ART Professionals Aim to Reduce Multiple Births

Not so long ago, in vitro fertilization caught the rap for rising numbers of multiple births, resulting from the once common practice of implanting multiple embryos in order to improve the odds for achieving a live birth. Anyone remember “Octomom”? Even in 2009, when the single mother of six made international headlines for giving birth to eight babies resulting from IVF treatment, improved reproductive technology had reduced the need for implantation of multiple embryos, and standard practice (since 1998) was to limit the number of embryos implanted to a maximum of two or three. The treating physician in that case was expelled from the American Society for Reproductive Medicine (ASRM).

The number of multiple births in the U.S. has continued to rise, and 46% of births resulting from IVF are multiples. Although the number of babies per IVF birth has dropped, today most of those multiples are twins. The next goal of professionals in the field is to reduce the number of twins.

According to the CDC’s 2010 data, the most recent year available, increasing numbers of women under age 35 who receive IVF treatment undergo elective single-embryo transfer (eSET), while the number of embryos implanted went up with the women’s age.

Nationally, among cycles in which at least one embryo was transferred, the average number of embryos transferred increased with increasing age (2.0 among women aged <35 years, 2.4 among women aged 35–40 years, and 3.0 among women aged >40 years). Elective single-embryo transfer (eSET) rates decreased with increasing age (10.0% among women aged <35 years, 3.8% among women aged 35–40 years, and 0.6% among women aged >40 years).

ASRM updated its guidelines for IVF in 2013 to recommend that intended mothers younger than 35 and in good health be offered single-embryo implantation (eSET) and suggested that no more than two embryos be transferred in any one procedure. Women ages 35 to 40 may receive two to three embryos due to the increased difficulty of conception.

Now the push in the field of assisted reproductive technology is to reduce the number of twins. Even though risk drops with the number of babies per birth, twins still have a higher risk of premature birth, of hospitalization, and of problems with brain and nerve development, according to the ASRM Fact Sheet on “Complications and Problems associated with Multiple Births.” Mothers of twins also face more complications during pregnancy, including higher risk of pre-eclampsia, hypertension, toxemia and diabetes.

One challenge physicians face in reducing the number of twins born via ART is financial. Each cycle of IVF treatment performed in the United States costs an average of $12,400, according to ASRM. Some intended parents resist physician advice to undergo single-embryo transplantation with economy in mind—a double embryo is “twice the bang for the buck.” Popular perception is that twin births are relatively safe.

ART is improving by leaps and bounds. New technologies such as chromosome testing and freezing of embryos, although they add to the per-cycle cost, also improve the odds of achieving live birth. As the risks of IVF drop and the probability of pregnancy increases, more and more intended parents will gain confidence in single-embryo implantation. If the U.S. government and insurers finally accept the premise that the ability to have a family is a health and wellness issue and cover the cost of ART, as is the case in many countries, perhaps one day money will no longer be the thing that pushes intended parents to accept the higher risk of twins.

For more information about U.S. multiple births due to fertility treatment:

IVF improving, but fertility treatments keep multiple births high,

New England Journal of Medicine, “Fertility Treatments and Multiple Births in the United States,”

Rich Vaughn
Richard Vaughn

Attorney Rich Vaughn is founder and principal of International Fertility Law Group, one of the world’s largest and best-known law firms focused exclusively on assisted reproductive technology, or ART, including in vitro fertilization (IVF), surrogacy, sperm donation or egg donation. Rich is co-author of the book “Developing A Successful Assisted Reproduction Technology Law Practice,” American Bar Association Publishing, 2017.

Peiya Wang
Paralegal (律师助理)

Peiya Wang joined IFLG as a paralegal in 2015, where she manages surrogacy, egg donation and parental establishment cases and provides translation services for many of IFLG’s international clients. Peiya received her bachelor’s degree from Beijing Technologies and Business University, where she majored in Marketing. She moved to the United States in 2012 to attend Northeast University in Boston, Massachusetts, receiving a Master of Science degree in Global Studies and International Affairs in 2014. Peiya moved to Los Angeles in 2015 and received her paralegal certification from UCLA Extension. When away from the office, Peiya is a dragon boat paddler and a ballroom dancer, where she favors Rumbas and Cha-chas. She is fluent in Mandarin and English.

Luis Sosa

Luis R. Sosa joined IFLG as a paralegal in 2016, where he enjoys pursuing his passion for family and reproductive law. While working toward his bachelor’s degree at Florida International University, Luis worked as a paralegal and legal assistant for family law litigation firms in Miami and Washington, D.C. As a paralegal and case manager for IFLG, Luis, who is bilingual in English and Spanish, manages surrogacy, egg donation and other reproductive law cases. In addition to spending time with husband Randy and dog Marty, Luis enjoys being outdoors and appreciating the arts.

Toni Hughes

After receiving her B.S. in Business Management, Toni joined IFLG to pursue her dream of working in the legal field. As a Paralegal with over 10 years of experience in the assisted reproduction technology field, Toni is our Managing Paralegal, responsible for training and managing our paralegal staff. From drafting legal documents to assisting our clients with post-birth matters, Toni embraces the challenge of learning something new in this field each day. Besides spending time with her son, Jordan, Toni enjoys exploring new things, cooking, spending time with family and friends, and serving as a Youth Advisor for “Next Generation.”

Miesha Cowart
Financial Coordinator

Miesha Cowart joined IFLG as a financial specialist in 2014 following a successful career in development and business finance. Miesha previously worked for 10 years in the construction industry as a controller and for 13 years as Development Coordinator for the non-profit U.S. Fund for UNICEF. In her free time, Miesha works with “Next Generation” at her church. “They are my heartbeats!” she says of the youth in her community.


Kim has over 25 years of experience in the legal field and has worked exclusively in surrogacy and assisted reproduction law since 1999. Kim is a senior case manager of surrogacy and egg donation cases, and is also responsible for managing parental establishment cases and interacting with IFLG’s Of Counsel attorneys across the country. With three children of her own, Kim understands the importance of family and finds working in this area of law a rewarding experience.

Rich Vaughn

Attorney Rich Vaughn combined his personal passion as a father of twin boys born via assisted reproductive technology (ART) with more than 20 years of experience in business and technology law to build International Fertility Law Group. Today IFLG is one of the most successful and best-known law firms in the world focused exclusively on fertility law, helping thousands of intended parents through empathetic listening, compassionate guidance, and unmatched legal expertise. As an advocate for reproductive freedom, Rich also contributes his knowledge and time to improving the understanding and practice of ART law, most recently as a founder of and speaker at the first Cambridge University International Surrogacy Symposium held in June 2019, as immediate past chair of the American Bar Association ART Committee, and as a popular presenter to law schools, faculty and advocacy organizations all over the world.

Elizabeth Tamayo

Elizabeth received her Bachelors of Science degree in Criminal Justice from California State University of Los Angeles. Shortly after graduating, she continued her education at the University of California, Los Angeles where she obtained her Paralegal certificate. Elizabeth is fluent in Spanish and has been in the legal field since 2009. She is excited to be a part of the IFLG Team helping families realize their dreams.

Sunny Chien

Sunny joined IFLG as a paralegal in 2017, where she manages surrogacy, egg donation and parental establishment cases for many of IFLG’s international clients. She holds a Bachelor of Arts degree in Philosophy from California State University of Los Angeles, where she graduated cum laude. Sunny is bilingual in English and Mandarin and has extensive experience as a legal assistant and paralegal at Los Angeles-area law firms. She is excited to be part of the IFLG team. In her spare time, Sunny enjoys spending time with her family and their dog, going to the beach, cooking, and being outdoors.

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Molly O'Brien

Fertility law attorney Molly O’Brien began working in the field of assisted reproduction technology (ART) in 2005, at an egg donation agency and a surrogacy agency where she became familiar with all aspects of in-vitro fertilization, egg donation and the financial aspects of surrogacy. Since becoming an attorney in 2011, Molly has drafted and negotiated surrogacy, egg donation, sperm donation embryo donation agreements for hundreds of her clients all over the world.