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Archive for April, 2010

The Wyden Bill Doesn’t Support Patients

By David Kreiner, MD

April 24th, 2010 at 6:00 pm

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Unlike most other fields in medicine, IVF success rates have been subject to public reporting since the passage of the Wyden Bill in 1992. The intent of the Centers for Disease Control and Prevention (CDC) report and the Society of Reproductive Technology (SART) report was to help infertility patients by informing them of the relative success of different IVF programs. Unfortunately, what sometimes creates the best IVF statistical outcomes in pregnancy rates is not always what is in the best interest of the mother, child, family and society.

Now that prospective patients are comparing pregnancy rates between fertility programs there is a competitive pressure on these programs to produce the best reportable rates. This means that patients with lower odds of success are less likely to be offered IVF retrievals and are diverted to IUIs or donor egg cycles.

The Wyden Bill results in competitive pressure to transfer more embryos to increase the pregnancy rate as reported. Despite the fact that there is evidence that a program can achieve similar live birth rates by transferring a single embryo each time, the Wyden Bill creates a disincentive to do so. It is no surprise that the clinics with the highest success rates have also had the highest triplet rates.

Live birth rates are reported per fresh cycle… those from subsequent frozen embryo transfers are reported separately. But again, success rates are reported per transfer, motivating programs to transfer multiple embryos to enhance their success rates. If live birth rates were reported per fresh IVF stimulation and retrieval… including those conceived from subsequent frozen embryo transfers, then programs would be likely to provide the less risky option of single embryo transfer to patients.

The risks of prematurity and pregnancy complications are far higher in multiple pregnancies than in single pregnancies. Financial and emotional costs to families and society are enormous. Multiple pregnancies result in longer hospitalizations, neonatal ICU (NICU) admissions, complications resulting in disabled children and occasionally death. They often do not have a happy ending, including increasing the incidence of divorce.

At East Coast Fertility, our Single Embryo Transfer program covers the financial cost for transferring one embryo at a time. For the fee of one IVF cycle, we offer free cryopreservation, embryo storage and unlimited frozen embryo transfers until a patient achieves a live birth. We also offer MicroIVF (minimal stimulation IVF) which is at least half the price of full stim IVF and about the same cost as a typical IUI cycle. Since minimal stimulation does not result in as many eggs, other programs are uncomfortable offering this treatment because it would lower their reported pregnancy rates.

If we are going to report IVF pregnancy rates as required by the Wyden Bill, let’s put all programs on the same playing field… enforce the number of embryos to be transferred and promote minimal stimulation IVF as safer and more efficient than IUI.

The Wyden Bill, without the teeth to regulate such things as the number of embryos transferred and reporting success per stimulation and retrieval and not by isolated embryo transfer, does more harm than good.

Let’s support efforts to reduce the number of embryos transferred by removing the added costs to the patient of cryo-preservation, storage and subsequent frozen embryo transfers and by absorbing them ourselves as a profession. This will go a long way in eliminating multiple birth pregnancies, and will do the right thing for the patients, their families and for society.

As Ghandi said “Be the change that you want to see.”

Let’s not just talk about it.

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