In vitro fertilization: Balancing success and safety

| Jul 12 2014

Trying, waiting, disappointment, trying again. Women and their partners who undergo infertility treatment such as in vitro fertilization (IVF) invest a lot to have a baby – physically, emotionally, and financially. IVF involves retrieving viable eggs and combining them in the laboratory with sperm to create embryos. One or more embryos are then transferred into the woman’s uterus.

Statistics from the Centers for Disease Control and Prevention show that the majority of patients and their doctors elect to transfer two or more embryos, even when transferring one has a high chance of success. Many women say transferring two seems intuitive. Twice the embryos, higher the chances of success, maybe even double the number of babies, quicker to the goal of a healthy baby, right? Not always. As a mom, I understand how powerful the desire for children can be. But as a clinician, I know reality is that having one baby at a time is safer.

Twins or higher multiple births like triplets come with greater health risks for mom and baby. On average, 60 percent of twins and 97 percent of triplets conceived through IVF are born premature and have a much higher rate of complications than single babies. Premature babies who survive can face life-long developmental, cognitive, respiratory, or digestive problems. Further, medical costs alone for premature babies can be more than 10 times that of healthy full-term babies. Families with newborn multiples also experience higher stress compared to single newborn families.

These risks and the associated costs are often underestimated and surprise – if not shock– parents. That’s why we have worked with organizations like the March of Dimes, the Hastings Center and others that encourage more detailed conversations with patients about the realities of multiples and strategies to achieve healthy pregnancies and babies — one at a time.

One of the most powerful strategies to support a healthy baby in IVF is to transfer back as few embryos as is medically recommended by the American Society for Reproductive Medicine. For many women, especially those who are under 35 and have not failed an IVF cycle, only one embryo is recommended for transfer. Aetna benefits align to medical evidence to promote the use of elective single embryo transfer (eSET). This voluntary transfer of only one embryo in an IVF cycle can increase the percentage of single babies born through IVF from 65 percent to 98 percent.

To remove financial hesitation of attempting eSET for women whose health benefits cover IVF, Aetna will cover the first transfer. If unsuccessful, Aetna also will cover a second attempt using a frozen embryo cycle. (If a plan includes a limit on the number of IVF cycles covered, the second attempt will not count against the limit.)

This approach strikes the right balance between success and safety, giving women the opportunity to have a healthy family while also reducing the risks associated with twins or multiples.

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