Monday, February 23, 2009

The Politics and Cost of Fertility

The woman who recently had octoplets has raised a number of interesting ethical questions about the infertility processes in this country.  Leaving aside the (ir)responsibility of mom and doctor in this particular case, I find infertility medicine extremely interesting.

Many people don't know that high-order multiples are more likely to come from fertility drugs than IVF (in-vitro fertilization).  This is because fertility drugs are harder to control and monitor than the implantation of embryos.  Most insurance companies will cover only fertility drugs (if they cover infertility treatments at all), not IVF.  IVF clocks in at around $12,000 a pop. This means that the folks who are least able to afford multiples are the ones more likely to have them. Multiples come with added costs in prematurity, birth defects, and long-term health care needs that taxpayers often pick up the tab for.  

I wonder if having a child should be a right.  If so, should insurance companies be required to cover IVF and other fertility treatments?  As a woman who has had a child, I understand how desperately people want to have children.  If I struggled with infertility, I don't know what procedures I would have been willing to undergo to have a child.

IVF itself raises a whole litany of prickly questions.  How many embryos should be created? Because of the expense associated with IVF, many parents chose to create quite a few and freeze them. 

How many embryos should be implanted? Current voluntary US guidelines recommend 1 and not more than 2 for women under the age of 30. Many European countries mandate the number of embryos implanted at any given time.  Of course, those counties usually cover the cost of the procedure as well. We don't mandate how many kids a family can have the old fashioned way, why should IVF be different?

What do you do with embryos that are "left over"?  There are many embryos currently on ice, in embryo limbo.  Some people choose to donate them to other couples, some thaw and destroy them, some keep them indefinitely or choose to try another implantation.

What do you think?

1 comment:

Becky said...

Well, you and I have talked a bit about this before. Clearly fertility drugs are a bit unpredictable, so you can't really regulate how many children a woman has while on them.

I think IVF needs something stronger than "voluntary" guidelines on the number of embryos implanted since they clearly aren't being followed. I think maybe you should lose your license to practice medicine if you are in violation of the rules.

Right now many "extra" embryos created for IVF could be used for stem cell research. (A presidential order from Pres. Bush limited federal funding, so many of them are just destroyed instead.) In my opinion, if we allow the destruction of extra embryos for IVF, we should also allow stem cell research to be done from them. They ultimately amount to the same thing, only stem cell research has the ability to cure diseases in the process.

I think IVF regulation will eventually get swept up into the abortion debate, which means there is no resolution in sight.

 
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