized bed rest, she managed to carry Susan and Bob’s twins to a healthy, full-term delivery, much to the relief of everyone involved!
So, yes, CDC, there are other factors in addition to how a baby is conceived that affect whether a baby is born pre-term. Those of us who practice in this field every day know that. It’s time that ART stops taking the blame for everything.
Diane S. Hinson