In Vitro Fertility Goddess.
Wednesday 5 March, 2009
Pictures of the frail Suleman octuplets, born nine weeks early and only as heavy as 1½ pounds, have been beamed into lounge rooms around the world. The newborns who came from six embryos, two of which split into twins, have sparked a heated debate as to whether the US should follow the cue from lead of Sweden and Belgium and replicate their laws that limit the number of embryos that can be transferred during IVF.
Lawmakers in two states have already introduced bills to limit embryo transfers: Missouri will demand that fertility clinics follow American Society for Reproductive Medicine or ASRM guidelines which allow for one or two embryos in patients under 35 and up to five in women 40 and over. Georgia has upped the ante by limiting women under 40 to two embryos and those +40 to three.
Pictures of the frail Suleman octuplets, born nine weeks early at weights as low as 1½ pounds, have been beamed into lounge rooms around the world. The newborns who came from six embryos, two of which split into twins, have sparked a heated debate as to whether the US should follow the cue from lead of Sweden and Belgium and replicate their laws that limit the number of embryos that can be transferred during IVF.
Lawmakers in two states have already introduced bills to limit embryo transfers: Missouri will demand that fertility clinics follow American Society for Reproductive Medicine or ASRM guidelines which allow for one or two embryos in patients under 35 and up to five in women 40 and over. Georgia has upped the ante by limiting women under 40 to two embryos and those +40 to three.
But a growing number of women who have concerns about multiple births are opting for a relatively new approach called elective single-embryo transfer or eSET.
While 10 years ago, transferring a single embryo would have been deemed inappropriate given the slim success rates, progress made since then have significantly improved the chances of younger women achieving a successful pregnancy with only a single embryo transferred. The journal Fertility and Sterility recently reported that eSET patients had the same pregnancy rate (65%) as those who transferred two embryos. But the big difference was that while only 1% of eSET patients had twins compared with 44% of the women who had received two embryos.
But the incentives faced by American patients to transfer more than the recommended number of embryos are too great to be ignored because large numbers of IVFers lack appropriate insurance for a procedure that costs about $12,500 a cycle. Many view twins as "two for the price of one" or see multiple transfers as increasing their chances of conceiving at least one healthy baby. And for fertility doctors, there's the incentive to boost transfer numbers in a bid to increase their success rates and their clinic's appeal to future clients.
Barbara Collura, the executive director of the infertility group Resolve, believes there is necessity to encourage women to take out insurance first because restricting embryo transfers without first addressing the insurance issue "is going to create more trauma and more problems. When you get to the point where this is covered by insurance, you have a completely different attitude, you're not as desperate."
Sean Tipton from the ASRM says that in Connecticut, health plans that cover maternity care must pay for IVF, but they can limit the number of embryos transferred to two. Governments can also intervene directly as is the case in the Netherlands where while there is no strict legislation on the number of embryos transferred, the government says that the transfer of more than two embryos shouldn't be reimbursed by national healthcare. And that's a strong disincentive.
Resolve urges women to consider their health and their baby's health when contemplating the transfer of more embryos than recommended by the ASRM.
But that is easier said than done as it's often hard to deal with them in a rational way when they're in perhaps the biggest crisis of their life.
And at the end of the day, while some fertility clinics support eSET, it's not always the case because fertility doctors only have to deal with patients up to the time they become pregnant, that's it. After that, they are out of their hands and they don't have to deal with the consequences of multiple births.
Sarah Williams
