New York Times Series Examines Risks Of Infertility Treatments

Main Category: Fertility
Also Included In: Women's Health / Gynecology;  Pediatrics / Children's Health
Article Date: 14 Oct 2009 - 5:00 PST

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The New York Times this week published a series of articles examining issues related to infertility treatments and premature infants. Although the infertility industry considers procedures like in vitro fertilization or intrauterine insemination successful if they result in births, some physicians and health officials have become increasingly critical of the high costs, prematurity risks and increased multiple births associated with the treatments, the Times reports. Summaries of the articles appear below.

• Twin pregnancies: In vitro fertilization procedures result in the birth of thousands of infants annually, making it one of the most popular options for infertile women, the Times reports. An increasing number of IVF pregnancies result in twins, which have higher risks of premature birth, mental retardation, ear and eye impairments, and learning disabilities. About 60% of twins are born prematurely, and the government estimates that caring for premature infants in the U.S. costs $26 billion annually -- including $1 billion for IVF infants. These costs "eventually get passed through the system and on to businesses and consumers," according to the Times. The article states, "The industry creates preterm infants with in-vitro and other fertility treatments even as government and nonprofit groups work to fight the nation's 12.7 percent rate of prematurity, regarded as a major national health care problem." The Times notes that a study released last week by the March of Dimes "cited fertility treatments as one of the main reasons for a 36 percent increase in prematurity in the last 25 years." However, the risks and costs are often overlooked by infertility doctors, who are under pressure to produce results for infertile couples -- many of whom pay for the treatments out-of-pocket and have experienced years of unsuccessful conception attempts. The American Society for Reproductive Medicine, the Society for Assisted Reproduction and the Centers for Disease Control and Prevention have been promoting the use of single embryos in IVF procedures for years, but "that has not translated into major action at the 483 fertility clinics across the country," according to the Times. William Gibbons, incoming president of ASRM, said the organization is concerned about the risks of twin pregnancies and plans to issue new guidelines at a meeting next week to discourage multiple births (Saul, New York Times, 10/11).
  

• Selective reduction: Although intrauterine insemination is less effective than IVF, it is used at least twice as often because it costs less, is less invasive and is more likely to be covered by insurance, the Times reports. According to the Times, "Multiple babies who arrive very early require the highest level of acute care for a longer time than any other patients. Despite the lower cost of IUI on the front end, many doctors point out that insurance plans bear higher costs when IUI goes awry and large broods are born." The article cites a recent study led by Dartmouth Medical School suggesting that if couples started with IVF instead of IUI, "it would ultimately lower both costs and the risk of large multiple births" because IUI often requires repeated tries. In addition, because IUI carries a higher risk of multiple births, many couples are forced to decide whether to attempt to carry all infants to term in face of health threats or use selective reduction to reduce the number of fetuses. There are no official statistics on the number of pregnancies resulting from IUI, but experts believe that at least 20% of IUI pregnancies are multiples. Most of these pregnancies are twins, though a 1999 study found that 8% of such pregnancies were triplets or quadruplets. Selective reduction of some of the fetuses often gives the others better chances at survival, according to doctors who perform the procedure. Mark Evans, a New York City-based doctor who performs selective reductions, said that 1,000 to 2,000 reductions are performed annually in the U.S., typically in the first trimester. According to the Times, some opponents of selective reduction view it as a form of abortion, and many couples who choose to carry all fetuses cite religious convictions as their reason to do so (Saul, New York Times, 10/12).

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