Tuesday, February 19, 2008

Too many twins? Says who?

Today's NYT ran a piece that describes calls to reduce the number of multiple births resulting from in vitro fertilization efforts. Since the introduction of IVF in 1980, multiple births in the United States have increased by a whopping 70 percent--in no small part due to the fact that many prospective parents choose to implant multiple embryos in the hopes of increasing the odds of a successful pregnancy and birth. Several of us have blogged on other issues re multiples before, too... here, here, here, and here.

The article quotes a few experts who basically say that as the technology has improved, the need to implant "extra" embryos has diminished; but this raises the question of just what a successful IVF result looks like. Is one baby? More than one baby? All the babies the woman wants? And what about the health status of the infant(s)? If carrying multiple fetuses increases the health risk to mom and babies, but the woman wants to "maximize her investment" in the painful and expensive IVF cycle by shooting for triplets, can/should physicians try to dissuade her? On what basis?

It will be interesting to see how this plays out, particularly since fertility medicine is largely a consumer-driven affair. Infertility treatment generally isn't considered medically necessary by insurers and therefore isn't a covered benefit. People who pursue it are paying thousands of dollars--per cycle--out of pocket. Given all that, I wonder whether "the customer is always right" will be the governing rule.


Bea said...

Doctors should absolutely try to persuade their patients to do what's in their best medical interests - it's their job. This means that doctors should be pushing for caution. A successful IVF cycle is, without doubt, one that results in the live, healthy birth of a full-term singleton child - just what the couple was trying for in the first place.

However, contrary to popular belief, infertility patients are just as rational as anyone. If you make them pay out of pocket, the risk/benefit calculation they make as a patient is going to look a lot different from the risk/benefit calculation made by an insured patient. The rest is simply a matter of informed consent.


Sue Trinidad said...

Agreed, Bea, and I hope you didn't think I was implying that infertility patients are irrational.

It *is* true, though, that at least some women do want to deliver multiples. They might not want to repeat the whole IVF process to have a second child; they might not be able to afford a second round; and there are probably other reasons as well.

One woman quoted in the NYT article was advised by her doc to implant 2 embryos, but she chose to implant 3 because she wanted twins. She lost the pregnancy altogether, but says she doesn't regret her decision.

MLO said...

I admit I'm weird, but doing IVF actually REDUCES my chances for twins due to my genetic lineage. Twinning is rampant in my family and, in all honesty, I would rather deliver two 7-lb babies than 1 13 lb baby. (Averages in my family.)

I grow tired of the generalizations running rampant in all of this talk. Not every patient is the same!

Bea said...

It's ok, Sue - I wasn't trying to imply that *you* were saying IVF patients were irrational, but unfortunately some parts of the media do tend to take that line when addressing these sorts of issues, hence the sarcastic comment.

Also agree that there are patients who desire twins (and perfectly fertile women as well, for that matter). IVF patients, on average, are *only* as rational as everyone else. This is why doctors have a professional responsibility to promote properly informed consent.


JF said...

I would like to point out that doctors don't *implant* embryos. The correct term is "transfer." The embryo must implant itself.