— The most comprehensive analysis of the health-care costs
of multiple births is a real (sticker) shock.
pregnant woman’s prenatal care and the babies’ care
through the first year are included, a single birth costs
$21,458, compared with $104,831 for twins and $407,199 for
triplets or more, according to a new study of insurance claims
in the American Journal of Obstetrics and Gynecology.
means twins cost five times as much as single births, and
higher multiples cost 19 times as much. Past studies, which
looked just at hospital costs, found far less disparity.
the price tags is the human toll. The study found that for
both mother and newborns, multiple births mean more deaths and
complications, and longer hospital stays. Even twins spent on
average a month in neonatal intensive care.
NICU costs can be pretty staggering," said study author
Bradley J. Van Voorhis, an ob-gyn who heads the University of
Iowa’s assisted reproduction program.
technology is the driving force for multiple births. Consider
that since 1980, the twin birth rate in this country has risen
76 percent, while the rate of higher multiples is up 400
guidelines have recommended that only one or two embryos be
transferred to the wombs of women using in vitro
helped — but mostly with higher multiples, and not enough.
In 2011, the number of higher multiples was the lowest since
1995. Yet 5,137 sets of triplets, 239 of quadruplets, and 41
of quintuplets were born.
rate has also stayed "stubbornly high" at 33 per
1,000 births, said Van Voorhis, who did the study with Merck
paper cited research that up to 85 percent of childless women
in fertility clinics said they wanted twins, even after they
understood the risks.
problem, the authors say, is that IVF usually is not covered
by insurance, so women want to maximize their chances of
getting pregnant on the first IVF attempt — even if that
means risking twins by implanting two embryos.
Voorhis said some clinics are persuading women to transfer
only one embryo and freeze others by promising not to charge
more when a second IVF try is necessary.
clinic has persuaded women to be conservative by proving that
it is safer and as effective overall. Iowa’s
"single-embryo transfer" rate is 36 percent, three
times the national average, while its twin rate is about 16
per 1,000 births, half the national average. Nearly 75 percent
of women under 35 have a baby with two IVF attempts.
feel if we educate patients … that resonates with
them," he said. "No one wants their infant to spend
the first month of life in a NICU."