Op-Ed: IVF Mixes Shouldn’t Discourage Expansion of Reproductive Care

The story is poignant: a family brings their newborn baby home but immediately doubts that the child is genetically theirs. DNA tests reveal the truth: A fertility center in the Los Angeles area had exchanged embryos between two families and transferred the wrong embryo to each couple during in vitro fertilization. Their children were born a week apart.

After learning of the mistake, the families decided to swap the children, so the parents ended up with their genetic daughters, although they have since kept in touch. In November, one of the couples filed a complaint against the affected clinic.

The pain and confusion for these parents is difficult to understand and unique to IVF. While stories of children “swapped” at birth have occurred since the advent of the hospital nursery, this error has also led mothers to bear and give birth to children who were not genetically. theirs.

But responding to a story like this with fear of IVF or increased regulation would be out of place. The most pressing problem is the lack of access to reproductive technologies for many people who could benefit from them.

IVF errors are rare. A study published last year found that between 2009 and 2019, out of approximately 2.5 million IVF procedures in the United States, 133 errors occurred that resulted in legal action – 87 of which involved two suspected failures of the system. freezing tank in 2018 and 2019. A 2018 study of non-compliance with International Organization for Standardization standards found that 99.96% of procedures during 36,654 cycles of IVF treatment in a network of clinics had not been breached. In short, the procedure is extremely reliable.

This is not to minimize the distress caused by a medical error, which can be devastating. But even if the true error rate in IVF is higher than these studies suggest, it is likely lower than error rates in medicine in general. Recent studies show that 21% of patients report having suffered a medical error.

The unique nature of IVF and fertility care may demand a higher standard to avoid mistakes. People facing infertility often do so with little support given the societal stigma, which makes it a particularly sensitive area of ​​health care. Unfortunately, as with all of medicine, the elimination of all errors is unlikely.

Some have called IVF “the Wild West” and approved federal or state oversight of embryo storage. US regulations are less stringent than those in countries with socialized medicine and broad access to assisted reproduction, such as the UK. But IVF is already one of the most regulated areas of American medicine, stricter than, say, the federal system that regulates medical devices such as the vaginal mesh used in pelvic reconstruction and a surgical tool used to remove. fibroids and uterus.

Rather than more regulation, a better way forward for IVF would be to improve processes for obtaining informed consent from patients and recognizing that rare errors will occur – while expanding access.

Many people who desire IVF cannot access it. A group of experts estimated in 2009 that only 24% of the needs for assisted reproduction technologies in the United States were met. Worldwide, this number is lower.

One of the reasons for the lack of access is the cost of providing this technologically complex care. Costs vary widely, but the average IVF cycle, including medication, is estimated to be around $ 25,000. Spending can increase with additional regulation and technology to reduce errors.

As costs increase, access is reduced. Our ideal as a society should be to ensure access for all, not just the typically rich and white patients.

IVF by its nature will always remain medically and emotionally complex. Helping patients and their families understand the potential pitfalls and the human aspects of this care – including the potential for error – before proceeding is difficult but necessary. Medical educators are refocusing our mission to ensure that we are helping students and practitioners develop communication and other skills to guide patients through this decision-making process.

Most IVF clinics already rely heavily on colleagues in social work and psychology for support in counseling and obtaining informed consent. Working with these colleagues to develop standardized counseling tools, including apps, can further help families understand IVF.

Medical error can be tragic for patients and their families. But so is the lack of access to deeply desired and life-changing reproductive care. While reducing errors as much as possible, the field should focus on achieving equitable access to IVF.

Louise P. King is Assistant Professor of Obstetrics, Gynecology and Reproductive Biology and Director of Reproductive Bioethics at Harvard Medical School.

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