IVF, Multiples, and Risk: Buyer Beware

Janet Farrell Leontiou reflects on her experience as an IVF patient who was misled into choosing several multiple embryo transfers.

__________________________________________

A recent article in The Guardian summarizes new research showing that the chance of becoming pregnant following in vitro fertilization (IVF) can be reduced by as much as 27% when more than one embryo is transferred. The reduced pregnancy rate was observed when two embryos were transferred, but only one of these embryos was of good quality. When two embryos of good quality were transferred the pregnancy rate was the same as for single embryo transfer. These facts, which support single embryo transfer, are important given the risks associated with multiple births following multiple embryo transfer.

Several months prior to this article, I had read in a New York Times article on IVF and multiple births that “Consumers can easily be overwhelmed by the available data and be unable to distinguish between good medical practices and a sales pitch.” The statement was attributed to Dr. Mark Sauer, a fertility specialist. As an IVF patient, I was surprised to read this, but the next statement was like a punch to the stomach. The doctor continued: “We all consider twin pregnancy to be an undesirable outcome that can be completely avoided if doctors and patients agree that a single embryo transfer is the right thing to choose.”

caveat-emptor

I went to a major teaching hospital in New York City for fertility treatment. I assumed that I would be treated by accredited professionals in good standing, not by charlatans. I was wrong!  Although I have a Ph.D., I fell for the sales pitch. I remember sitting in the first doctor’s office and being told: “Hopefully two embryos will implant; hopefully they will be a boy and girl. Instant family.” I now know this to be a sales pitch.

In total, my partner and I had four IVF cycles. With each cycle, we did not learn how many embryos would be transferred until I lay on the examination table. Each time, we agreed to the transfer of more than one embryo as recommended by our doctors. Not one of our doctors – a total of three fertility specialists and my obstetrician/gynecologist – warned us about the increased risks to myself and my child(ren) with multiple births.

As I recall, with the third cycle, the doctor said: “We have seven embryos. Take a minute to decide if you want us to transfer all seven.”  As unbelievable as it now seems, we decided to transfer all seven embryos. Thankfully, none of them implanted.  If several embryos had implanted, we were told we could choose “selective reduction” to eliminate some of the embryos that had implanted.

With the fourth IVF cycle, three embryos were transferred. Again, as I lay on the table, I remember the doctor saying: “Three is considered the gold standard. Can we transfer three?” My partner and I agreed. We were easily sold on transferring three embryos because we had been through three previous cycles involving multiple embryo transfer. I also remember the doctor asking: “Is it OK with you if we say God Bless as we perform the transfer?” “Yes,” we answered. I now wonder, was invoking the name of God part of the sales pitch?

On our fourth attempt, we had twins, one of whom has cerebral palsy. As we were encouraged to transfer multiple embryos without a single word of caution, I believe there was no informed consent. We thought that the biggest risk was premature labour. So, when I carried the pregnancy to term, I thought we were in the clear. The healthy birth weights and high Apgar scores at birth also did not predict that one of the boys would have cerebral palsy.

Since the birth of my twins, there have been several articles in which doctors are beginning to sound the alarm warning IVF patients to beware. As Dr. Allen Merritt and colleagues explain, because the fertility industry is largely unregulated and compliance is purely voluntary, there is no consistency within the industry. Some doctors advise against multiple embryo transfers and some doctors do not. One way to address this is to ask insurance companies to refuse to cover multiple embryo transfers.

In the meantime, if doctors do not adhere to the principle of primum non nocere (first do no harm) as stated in the Hippocratic Oath, then the patients must adhere to the principle of caveat emptor (the buyer takes the risk).

__________________________________________

Janet Farrell Leontiou is an Associate Professor of Communication at Nassau Community College and the author of What Do the Doctors Say?: How Doctors Create a World through Their Words (2010)

For more about Janet’s story see here.