Cowboys and Embryos

Over at Slate, Maggie Jones argues for government-mandated embryo capping:

…The fertility industry has been far better at inventing awe-inspiring technology—and selling it to the public—than it has been at counseling patients about the risks of procedures and how these technologies will shape families, sometimes in ways they didn't anticipate.

One of the clearest examples is the twins and triplets that now populate our day cares, elementary schools, and also, unfortunately, our newborn intensive care units. Some European countries limit the number of embryos a doctor can transfer during IVF; Great Britain, for instance, allows only two embryos, or three if a woman is over 40. The United States, by contrast, has no federal regulations on embryo limits. So, while a conservative doctor may opt for one or two, a cowboy physician—hoping to increase his clinic's pregnancy rates and thereby draw more patients—may implant four or five or more.

No spin there! As Jones herself reveals six paragraphs later, the cowboy/conservative dichotomy doesn't hold up. It's true that physicians have an incentive to implant more embryos, increase the rate of pregnancy, and thereby attract more patients. But fertility patients also have reason to want a passel of embryos implanted at every go: Each IVF round involves financial and psychological costs. A woman who asks for more embryos at the outset will be less likely to need a second round.

So there is a more precise distinction to be drawn among doctors: those who will implant the number of embryos patients ask for--letting women negotiate the actual risks--and those who will impose some upper limit regardless of what women may want.

As an afterthought--perhaps a crackpot one--I'm not sure that it's in the doctors' interest to load up every uterus with as many babies-to-be as will fit. The incentives don't just run in one direction. If a round of IVF fails because the doctor implanted two instead of five embryos, the patient will likely come back for another very expensive round. There should be some optimal number of embryos such that some women have to pay for extra rounds, but the pregnancy rates still look competitive.