The fertility biz: too many hazardous twins?

The NY Times reports on the complicated incentives in the fertility business that often lead to the birth of twins, despite the increased hazard that attend low birthweight babies: The Gift of Life, and Its Price .

"...leaders of the fertility industry and government health officials say that twins are a risk that should be avoided in fertility treatments. But they also acknowledge that they have had difficulty curtailing the trend.
Many fertility doctors routinely ignore their industry’s own guidelines, which encourage the use of single embryos during the in-vitro fertilization procedure, according to interviews and industry data. Some doctors say that powerful financial incentives hold sway in a competitive marketplace. Placing extra embryos in a woman’s womb increases the chances that one will take. The resulting babies and word of mouth can be the best way of luring new business." (emphasis added)
"Doctors are also often under pressure from patients eager for children, who have incentives to gamble as well. Frequently, they have come to IVF as a last resort after years of other treatments, are paying out of pocket, and are anxious to be successful on the first try. And many do not fully understand the risks. "

A subsequent report, Grievous Choice on Risky Path to Parenthood, indicates that more multiple births result from intrauterine insemination than from in vitro fertilization, but that

"While less effective than IVF, intrauterine insemination is used at least twice as frequently because it is less invasive, cheaper and more likely to be covered by insurance, interviews and data show."

The story goes on to suggest that IU may not in fact even be cheaper, when subsequent care for compromised low-birthweight babies is taken into account.

Earlier, the Times invited several commentators to discuss the issue: Eight Is Enough
"A woman in Southern California has given birth to eight babies, the world’s second live-born set of octuplets. With advances in fertility treatment, multiple births are becoming more common, but how many are too many? What are the costs of delivering and caring for premature babies? And what about the emotional costs? We asked several experts to give us their thoughts.
Jeffrey Ecker, perinatologist
Felice J. Freyer, medical writer at The Providence Journal
Mark I. Evans, a doctor who specializes in reproductive genetic services
Ellie Tesher, the author of “The Dionnes” "