One at a time

A 47-Year-Old Woman With Fertility Problems Who Desires a Multiple Pregnancy

“…Therefore, these statistics can be an incentive to clinics to keep pregnancy rates high without much regard for multiple pregnancy. 7,15 While information about the complications of multiple pregnancy is often in conflict with patients' desires and autonomy, 2,16 increasing evidence suggests that patients do respond to education about the risks when given information. 5,6,8,9 Mrs Z's ambivalence is evidence of her clinician's educational efforts and demonstrates the difficult crossroads at which she finds herself.…”

“…6,7,43 Last, the realities of statistics-driven competition among clinics and the time lag for data collection and publication of improved clinical success contribute to the problem. 16 In the end, infertility specialists started doing too good a job clinically, but not as good a job in responding to the progress.…”

“…Progress has been more notable in Europe where health systems often support and/or legislate initiatives that strictly limit the risk of multiple pregnancy to individual patients and society, 16,45,[51][52][53][54] compared with the US health care system, which is centered on patient autonomy and has a fragmented state and employer-driven health insurance system. 55 Yet US efforts have accelerated and have begun to show results.…”

“…15,55 The FCSRCA continues the mandated CDC/ SART partnership 14 in which all US IVF programs are required by law to report validated data from every initiated cycle in patient care, including pregnancy outcome. 16 In 1994, the American Society for Reproductive Medicine (ASRM) Ethics Committee made recommendations to limit multiple pregnancy by specifying an ideal number of embryos to transfer based on the age of the woman. These numerical embryo transfer guidelines were revised in 1998 and again in 1999 by the ASRM Practice Committee.…”

“…Patients more readily accept eSET when they have insurance coverage for IVF. 7,11,12,16 Patients who pay for IVF 19 prefer more embryos be transferred to maximize their chances of having a live birth in any 1 cycle to avoid recurring costs. This strategy has consequences.…”