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One Solution to the Twins and IVF Conundrum

It doesn’t seem like a slow news week.  There are plenty of things happening in the health world, and yet the AP trotted out this breaking story on… I know… stop the presses… single embryo transfers.  The version of the story on Yahoo News starts out: “Now fertility experts are pushing a new goal: One.”


It continues, “A growing number of couples are attempting pregnancy with just a single embryo, helped by new ways to pick the ones most likely to succeed.”

A growing number?  What about everyone who has been pushing for e-SET for years?  This is not news.  This has been the goal of doctors AND patients for years, despite the way the media portrays both reproductive endocrinologists and infertile women.  Do you know what keeps doctors AND patients from moving towards e-SET as the given rather than the exception?  A lack of insurance coverage.

Cover the cost of IVF and you can lower the risk of prematurity from a multiple birth.  Insurance companies stand to save money on the other end rather than gamble with women’s (and children’s) lives.  As the article states, “It’s mostly an American problem — some European countries that pay for fertility treatments require using one embryo at a time.”

And the Affordable Care Act has no clause that covers mandated fertility treatments.

It is frustrating to see the cat racing to catch its tail year after year.  First a story comes out about problems with multiple births.  Then comes the response that if insurance covered infertility treatments more people would transfer a single embryo.  Then come the comments about how family building is elective and shouldn’t be covered by insurance.  And then we get the next wave of studies done fretting about the rise in twin births in America.  And in between, the general public weighs in with unhelpful advice and hurtful commentary in the comment section.

Do you know what I would love?  To open up the health section of one of the numerous sites I read daily and see a story about great strides being made in treating infertility and building families.  I’d love to have a morning where I don’t wake up to either a rehashing of old news or a sensationalistic story about some infertility outlier that will skew the general public’s perception of the disease.

A piece of advice: don’t read the comment section on that article.  Just don’t.

Though, because it was sent out by the AP, this topic is everywhere this morning.  I’ve already encountered it three times.


1 Hope { 12.03.13 at 8:40 am }

Well, I’ll give them a few points for using “transfer” instead of “implant,” and for including actual dollar amounts.

But the amounts they’ve included sound low. Yes, I’m paying about $4,000 for genetic screening, but that’s not including the embryo biopsies and FET cycle. Not to mention that, by the time many people reach this point, they’ve already spent their life savings trying lots of less-aggressive treatments.

Yes, these discussions ARE like a cat chasing its tail.

2 Sian { 12.03.13 at 8:54 am }

Here in the UK (Wales) IVF is covered for two cycles. If you are under 37 years old then eSET is the norm. If the first cycle is a sucess then you don’t get a second cycle. I had two fertilised eggs but could only have one transferred. At the time I was heartbroken. I often think of what could have been. On the other hand from the eSET I have my daughter.

3 jjiraffe { 12.03.13 at 9:32 am }


4 Katie { 12.03.13 at 9:58 am }

I’m oppositional. As soon as you told me not to read the comments, that’s the first thing I did 🙂 All I have to say is that people are dumb. The blatant disregard for research is scary, but not surprising. The fact the article barely touched on the insurance coverage issue is upsetting. I have a lot of critcisms about the one study that offered to pay for an IVF as a justification that it’s not about the finances – 1) they offered to pay for 1 IVF treatment, so the same argument on wanting to increasing your odds still applies and 2) the rest of the treatments and all the previous treatments were not covered or payed for the couples are still looking at a financial loss.

5 Heather { 12.03.13 at 10:36 am }

Ugh. Ugh. Ugh. I read your post title and immediately thought that it wouldn’t be an issue if IVF was routinely covered by insurance. You know like vasectomies and Viagra typically are. I just don’t get why it seems to be a political issue. Cover it and it will cost less overall. Seems like a no brainier. Although years ago my insurance company didn’t cover BCPs. Errr…I guess babies cost less than $30 a month.

And don’t even get me started on the comments!

6 loribeth { 12.03.13 at 11:43 am }

(standing and applauding)

Not going anywhere NEAR the comments…!

7 mrs green grass { 12.03.13 at 12:10 pm }

Money should absolutely not be a factor in a decision about how many embryos to transfer. When I transferred, I really thought 2 was the norm and. I transferred two and one split into triplets while the other implanted normally. I really didn’t know that was a possibility. I endured a very traumatic pregnancy and ended up giving birth to my son (after reduction) at 25 weeks. Who knows exactly why he was born so early, but I know for sure that the cost of my IVF was a hell of a lot cheaper than his nearly 5 month NICU stay and our dozens of appointments since.

8 chickenpig { 12.03.13 at 1:44 pm }

All of my IVF cycles were covered by insurance and I still did two embryos at a time. Because my embryos suck. And because even with insurance, the amount of cycles you can attempt are limited. If PGD were covered by my insurance that would be a different story. Now THAT would be news 🙂

9 lmaclen { 12.03.13 at 2:13 pm }

I may not be the norm here- our insurance covered a portion of our cycles. First IVF, we transferred two good blastocysts and neither took. Second IVF, we transferred three morulas all mediocre quality. We knew the chances of twins, but we also took into consideration the emotional toll IVF takes when you get a BFN, and our limited coverage. I’d take triplets or twins over no baby in a heartbeat.

10 fifi { 12.03.13 at 2:55 pm }

I’m betting that the comments fill out the full infertility bingo card. Reproduction is not a right. What about the needy children lining up to be adopted? What’s so special about your genes. Something something selfish something overpopulation something.

11 Bionic { 12.03.13 at 3:49 pm }

Yep. The fact that insurance covered my IVF and FET cycles (and would have covered more cycles*) is exactly why I was so comfortable transferring just one each time. And believe me, I explain that in detail — including how much cheaper IVF is than NICU time for multiples more likely to be born early — to anybody I can get to stand still long enough.

*I was in a group with good odds for our first IVF cycle (and had plenty of embryos for the FET). I said at the time that if the first cycle didn’t result in pregnancy or good-quality frozen embryos, I would revisit the transfer number.

12 JustHeather { 12.03.13 at 3:56 pm }

Finland is one of the European countries where 1 embryo is the norm, but sometimes 2 is transferred, depending on several things (age, quality of the embryo,…). Also, if you are “lucky” (I say that with quotes, because IF isn’t lucky) enough to go through the government for treatments, it is insanely cheaper, not that private clinics are that expensive here, compared to US (for example).

We went through the government, used all three chances of IVF (plus several IUIs and any FETs that were produced from IVF cycles) to finally get one pregnancy/child and now 1 frozen embryo waiting for us. Most times we transferred two embryos (if there was that many).

In fact, there was just an article in the newspaper here last week that was about IF and IVF treatments and women’s fertility. I wanted to share it with you all, but it’s in Finnish. It’s a good article. 🙂

13 Pepper { 12.03.13 at 10:03 pm }

Coverage like this just sucks all around. I wish I could think of a more articulate word but I think suck covers it. My daughter was a preemie and spent time in the NICU. We had the best possible experience and outcome and I still wouldn’t wish it on anyone. This is one of the reasons we are choosing not to pursue IVF a second time – we could only afford one cycle, our doctor recommends in our situation that we transfer two embryos… I’m already predisposed to preterm labor/preemies and we don’t know why… so I would basically be getting pregnant with children (if the cycle was a success) and knowingly setting them up for serious risks. ugh.

Sorry for the rant – this article just really made me mad. I think your comments were spot on. And I did not read the comment section of the article – I can only imagine.

14 Alexicographer { 12.03.13 at 10:04 pm }

I haven’t read the article and don’t plan to. I agree, insurance would help — but as others, like @lmaclen say above, it’s not just about the financial cost or even the ability to try again.

I almost always transferred two (three, my last cycle, at age 41 and knowing the clinic refused to freeze the third because of its poor quality), which was a lot fewer than were recommended by my REs (3 different clinics across 6 cycles) — when more were available to transfer; I never had more than 4 embryos in a cycle as I was a high FSHer and told I’d never get pregnant with my own eggs. And across those 6 cycles I did get pregnant, exactly once — a healthy full-term singleton, as it turned out.

While I’m sure I’d have embraced twins had I been blessed with them, I was really clear that twin pregnancies are high-risk pregnancies and that there were things that could have happened that I thought I’d find far worse than never getting pregnant. I was lucky and didn’t find out (touch wood and all that going forward, but the ttc and pregnancy part of my life, at least, is behind me). Because it’s one thing to consider healthy twins — who wouldn’t prefer healthy twins to not getting pregnant? — and another to contemplate losing a pregnancy, and I do think that possibility, or at least that the likelihood of it happening isn’t trivial — sometimes gets obscured as we seek to grow our families. But of course, not without good reason; these are hard choices we make without knowing what their results will be.

15 Aerotropolitan Comitissa { 12.04.13 at 10:16 am }

“Do you know what keeps doctors AND patients from moving towards e-SET as the given rather than the exception? A lack of insurance coverage.”

Exactly. Exactly.

Although chance of success per embryo and success of thawing to previous viability is also a factor because cycles are also time consuming and emotionally taxing and who wants to waste good embryos needlessly so obviously if any advances there, etc etc.

But insurance. Top of the list and hey! something we can do *right now*, no scientific breakthroughs necessary.

And the whole concept of eSETs is so seven hundred and fifty six minutes ago (I mean, it’s practically retro.)

One day they’ll learn.

I wonder what real news they wanted to distract which segment of the population from?

16 Turia { 12.04.13 at 1:16 pm }

I have been thinking about this a lot, and was completely taken aback when my city’s Metro had a big article boasting this ‘news’, because for the life of me I couldn’t figure out what was new about it. (Turns out, as I suspected, nothing.)

We are gearing up for our final shot at IVF to get a 2.0, and the two vs. one embryo debate has weighed heavily on my mind. My son is the product of a two embryo transfer, and the only one of ten apparently perfect embryos that chose to stick around.

In a perfect world, with insurance coverage that included procedures and not just medications (although I am very grateful for that), I would probably be willing to opt for one. We just did two failed FETs back to back where we transferred one blast at a time for exactly this reason- we don’t want to face the complications of twins.

But- we are running out of money, and out of options, and I think my body doesn’t like our embryos. So we’ll probably roll the dice this time and transfer two.

(c) 2006 Melissa S. Ford
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