A recent study by the Gertner Institute for Epidemiology and Health Policy Research points to a rise in the number of twins in Israel who were born premature and with a low birth weight between 1995 and 2009.
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According to the report, the number of premature, very-low-birthweight (under 1,500 grams ) twins rose from 111 in 1995 to 241 in 2009. The authors noted that multiple-embryo pregnancies account for 40 percent of all premature, low-birthweight babies born in Israel, and that in more than 60 percent of these cases the reason for the multiple embryos is the use of in vitro fertilization. The figures match data from the Central Bureau of Statistics showing a near doubling of twin births in Israel over a similar period, from 3,588 in 1995 to 6,989 in 2008 - 4.5 percent of all births in that year.
Multiple birth increases the risk of complications, including premature birth - itself a risk factor for developmental disorders.
According to the Gertner Institute report, between 1996 and 2000 the number of hospital admission days in preemie wards in Israel rose by 23 percent; 70 percent of the increase was attributed to multiple births. The survival rate of preemies in Israel also improved during the period covered by the study, however. From 1995 to 2009 a 15-percent decline in the percentage of premature infants with sepsis was recorded; the number of sepsis cases involving gram-negative bacteria declined by 36 percent, while life-threatening fungal infections dropped by 58 percent.
The research findings will be presented on Monday at a conference marking the 10th anniversary of the founding of the Gertner Institute.
The report's lead author was Dr. Brian Reichman, principal investigator at the Women and Children's Health Research Unit at the Gertner Institute and Sheba Medical Center, Tel Hashomer. He and his co-authors support the introduction of a policy limiting the number of fertilized embryos returned to a woman's womb during IVF treatment.
While the number of twin births in Israel has risen, the number of triplet births declined, from 120 a year in the mid-1990s to 30 a year more recently. The decline is in part the result of a 2004 Health Ministry directive reducing to just two the number of embryos returned to the uterus during standard fertility treatments. In April 2010 the Israeli Fertility Association issued new directives to consider returning just one embryo to women aged 30 or younger in the first round of fertility treatment, in the event that embryos identified as "highly viable" are obtained. The common practice in Israel today, however, is to return two embryos, and in the case of a third IVF treatment round, to consider implanting three in order to increase the likelihood of pregnancy.
The report's authors recommend adopting European policy models in an effort to reduce the number of twin births; in Belgium, for example, the state offers a discount on IVF treatment costs to women who agree to have just one embryo implanted.
In Britain, the Human Fertilization and Embryology Authority sets targets for gradually reducing the number of multiple births resulting from IVF treatment, starting in 2009 with a target of 24 percent of all pregnancies obtained at fertility clinics. That figure dropped to 20 percent in 2010 and 15 percent in 2011. In Israel, multiple births represent an estimated 30 percent of all births resulting from fertility treatments.
An initiative to create a central database of all IVF clinics, operated by the Gertner Institute, has been in the discussion stage for more than a decade. Fertility doctors resisted the idea; they sought guarantees that the database not be used to carry out comparisons on the number of pregnancies achieved at different hospitals.
The dispute escalated when the Finance Ministry made the creation of a comparative database, following Western models, a condition for allocating state money to the project. A compromise was eventually reached, according to which the published figures would include only the national average, while each clinic would receive details on its comparative ranking. Some months ago the initiative was suspended, for budgetary reasons.