Do fertility doctors or clinics have any kind of a “deal” worked out with people they are helping? I ask out of curiosity because there are increasing multiple birth stories in the news due to the use of fertility drugs, and the stories are usually cast in a happy “miracle of life” context. I’m beginning to wonder, however, if a lot of these stories are the result of broken deals between the docs and parents, or con jobs by the parents to get the drugs and them changing their minds about reducing the embryos down to one.
I always thought in these births that a woman could often conceive multiple embryos, and the docs would pare them down to one in utero by sucking out (or whatever) the other embryos. In multiple birth stories like the one linked, are these the result of people changing their minds about this paring down process, or do fertility doctor and clinics normally not have any kind of a “deal” re this issue with people they are helping and just hope the people won’t be idiots?
In all our discussions with our fertility doctor, my wife and I have never been presented with any kind of “deal”. For most people trying so hard to have a baby that they need to see a fertility specialist, the idea would be unthinkable. Such a procedure couldn’t be done without some measure of risk to the mother and the one embryo that was being kept. Most people in that position would rather have three babies than none.
What has been discussed is that if there is a health risk to the mother or fetuses, it is an option to attempt to terminate some of the fetuses so that the others may survive, or to prevent the mother from having complications. But, as long as the mother and fetuses are healthy and there are no problems, it’s not something they would normally do.
Now, as for sextuplets, I’m sure at some point the risks of carrying six babies to term and the options were presented to this couple and the doctor may even have recommended aborting a few. However, to think that a doctor would make a “deal” up front to limit the number of babies to one per pregnancy just because that’s the way it “should” be is, well, ludicrous. No fertility doctor in his right mind is going to tell a woman she’s got three embryos, but has to give two of them up.
So… fertility doctors and patients have no “understanding” (tacit or otherwise) that multiple embryos will reduced down to one or two, and are content to let as many babies stay in the womb as are physically (within safety limits to the mother) supportable? That is surprising.
If the fertility treatment consists only of things like fertility drugs, then there is nothing going on at all. Such drugs just greatly increase the chances of multiples. The prospective parents are told this ahead of time, if they take the drugs, they deal with the consequences. What they do when they discover they are having multiples is their business. Conception of multiples is conception of multiples, the drugs just change the odds.
Selective abortion is likely to result in complete abortion. It seems extremely unlikely that people wishing children so much would often take such a risk.
In the case of methods such as IVF, multiples are implanted in the hope that at least one survives. Again, the prospective parents are fully informed of this and what happens once pregnancy is accomplished is solely up to the parents and it is again highly unlikely that selective abortion would be used except in extreme cases.
Or to sum things up, I have no idea what the OP is actually asking. Con job???
I believe that there is no preliminary “deal” because one is not really needed. Although fertility drugs increase the chance of conceiving multiples, the vast majority of conceptions will be of either single babies or, less frequently, twins. It seems more likely that the couple will not conceive at all then that they will conceive four or more babies.
My aunt had triplets as a result of fertility drugs, and she actually got the opposite warning from her doctor, that it was likely that one or more of the feti would be spontaneously aborted. While she did come to grips with this (fortunately all three survived and thrived), she certainly wasn’t about to help Nature along, and her doctor never encouraged her to.
Why would the doctors care? It’s not like you’re ripping them off by getting three babies for the price of one.
Because I would think that carrying 4 or more babies as a result of fertility drug assisted conception would be potentially dangerous to both the mother and babies, and that doctors would seek to reduce this risk if possible. Apparently, however, according to responses in this thread, to ability to selectively and safely reduce the number of embryos is a lot more limited than I imagined, so you’ve essentially “got what you’ve got” after the drugs take effect.
A couple undergoing fertility treatment will usually have a discussion with the doc about the increased chance of multiple babies with treatment, and the doc should advise the couple to consider what would they would choose to do in cases of three or more babies. A discussion regarding statistics and success in carrying multiples and high order multiples should occur early in the treatment course and be repeated again later if a pregnancy results. A doc can advise and even encourage a course of action using statistics, but often the desire and great effort required to achieve a pregnancy will override a doc’s advice. It’s important to note that many fertility docs just achieve the pregnancy and don’t follow the patient through to delivery, but pass the couple back to the referring OB-GYN.
Most women taking anything more than low doseage pills should be followed with ultrasound to see how many follicles are growing. In IVF cases, the number of embryos implanted depends on the quality of the embryos, with most docs advising no more than three embroys be implanted (depending on the quality, of course).
A woman taking oral or injectable medication and planning to concieve through intercourse or IUI would be advised to cancel the cycle if she has over produced follicles. Many follicles are desired per cycle for IVF proceedures.
Industry gossip says that many cases of high order multiples are cases where the couple has been using injectable follicle stimulation and intercourse to achieve pregnancy, and that follicle overproduction has occured, and that the couple was advised to discontinue the cycle but chose not to do so. A cycle with an overproduction and IUI may proceed, again depending on the quality of the follicles and sperm.
Also, there was an interesting case in Houston recently involving and IVF and two good quality embryos that both split resulting in one pregnancy with two sets of identical twin boys (4 boys all together). Reported odds were one in 11 million.
I’m wondering if they got an unusually high dose. The drug mentioned certainly isn’t a ‘first’ drug, they start you on Clomid and work you up.
The other option is the opposite of secondary infertility … secondary fertility? Without knowing her cycle history after her first two children, I don’t know if they just dropped her back on it again this time, or monitored to see if she even needed anything for this third attempt.
Thirdly, from what I’ve heard from friends who have gone through various invasive levels of drugs and therapy, in theory she should have been monitored and warned that she had that many follicles this time around, causing them to either go for it or to skip that cycle of trying to get pregnant, and going back for another cycle with fewer follicles (potential eggs).
My wife and I went through IVF and one of the many documents we had to sign was an agreement that if more than three embryos implanted, then she would have selective reduction to bring the number down to three. The idea being that if a woman attempted to take more than that to term, most likely none would make it. We were heavily counseled that if we absolutely couldn’t bear the thought of going through selective reduction, then we should not implant more than three embryos.
This particular fertility clinic has been around for about ten years, and in that time there was never a pregnancy where more than three successfully implanted, so no one had the reduction done.
Obviously, if a woman got pregnant with quads or more and then did not want to go through with the reduction, then there’s nothing the fertility folks will do about it, but at least they have it documented that she was strongly warned, in case things didn’t end well and the parents decide to get litigious.
To me, it all seemed reasonable. I would not have had a problem with doing the selective reduction, since it meant that three embryos would have a fighting chance. My wife had more of a struggle with the idea.
btw, we attempted in-vitro four times. In the first attempt, they retrieved only three eggs, but none of them fertilized. Then they increased the stimulation drugs and performed intra-cytoplasmic sperm injection, and transferred three embryos back in. She became pregnant but it turned out to be ectopic. For the third attempt they modified the dosage again, and five embryos were transferred, but no pregnancy resulted. On the fourth attempt, four embryos (of not very good quality) were transferred back in. One implanted for a few weeks, but apparently didn’t “take”, so that was the end of that.
