This is fucked up for so many reasons. I guess they didn't actually consult any reproductive endocrinologists when drafting this bill.
Here's the problem. Embryos die. Embryos die all the time. Even for non-infertile couples who make babies the normal way, some estimates are that 75% of fertilized eggs die before they ever make it down to the uterus and implant in the uterine wall, resulting in a pregnancy. The embryo that actually survives long enough to implant and become a pregnancy is the exception, not the rule.
So this is true with IVF as well. Most embryos die before they even become blastocysts at the day 5 mark. Let's take my case. 11 eggs were retrieved. 9 were normal enough to be fertilized. So we had 9 embryos. By the time they were 3 days old, 4 of them had died. There were 5 left. Two of them were pretty good quality, two looked so-so, one looked pretty iffy. At that day 3 mark we transferred 4 embryos (not a good decision, looking back on it, but there were special reasons for this). We saved the 5th embryo to see if it would survive to become a blastocyst. If it did, we would freeze it. It did not survive, so we had 0 embryos left over to freeze.
I had researched the statistics. There was roughly a 60% chance of not getting pregnant, i.e. all 4 transferred embryos would fail to implant and would die. There was a roughly 40% chance that I would get pregnant. If that happened, then the overwhelming odds were that we would have one baby. There was about a 14% chance of twins, and the odds of conceiving triplets or quadruplets were less than 1%. I was surprised when we ended up with twins. But back on that day when we transferred 4, I remember secretly thinking to myself "better two than none". That is bad medicine, driven by desperation, but that's another story.
So 9 embryos became 2 babies, and the rest all died naturally. And that's actually a pretty good ratio. It's not uncommon for women to have to go through multiple rounds of IVF, ultimately creating way more than 9 embryos, in order to end up with one baby in the end. If we had only fertilized two eggs, what are the odds that those two would have lived? They're very low. If we had only fertilized two eggs, they probably would have been in the group of 7 that died, not the group of two that lived. It takes lots and lots of embryos to create a viable pregnancy because embryos die more often than they live. I don't think people know that, in general. If they did, they certainly wouldn't introduce legislation like this. I also wonder if people would get so worked up about birth control options like Plan B if they knew how common it is for embryos to die naturally.
Transferring 1 or 2 embryos makes the most sense, especially for women under 35. In Britain, for example, the limit is 1 under most circumstances. The rate of multiples and higher-order multiples is very low as a result. That is healthier for everybody. So why don't we do it the same way here? Well, here we generally do not cover infertility treatments under medical insurance. The infertile people who happen to be poor are not allowed to conceive. Only those who can afford it can do so, unless you happen to live in one of the few states that mandates that insurance covers these treatments, like Illinois.
My state doesn't have that rule (most don't), so my insurance didn't cover a penny of our treatments. Not our diagnostic testing, not our drugs, not the ultrasounds, nothing. For many couples, infertility is linked to very real health problems (not that infertility itself isn't a health problem, but I mean other health problems), and treatments that address underlying health issues still aren't covered if they happen to also address infertility issues. IVF costs, in general, about 12K - 15K for one try. Under the best of odds, with a young couple, the success rates never go above 50%. As couples get older, those rates go way down. So you're spending, say, 15K on a very, very, very big gamble.
That is why doctors and patients transfer more embryos than they should. Doctors want their clinics to have strong success rates, because they will report those rates and potential patients can look them up online and choose the clinic with the best rate. Patients want it to work the first time because they can't afford to try again. Maybe they've taken out a loan to try just the one time. If it fails, you still have to pay the bill. Imagine what that feels like, to receive bill after bill for services after it has already failed, to have to write check after check to pay off a failed attempt. I've done that. It's a bitter feeling.
In the UK and other European nations, insurance covers fertility treatments, so the stakes are lower. It is still emotionally devastating to have a failure, and it still means having to pick yourself off the ground, prepare to go through the whole thing again, the shots, the ultrasounds, the exams, the humiliation, the pain, the side effects, all of that. So it's not like it's easy, but at least the financial aspect doesn't come into play. At least you don't have to decide whether to quit because you can't afford it, or whether to take out a loan to try again, or whether to take out a loan to try to adopt, because adopting is also expensive (about the same as IVF for a domestic adoption and much, much more for most international adoptions).
So this bill would tie doctor's hands but not provide insurance coverage for these treatments. In addition, it would prevent IVF from ever working, just about, because you're not going to achieve a pregnancy when you only start with 2 embryos. In addition to that, it removes the option of a frozen embryo transfer later on. If the first round of IVF fails but some embryos survive to become blastocysts, a couple can freeze the embryos. Then they can try again with those embryos, not having to go through the time-consuming, painful route of IVF. A frozen embryo transfer is also much, much cheaper than IVF. In some cases it can cost as little as a few hundred dollars, in comparison to 12K - 15K. So for couples who have frozen embryos, it can be a great solace to know that they have the option to try again. This bill would eliminate that entirely.
I knew that the octuplet case would lead to these kinds of discussions, but I am surprised by how quickly a legislative effort has arisen. I don't know why. The terrible media coverage of this extremely unusual case is making it harder for all infertile couples everywhere. And frankly, it's hard enough as it is.






