The Single Embryo Debate Continues
By Theresa M. Erickson
The New York Times brought up the ever evolving debate regarding multiple births and single embryo transfers. In fact, it is my opinion that the piece was meant to blame some of the rising health care costs on the IVF patients themselves. Yet, what I don’t believe they addressed well enough was the flip side of this industry that involves the use of stimulation medications by OB/GYNs in order to obtain a pregnancy without the supervision of an IVF doctor. As in the case of “Jon and Kate plus Eight” and other high order multiples, they are often the result of the use of medications such as Clomid (excluding the “Octomom” of course) and interuterine insemination.
The piece does, however, address the painful choice that the patients, as well as their doctors, must make in balancing their desire to have a healthy children against statistics that are often not in their favor. However, why is the IVF patient who is expending large sums of money and often betting it all on one cycle being targeted? Again, what about the use of these stimulation medications without the counseling that is often required by IVF clinics in order to make certain that these patients understand the true definition of selective reduction and its risks? Then again, as was addressed by E.E. Evans in the piece, “Three in a Casket,” even if the patients are counseled, they often reject their own physician’s advice to reduce.
Truly, this is a national debate, which is one that is likely not to go away; however, there is a much bigger issue that involves the lack of medical insurance coverage for fertility treatments. How can the government or state legislatures regulate an industry that is not covered in some degree by the insurance companies? Yes, they can restrict the practice of one embryo per women of a certain age, but only if there is some coverage for IVF cycles, as in the UK. For now, these treatments are costly, and the likely solution is to bring the IVF physicians in on the risk by offering free storage and/or no subsequent frozen embryo transfer fees.
We need to continue this debate.
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As I suspected, the Times article has people thinking about health care reform. What say you?
Health Reform Should Regulate the Fertility Industry.
The Times is midway through a really great series on the financial, physical, and emotional wreckage often left in the wake of extreme fertility treatments. What hasn’t been addressed — at least, so far — is how health reform would alter this landscape. As I reported in a piece for Double X, other countries highly regulate fertility clinics in order to tamp down on dangerous multiple births.
Britain’s National Health Service pays for every infertile woman to undergo three IVF cycles. And, sure enough, in the United Kingdom, single embryo transfers are the norm, and preimplantation genetic diagnosis (PGD) is generally used only when the parents’ medical history suggests an increased risk for fetal genetic abnormalities.
In the United States, however, we have a classic divide between haves and have-nots. For the poor, even basic prenatal genetic testing can be out of reach. Medicaid pays for 40 percent of American pregnancies—1.6 million annually. But while 46 states and the District of Columbia provide some Medicaid coverage for prenatal genetic testing, the reimbursement rates are low, and parents often can’t afford to pay the rest of the bill.
The health-reform bills in front of Congress don’t address these issues — they leave it up to the Department of Health and Human Services, after reform passes, to decide what specific procedures should be covered and regulated. If fertility treatments and genetic testing were defined as part of a basic care package, though, it would allow for increased government regulation of this industry, which, as the Times reports, is currently driven both by its own profit margins and by patients’ inability to pay for multiple rounds of IVF, which leads couples to demand that several fetuses be transferred at once into the woman’s uterus.
It all serves as a reminder that there will be a lot of controversial health policy-making to be done after a reform bill makes it through Congress. In many ways, we’re just beginning this process.
–Dana Goldstein
http://www.prospect.org/csnc/blogs/tapped_archive?month=10&year=2009&base_name=the_times_is_midway_through