Cowboys and Embryos

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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.

NEXT: Result-Oriented Science

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  1. Multiple births are still such a rarity as to make Eye Witless News at Six. So where, exactly, is the problem?

  2. What, no reference to “I Wanna Be A Cowboy” by Boys Don’t Cry?

  3. a cowboy physician

    I guess “Rambo” has become passe as an epithet.

  4. TWC

    Good point, although it depends on the deviation from the normal incidence of multiple births.

    Also, as they get better at ensuring the survival to term of implanted embryos, Doctors are likely to reduce the number they attempt to implant in any one procedure.

  5. I get so sick of these idiots who think that the infertility business is somehow out of control and needs to be regulated. Their “proof” is always anecdotal. More government regulation is going to end up prohibiting some people from being from being able to conceive or bear chilren (though limits) or drive the costs up so much that even more people won’t be able to afford it. Hey, I’ve been through the process — infertility treatments, IVFs, donated eggs, donated frozen embryo (which resulted in a kid!) and adoption as well. It’s a hassle, expensive, and sometimes you don’t get the outcome you hoped for. But, it’s working, so leave the government the hell out of it.

  6. Thanks Aresen, anecdotally speaking 🙂 the odds of quadruplets that didn’t result from implants (eggs not boobs) or drugs is infinitesimally tiny. 1 in 729,000 of all natural births.

  7. Where is my Marlboro Man? Where is his shiny gun?

  8. You guys are just corporate shills for Big Embryo!

  9. Mama, don’t let your embryos grow up…

  10. TWC

    I knew the odds were small, but it is still amusing to think of the result if the Docs pushed the success-to-term rate to 100%.

    Imagine being the only single birth child in a class consisting of you and five sets of quads? 🙁

  11. Aresen-LOL

    Speaking of Quads……

    High, embryos that grow up to be cowboys herd cattle on Quads these days.

  12. Mama, don’t let your embryos grow up…

    I was going to say “Mother’s don’t let your sons grow up to be cowboy physicians.”

  13. This is nuts. When we did IVF, we spoke with 2 doctors. 1 wanted to implant 3 embryos, with the recommendation that we “reduce” down to 2 in the unlikely event that all 3 implanted.

    The other wanted to implant only 2 embryos.

    But seriously, the frequency of people choosing to implant 4 (or even 3) and then carrying to term 3 or more has got to be vanishingly small.

  14. I’d worry less about the number of implants and more about the litters produced by fertility drugs.

    Considering that being part of a litter has adverse effects on the health of the kiddies, why not insist on reduction down to two, especially if the taxpayers are the ones who are going to have to pick up the extra? Twins are pretty common and are usually healthy–when you get beyond that, you’re fighting for nutrients and survival. Result: premature births, lots of medical care. Guess who usually pays? …the taxpayer….

  15. And the taxpayer pays millions for each litter (or so I’ve read).

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