Making in vitro births safer and less costly
In Vitro Fertilization often leads to multiple births.
Shortly after Megan Wood’s 26th birthday, she and her husband Brian decided to try to get pregnant. Wood says she was young and didn’t anticipate any problems, so the couple was surprised when they weren't able to conceive quickly and easily. But after spending three years pursuing less expensive medical options, the Woods traveled from their home in Idaho Falls, Idaho to California to try IVF. When they returned home Megan Wood says they got some unanticipated news.
“I was laying on the table and I remember the ultra sound tech looking over at my husband saying ‘Did you see that’?”
The couple already knew they were pregnant. Wood had transplanted two embryos hoping for one healthy baby, a decision she says they discussed at great length with her doctor, and things were going well with the pregnancy. But embryos can split -- and that’s exactly what happened to Megan Wood’s.
“It’s blazoned into my memory for all time,” she says. “I cried. I was terrified. I wasn’t afraid to raise triplets, but the thought of losing all of them was terrifying.”
A new statement from the National Perinatal Association says that because transferring more than one embryo at a time often results in multiple order pregnancies, the practice can mean dangerous and expensive births. Sean Tipton, Chief Advocacy and Policy Officer for the American Society of Reproductive Medicine says it can be very challenging to try to educate patients about the risks that multiples pose.
Of the patients he says, "They're thinking 'I want to have a baby' and many of them think twins are an optimal outcome even though from an obstrical and pediatric standpoint, twins are not optimal."
Source: Centers for Disease Control and Prevention
Only 15 states require insurance coverage for infertility and Wood’s home state of Idaho wasn’t one of them. So even though she describes herself as “very lucky to have a husband with a union job and good health insurance,” her IVF wasn’t covered. With the cost of medical bills, and travel to her out-of-state doctor, one cycle of IVF cost Woods $25,000. She says the high cost was a big reason they decided to take the risk of transferring more than just one embryo, although she and her husband know that medically speaking, single embryo transfers are preferable.
“We wanted to make sure that was a reasonable risk to take before transferring two embryos,” she said. “Certainly when you’re gambling that much money at just a chance to get pregnant you want your odds to be as good as possible.”
Sean Tipton says access to insurance would go a long way towards alleviating the problems of human engineered multiple births. In several states, he says, that have mandated infertility insurance coverage, the levels of multiple births are lower than in other states.
“When you can factor out the economic costs and let the decision be made on medical criteria alone,” he says, “you reduce the number of multiple births.”
Infertility, says Tipton, should be treated like a disease.
Megan Wood’s 5-year-old triplets -- Ginger, Daisy, and Edison -- were born two months early and ended up in a Neonatal Intensive Care Unit. According to the NPA, the average cost for multiple births like Wood’s trio is 20 times higher than for just one baby. $105,000 per twin, and $400,000 thousand or more per triplet.
“It’s not uncommon for babies to go home on heart monitors or with breathing support. Some babies end up needing interventions like tracheostomies or feeding tubes," says Erika Goyer, Program Director of Hand to Hold, a non-profit that works with families dealing with difficult pregnancies, and a board member of NPA.
Goyer says the problems that twins or triplets from multiple transplant IVF births, as well as those born of less expensive, and less precise treatments, can bankrupt families. She notes that a lot of families of children with special healthcare needs face a dilemma – how to qualify for Medicaid after leaving the hospital, a point at which coverage usually stops. Some families, she says, go to great lengths to ensure that they continue to qualify.
“Families will rearrange their finances and make changes so that they never make anything more than what they’re allowed to make and still qualify for services," Goyer says. "Some families with special needs are really faced with the choice – how do I live my life, just at the right level of poverty so that we get the health care coverage we need?”
But Goyer is also Megan Wood’s sister, and she says she understands how and why the NPA’s suggestion to transfer just one embryo at time is tough. Emotionally, she understands why families use more. But clinically, she says the safest choice is transferring just one embryo at a time.
A lot of ethical decisions, says Goyer, about in vitro fertilization need to be discussed.
“And at this point,” she notes, “those decisions are being made by the marketplace.”
Miriam Zoll, a health and reproductive rights advocate, and author of Cracked Open: Liberty, Fertility and the Pursuit of High Tech Babies, says part of the blame for transferring too many embryos is due to a different kind of financial pressure. The clinics that provide fertility services to prospective parents stand to gain more clients if they acheive higher sucess rates. So, althought it may not be best for couples seeking treatments, it's in the provider's best interests to transfer multiple embryos."
“The higher their success rates," says Zoll, "the more likely new customers will come to them."
Zoll says there's also the problem of inflated rates. Some in the medical industry set rates far higher than necessary, seeking to tap into fearful patients desperate to conceive and willing to pay. Reproductive work, she notes, is referred to by some care providers as the new “oil”.
But aside from wishing that insurance had covered the hefty price tag of her in vitro, now mom-to-triplets Megan Wood, says she wouldn’t change a thing about her pregnancy, even if she could.
“There’s no guarantee that you’re going to have a healthy pregnancy when you’re 21,” she says, “and there’s no guarantee that you’re going to have a healthy pregnancy when you’re 45. Pregnancy is always a gamble and it’s a gamble that we’re willing to take to become mothers.”