Mad props to Mr. Rooney for pointing out this interesting article about IVF. We never ventured into the world of IVF, but this would be good information for anyone who was considering it.
In case you didn't bother to read it, the article presents the position of some fertility experts who want to limit the number of embryos implanted in any given treatment cycle to one. The common practice in North America is to implant two or more embryos, in an effort to increase the chances of success on the first try. This often results in twins or triplets (nearly half of all IVF babies are involved in a multiple birth - wow). However, there are several risks associated with a multiple pregnancy. The experts claim that you get similar rates of success by implanting one embryo at a time, and you avoid the risks of multiple pregnancies. I think this makes good sense.
There are pressures to continue the practice of multiple implantation, however. Unbeknownst to me, there is a published "league table" for fertility clinics, which lists the ratio of live births vs. IVF procedures for each clinic. In the past, some couples have used this data to select their clinic -- equating a higher ratio on the table to a better facility. Obviously, instances of twins or triplets boost these statistics, so there has been little incentive for clinics to reduce the number of embryos implanted in each cycle. Some will implant as many as five embryos, occasionally requiring "multifetal pregnancy reductions" (using abortion methods to reduce the number of gestations to a safer number).Pressure also comes from prospective parents who are desperate for results:
Many patients see twins as the ideal outcome of IVF. “They have this picture of healthy, bouncing twins,” says William Ledger, a fertility specialist at the University of Sheffield, UK, and a member of the expert group. “We doctors see the premature babies in intensive care.”
This describes my previous mindset perfectly. Although I wasn't really hoping for twins, I thought it would be a nice outcome, because it would result in an "instant family". This article has caused me to reconsider my position, mainly because of the risks:
-birth complications six times more likely
-mother mortality rate three times higher
-IVF twins average three weeks premature and 1kg lighter
-infant mortality at birth is higher (twins 3x higher, triplets 9x higher)
-physical & mental disabilities increase (ie: cerebral palsy 6x/18x higher)
Here is a counter-argument from an expert in London: "If the HFEA moved towards adopting single embryo transfer indiscriminately – it would probably result in a small decrease in twins but a larger number of people who do not become pregnant."
In our case, a single implantation would make some sense, because R is not a high risk case and she has no history of miscarriages. Circumstances are different for different couples, though. I know quite a few people who are involved in IVF treatments at some stage or another. I hope this information is useful for them as they consider their options.
To close, here are some interesting facts from Wikipedia:
The first successful IVF treatment in the USA (producing Elizabeth Jordan Carr) took place in 1981 under the direction of Doctors Howard Jones and Georgeanna Seegar-Jones in Norfolk, Virginia. Since then IVF has exploded in popularity, with as many as 1% of all births now being conceived in-vitro, with over 115,000 born in the USA to date. At present, the percentage of children born after IVF or ICSI has been up to 4% of all babies born in Denmark.
5 comments:
Good info D. So maybe the people pushing for only one at a time are in it for the money. I mean at ~$7500 a pop, they're game to make a LOT more money if they have to try a few times vs. just one. Also, implanting only one embryo lowers the odds drastically in some cases. Every single attempt is extremely physically and emotionally exhausting. I think people with tough cases would give up long before success with this method being required.
Eric,
I had a similar thought. If they could spread the procedure out over a longer period of time, it could generate more cash.
The article (and the other articles linked to it) make some decent-sounding counterpoints, but I don't have enough info to figure out if they're valid:
They say that it doesn't cost much more to implant one at a time, because you can freeze the unused embryos, to be used in the next cycle. You pay for the harvesting and fertilization already (and freezing if you get many embryos), so the only added cost is at the tail end of the procedure. I don't know what that costs.
For IUI, the last day of the procedure takes 15 minutes in an exam room with a nurse. From what I can tell, IVF embryo transfer is done the same way.
The fee schedule for our clinic lists a complete IVF cycle for $5400. To do a transfer of a stored embryo is $1100. To store the embryos for a year is $550.
On one hand, they could be driving up the cost. On the other hand, you can do several cycles without having to go through the harvesting stage. Neither way is any easier emotionally.
Yeah, even using the frozen embryo's it could add up to a lot more money. Also, your clinic seems to be a better deal than ours. ;)
Once you add the required meds, labs and other fees... a single cryo attempt can easily be over $3,000.
Bottom line... I think it's all about the mulla! heh
I know what you mean -- It's always the meds that kill you. The fee schedule only shows what you have to pay to the clinic. Even in IUI, the meds were nearly as expensive as the procedure itself.
I hear your point about difficult cases. I think the experts were suggesting the embryo limits in high-probability cases. In hard cases, they were more willing to leave it up to the doctors.
In fact, one of their suggestions was to require that clinics keep the incidence of twins under 10%, and leave it up to the clinic to decide how to achieve it.
Luke,
The more I read the posting, the more those stats stuck out to me as inadequate. I have added some more of the stats and I've also added the counter-argument that Eric brought up in his first comment. Hopefully, it's a little more balanced now.
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