The Single Embryo Debate Continues
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.
