This report comes from an invitation only meeting conducted in November 2009 and hosted by the federal agency, the Canadian Fertility and Andrology Society (CFAS) and the Society of Obstetrics and Gynecology of Canada. The agency has never reported on it publicly before.
The debate highlights the dilemma faced by patients who desire a pregnancy but not necessarily more complicated multiple births (even twins) are more complicated for baby (particularly) and mother (less risk than for baby). The issues are complicated and involve medical facts, finances and psychology.
Click for original reference article. Please see the poll at the bottom of the post and share your thoughts.
From my personal experience:
- Patients want the autonomy to choose the number of embryos for transfer after informed consent
- Our embryo scoring and our patient prognosis scoring is not perfect so that calculating delivery rates and multiple birth rates are imprecise and require a combination of educated guessing and luck
- Success rates are generally higher with more embryos transferred (please read on for details)
- We are only recently getting to the point that elective single embryo transfer (eSET) provides essentially the same success rate as double embryo transfer and only in the youngest and best prognosis patients
- Without question, in our practice (and we have very high pregnancy rates) women 38 years and older need more embryos transferred to achieve decent delivery rates
- Even with younger patients, if the medical situation renders a patient as a poor prognosis, they will only get a reasonable pregnancy rate with more embryos and even then they have 50% or less chance of having a baby (see our success rate page)
- Patients risk rather large sums of money on IVF treatments and failing to get a baby may be the only chance they get
- In US states where IVF care is mandated to be covered by insurance, fewer embryos are transferred implying that when patients have the option of extra treatments should the first fail then they are more willing to consider a lower pregnancy rate and lower multiples
- Refund guarantee programs not only make IVF treatment less scary financially but it also allow patients to consider a more conservative first try when they know that they can try again
- Many of my patients want multiples. They don’t want to go through the process again and they like the idea of being done with building their family after a single treatment
- They usually do not fully understand the risks associated with multiple births
- OR They underestimate the likelihood that it will happen to them
- Education surrounding the risks could be better so that everyone really understands what they are deciding
Please understand that deciding on the number of embryos for transfer to achieve success without multiples is complicated and emotional. There absolutely are societal implications but there are also patient autonomy implications.
I confess that as an American I believe in patient autonomy, so I am not anxious for government to tell any of us what to do here. I am also the father of naturally conceived twins born at 28 weeks gestation and who spent 5 months in the NICU – so I do have an rather personal understanding of the implications of multiple births and prematurity.
I do think we need to work as hard as possible to reduce the number of embryos transferred when that is possible.