There’s No Business Like Show Business, Except Fertility
The fertility news is constantly highlighted in sensational headlines, the most recent of which was “Forty-nine-year-old woman conceives with own egg through IVF.” In the past several months, readers have been entertained with Octomom, “a woman pregnant with a supposed dozen,” Jon and Kate Plus Eight and “a sixty-two year-old mother through IVF” not to mention the numerous over forty-five and sometimes over fifty-year-old celebrities having babies supposedly with their own eggs.
Reading these “news” stories, one may get the impression that fertility is a thriving business bearing little resemblance to the medical specialty of reproductive endocrinology requiring seven years of post-medical school training. The medical pioneers Drs. Steptoe and Edwards in the UK and Drs. Howard and Georgeanna Jones Jr. in the US envisioned a world in which couples inflicted with the curse of an inability to procreate, would, with the benefit of this technology that they developed, give these couples the ability to build their own families. They were excited that as the technology improved and became more efficient and the cryopreservation of embryos became routinely available that risky multiple pregnancies could be eliminated. They believed that insurance companies would pay for an IVF benefit that had a high success rate and could deliver healthy singleton pregnancies with far greater confidence than any alternative treatment especially intrauterine inseminations (IUI). They were unhappy that in the early years when IVF was inefficient, many embryos needed to be transferred in order to give a patient a reasonable chance for success. This resulted in multiple pregnancies, many of which delivered prematurely requiring expensive neonatal intensive care and unfortunately many did not end well. Today, we have control over this with IVF by transferring one embryo at a time but not with IUI.
They also did not believe that women should be subjected to the medications, blood work, and retrieval process without a fair chance for a successful outcome. The idea of subjecting a forty-nine-year-old woman to IVF for what may be a 1 percent chance of conception with a greater than 50 percent chance of miscarriage is not medically reasonable. Women of this age have a 70 to 80 percent chance for conception through egg donation. This is how the fifty something celebrities are getting pregnant. They are not using their own eggs. Misleading the public with news stories that feature these older pregnant celebrities gives patients the misconception that they too can create their families at the same age using their own eggs.
We have recently performed IVF on two perimenopausal patients with FSH levels over fifty at age forty-five after days of counseling regarding the extreme low odds of pregnancy and a live birth. In both cases, they felt they needed to give it one shot before moving on to egg donation. They had one follicle each and both resulted in pregnancies with a gestational sac seen on ultrasound. One has since miscarried and will now move on to egg donation where her odds of having a live baby jump from less than 5 percent to 60 percent per attempt. The other remains pregnant and is miraculously the exception to the rule.
IVF is a medical procedure that is part of a proud tradition of reproductive endocrinology. It is a medical treatment that can cure one of the cruelest maladies known to man, the inability to have a child. This problem is featured in the bible with several references including from the woman’s perspective with Hanna weeping for a baby of her own. The Old Testament proclaims the commandment to procreate. This is part of the human condition. Does it not make sense then that insurance companies provide the financial coverage to allow IVF, a treatment that can be controlled by transferring one embryo at a time to result in a singleton pregnancy? Regulations to prevent costly dangerous multiple pregnancies and the performance of IVF in patients with unreasonably low odds of success need to be instituted. Financial programs that make it no more expensive to patients to transfer one embryo at a time such as our Single Embryo Transfer program at East Coast Fertility need to be the news highlight of the day not the forty-nine-year-old who conceived on her sixth try.
Originally published on FertilityTies