IVF and Twins

The New York Times ran an article today about the high rate of twin births associated with IVF, and all of the related risks.  And it got me thinking… which gets me writing.

I’m not going to rehash the entire article, but it makes a few good points about why there are so many more twins and why that’s not actually a good thing (twins are much more likely to be born prematurely, which can lead to a host of short- and long-term problems).  But before I get into it, I want to say this to all of the parents who have gone through IVF and ended up with twins:

I get it.

I totally get it.  I so understand the difficulty of the decision, the desire after so many months of trying, after so many months of appointments, injections, tests, and procedures, to do anything you can do to maximize your chances of getting pregnant.  And so you hear that your chances of getting pregnant will increase if you transfer two embryos instead of one, and you know that your chances of getting pregnant with twins increases, and that having twins is risky, but then you think about all of your friends who have had healthy twins and it doesn’t seem like such a big deal.  And if you only want two kids, well, how great would it be to never have to go through IVF again?  And, if you’re paying for all of it (which Josh and I didn’t – we’re lucky enough to live in a state where fertility is covered through insurance), then the pressure is even higher.  What if it doesn’t work this time?  Will we be able to pay for it again?

Like I said, I get it.  I’ve had all of these thoughts, and more.  Josh and I really struggled with the question of how many embryos to transfer.  Our doctor would have transferred two if we had really pushed, although she strongly recommended only one.  In the end, we transferred one, and I delivered a healthy, full-term baby, for which I feel very blessed.

Anyway, back to my thoughts about the article.  It points to two financial incentives for transferring more than one embryo, one which is patient-initiated, and one which is physician-initiated.  I already mentioned several reasons why patients might want to transfer multiple embryos.  Physicians are motivated by their success rates – first, they got into the profession to help people get pregnant and have healthy babies, so they feel better when it all works.  Secondly, and more cynically, fertility clinics’ stats are public record, and fertility treatments are big money.  The more embryos transferred, the more likely you are to get a pregnancy, the better the clinic looks, the more patients seek treatment there.  Despite the guidelines of several national organizations discouraging multiple births (as noted in the article), fertility docs keep transferring multiple embryos.

So, what can we do about this?  First, this is yet another reason why we need serious health care reform (and, in my perspective, a public option plan, but let’s not focus on that here).  If fertility treatments were covered by insurance, patients wouldn’t feel compelled to transfer multiple embryos because of an inability to pay for a second IVF round if the first one didn’t work.  Furthermore, the cost of a single IVF treatment pales in comparison to the astronomical costs associated with taking care of premature babies, both in the immediate aftermath of birth and in the long-term.

Secondly, although I do appreciate that doctors need to earn a living, and I do believe that most doctors make decisions based on their patients’ well-being, I also think that doctors are only human.  Thus, I think fertility doctors who have high rates of multiple transfers need to review and re-evaluate their practices and procedures.  Perhaps they are making the best decisions possible, perhaps they aren’t, but they need to seriously consider what is motivating the choices they make.  Health insurance reform might take some pressure off these doctors, because it would take pressure off the patients to want to get it all done in one shot.

The reality is, it’s a hard decision, and having been there, I don’t envy any of us who end up having to make it.  I guess the best we can do is to stay informed, seek support, and make the best choices possible.  Read the article and share your thoughts – I’m interested.