ART, Expense, and Infant Health

A recent NY Times pair of articles focuses on the human, medical, and social costs of implanting multiple embryos via IVF and IUI, resulting in a spike in both multiple births and a litany of health risks to these babies. The articles, and ensuing barrage of public comments, can be read here: “The Gift of Life, and Its Price,” “Grievous Choice on Risky Path to Parenthood.” In IUI, parents who conceive multiples also face the decision of whether to terminate some fetuses using the procedure termed “selective reduction”. IUI is much cheaper than IVF, and more readily covered by insurance, but the chance of success is lower and ability to control multiples non-existent.


The most startling assertion in the IVF article was an analysis by reproductive health experts and providers explaining the financial and business motivations on providers to disregard medical guidelines by implanting more embryos than may be safe for mom or her babies. Fertility practices want to boost their success rates and attract clientele in a highly competitive and lucrative medical field, and parents apparently think that implanting more, or rejecting selective reduction in IUI, will secure greater chances of a viable pregnancy and satisfy their emotional or religious needs to a degree that makes the risks worth taking. If the underlying reason for the increase in multiple implantations and subsequent births is really a symptom of our profit-based medical system, some suggest we utilize insurance schemes as a way to address this issue. If insurance companies are required to cover IVF, whereas many now only cover IUI, they could regulate the financial incentives by only reimbursing doctors for single implantations.


Thus, the questions clamor – is it acceptable to allow patients, with full information about the risks and costs, to ask for multiple implantation in IVF? How can we monitor the provision of the required medical information to make balanced decisions regarding both procedures? What if the doctors themselves are not fully apprised of the risks, as the articles suggest? With comparisons of infant health stark against countries such as Finland and Sweden which limit IVF implantation to one, is it justifiable in light of our constitutionally protected reproductive freedoms to regulate how many embryos a couple may opt to implant? Does the availability of these technologies create a right to biological children, beyond the fundamental due process right to procreate, where infertility conditions would otherwise deny families such a right? What would such a right mean in light of the fact that the families that can even attempt these procedures tend to be affluent?


To my mind, the over 50% chance that multiples will be born preterm and at low birth weight, combined with the over $1 billion in care we collectively spend yearly to keep premature babies alive, is more than enough evidence that these practices are neither sustainable nor just in economic, ethical, or emotional terms. However, the debate is flourishing – I am curious to hear what others on this blog think.


Dante Costa