OctoMom Backlash in Georgia - Would Result in No IVF There, Would Endanger Moms and Destroy Human Embryos and Eggs

The Georgia Senate has proposed two new bills in an overt attempt to reduce multiple births and a covert attempt to ban IVF in that state. The bills, if passed, would limit the fertilization of only 2-3 eggs, would ban any embryo freezing, would allow only 2-3 embryos to be transferred and would ban monetary compensation for egg donors.

As a clinical embryologist with over 20 years of experience (and a staunch Republican) I take issue with these two bills that will severely compromise the ability of infertile couples to become pregnant and to even afford pregnancy. These bills are probably in response to the mother of octuplets in California, but they will not reduce significantly the incidence of multiples and they will significantly reduce the chance for infertile couples to becoming pregnant, endanger the lives of IVF patients and make IVF more expensive. (Most high order multiples result from inseminations while on hormones.)

The physician that transferred the 6 frozen embryos was an aberration. His alternative was to transfer 2 frozen embryos and then wait to see if the woman became pregnant before transferring any more embryos. By transferring six he endangered his patient's life and the well-being and lives of the resulting children. SB 169 would only allow 2 to 3 eggs to be fertilized. This would result most commonly in 1 or two embryos and in many cases would result in 0 . A patient would pay about $10,000 yet have a very low chance for a pregnancy. Only the wealthy would even consider this option. This is because although fertilization rates are about 70%, this 70% rate is made up of many with low fertilization rates (below 50%) and many with high fertilization rates (above 70%). If you look at the distribution then, there would potentially be a large proportion of patients that would have no embryos due to lack of fertilization. Second, current methods of IVF depend on having many embryos to culture and then after 5 days culture, selecting only the best 1 or 2 to transfer. The probability of an embryo (fertilized egg) resulting in a good embryo on day 5 is about 30 to 40%. So in order to even have one embryo to transfer, you must begin with at least 5 or 6! The most common scenario with only fertilizing 1 to 3 eggs is maybe having 1 or 2 fertilize and then none developing to day 5. I would estimate that the percent of patients becoming pregnant with this method would be about 5%, compared to the current average of 30 to 40%.

To reiterate, very few eggs are capable of making a good blastocyst. The only way we can find the best eggs is to have many eggs, fertilize them and let them sort out which ones are the best and will survive to day 5. This incidentally also decreases the incidence of high order multiples as we have great pregnancy rates with transferring only 1 or 2 day 5 embryos. These day 5 embryos have about a 50% chance of implanting while day 3 embryos have a bout 15 to 20% chance of implanting. (Maybe a better solution would be to require the culture of all embryos to day 5, with a maximum of 2 to transfer!)

Another significant flaw in this bill is not allowing freezing. Freezing is what allows IVF clinics to transfer fewer fresh embryos. One can transfer fewer fresh and rely on frozen embryo for transfer. It also is an integral part to IVF safety. If a woman gets a serious condition called severe ovarian hyperstimulation syndrome, that can be lethal, her risks can be reduced to almost zero by freezing all of the embryos on that cycle. If this law were passed, it would encourage the transfer of embryos in this risky condition as the only other alternative would be to discard them. Is this truly what the people of Georgia want - embryos discarded because it would be too dangerous to transfer them? Another scenario when we rely on freezing of embryos is if the woman's uterus contains fluid. If we transfer into this type of uterus the pregnancy rates are diminished. We would transfer no fresh embryos in this case and freeze all the embryos for a frozen transfer where here chance of a pregnancy would be much higher. With this bill, the clinician would have to either transfer the embryos into a poor environment (basically causing the demise fo the embryos), or they would have to be discarded (demise again).

Also, as has been shown in other countries, when tissue donors are not compensated for their time and suffering - which is extensive - the donor pool will dry up and the business will move to other states without these restrictions. Why would we allow men to be compensated for sperm donation (which is less intrusive) and not allow women to be compensated for their gametes (eggs)? I think all too often we confuse the issue of tissue donation (which is a renewable item) with organ donation, an irreversible and risky process.

Finally, regarding SB 204: it will greatly increase the costs of embryo donation and most likely will result in more embryos being discarded than being used to help infertile couples that can't afford IVF obtain a family.

I find it strange the a right-to-life group would even sponsor such an ill-though out bill that would actually result in the destruction of embryos, the destruction of eggs (potential life) and would endanger a female undergoing IVF. What a disregard for life!

Is Eight Enough? How About 14? Octuplets

This week's news regarding the lady (Suleman) with octuplets has started a lot of discussion, unfortunately I think it together with the economic stresses has stirred up a hornet's nest of prejudice passion. Suleman gave birth to octuplets after "successful" IVF treatment. She is a single mother with 6 other children, also conceived through IVF. Three of her older children (ages 2-7) have disabilities. It seems that the octuplets were conceived via frozen embryos from a previous IVF cycle. (Probably the ones where she had her first 6 children.)

First, at issue is not how many children a single mother should have. For some, one is too many; while others would like 10 or 12. There are two big issues here (but I will not discuss the second issue which is how much will all of this cost the public who will be paying for most of this and the associated problems?):

How could a physician who takes the Hippocratic Oath ("I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.") risk the mother's life and the potential children's lives and well-being by transfering 6 embryos into a woman that previously had little problem getting pregnant via IVF??

Steven Orry, president of the American Society for Reproductive Medicine has said, "Infants born as multiples are almost always premature and have higher rates of low birth weight, cerebral palsy, developmental delays, birth defects and death. Even twins, who usually survive, are hospitalized twice as long as singletons and have much higher medical costs over the first five years. Cost of multiple births can easily top $100,000."

Complications
The most important complications to the mother are pre-eclampsia, preterm labor
and delivery, and gestational diabetes. As the number of fetuses go up, thes risks of these complications soars. Other complications include cholestasis, dermatoses, excess weight gain,
anemia, hyperemesis gravidarum, exacerbation of pregnancy-associated gastrointestinal symptoms including reflux and constipation, chronic back pain, intermittent dyspnea, postpartum laxity of the abdominal wall, and umbilical hernias. (Source: ASRM Practice Committee Guidelines on Multiple Pregnancies).

Complications for the babies (according to the ASRM Practice Committee) include complications from pre-mature birth: "cerebral palsy, retinopathy of prematurity, and bronchopulmonary dysplasia as well as those of fetal growth restriction (polycythemia, hypoglycemia, necrotizing enterocolitis). It is unclear to what extent multiple gestations themselves affect neuro-behavioral development in the absence of these complications. Rearing of twins and high-order multiples may generate physical, emotional, and financial stresses, and the incidence of maternal depression and anxiety is increased in women raising multiples. At mid-childhood, prematurely born offspring from multiple gestations have lower IQ scores, and multiple birth children have an increase in behavioral problems compared with singletons."

Alternatives?
The potential outcome (a healthy child) was not worth the risks (including death of the mother and the babies). Was there an alternative? Sure! Thaw fewer embryos and transfer only 2 and then if the woman did not get pregnant, thaw another 2 and transfer.

The physician is lucky Suleman survived her pregnancy. Now she must wait to see what this will cost her children. How many will survive? How many will have life-altering consequences for the rest of their lives?