Explaining Goal #3
Goal #3: To improve the efficacy and safety of infertility treatment
The power to produce an effect is the Merriam Webster definition of the word efficacy. It’s interesting that the word efficacy is used for this particular goal, considering how little power most infertility patients actually think they have over the entire infertility treatment process. I suppose the choice was aimed at infertility professionals, who have at least the resources and research to provide some degree of power over the outcome of a particular treatment.
Since the cost of infertility diagnosis and treatment is paid for mostly by patients without insurance coverage, research would be done as part of this plan to standardize procedures for identifying the characteristics of oocytes and embryos to predict successful implantation and ultimately the birth of a healthy child.
Coming from the viewpoint of a former patient, I will say the ‘grading’ scale needs to be perfected. Our daughter was considered a ‘poor quality embyro’ by the clinic we went to for our final IVF attempt. The three embryos that were transferred for our fresh embryo IVF were considered top tier. We even had to sign a waiver of responsibility if we ended up having triplets.
We got a BFN (big fat negative) when the blood test results came back. Two months later, the subpar frozen embryos were transferred into my wife, and 10 months after that, a healthy 8 pound 6 ounce baby girl came into our lives.
With infertility, there is no safety in numbers
The frequency of multiple pregnancies as a result of ART (Assisted Reproductive Technology) procedures has produced a lot of debate over the safety of infertility treatments. The Octomom and "John & Kate Plus 8" are extreme examples of adverse outcomes that resulted in ‘happy outcomes’ (all of the children lived and are fairly healthy). The cost of caring for that many children at once is astronomical, and certainly puts on a burden on the healthcare system, not to mention the parents of such a (sudden) large family of children all growing at the same age.
Some of this may be attributed to patients, who have limited financial resources or no available insurance coverage, ‘pushing the envelope’ with the transfer of embryos or the use of infertility drugs, to maximize the cost effectiveness of each cycle. Studies and research could be done as part of this plan to quantify the cost on the overall healthcare system of multiple births, and perhaps motivate a rational debate about the true cost of not including infertility coverage as part of normal reproductive care.
Non ART procedures may be more successful than current numbers show
One interesting point made by the CDC white paper was in reference to infertility treatments other than assisted reproductive technology. Ovarian stimulation followed by natural conception, or IUI, is much more common than ART. Although the pregnancy rates are generally below 15%, the white paper suggests the higher frequency makes it likely that there as many children conceived from IUI as there are from IVF. More study is needed on a broader population to determine if this suggestion is accurate.
There is also a need to analyze the adverse outcomes associated with IUIs, especially given that there is no way to control the number of eggs that are fertilized in an intrauterine insemination. The idea is to give the sperm as many targets as possible by stimulating the ovaries to produce more than the normal number of eggs in a given cycle. The adverse effects of this type of procedure are borne out by the sensationalized media coverage of the Octomom.
Ethics and Infertility
The proliferation of egg and sperm donation, fertility preservation techniques, and embryonic research has brought ART to a challenging ethical crossroads. Complex decisions that were never considered before now need to be debated. Policies and laws will need to be created to protect the rights of parents who create embryos, even if they don’t ultimately end up using them to create life.
The military must grapple with whether or not they will establish a protocol to retrieve sperm from soldiers wounded by exposure to battlefields that have had more explosive devices than have ever been encountered in any recent conflict.
Egg donation centers must be ready to explain marketing practices that induce college age women to sell their eggs for a fee, as many policy groups across the country lobby to put an end to any and all egg donation practices.
These issues have an effect on the safety of infertility treatments, for both patients, and the biological donors who become involved in the ART world. These issues will all be topics of discussion that will need to be tackled as part of the implementation of infertility as a primary concern on the public health front.
Next time, I will cover Goal #4: To improve the quality of life of Americans who live with infertility.
Read the Entire Four Part Series
- The Public Health Focus on Infertility
- Improving Access to the Diagnosis and Treatment of Infertility
- Improving the Efficacy and Safety of Infertility Treatment
- Improving the Quality of Life of Americans Who Live With Infertility