The ART of Getting Pregnant: Benefits vs Risks of Artificial Reproductive Therapy

Assistive (Artificial) Reproductive Technology (Therapy) (ART) is the modern way for women who desire children but are unable to become pregnant can have their wish fulfilled. But as Annie Janvier, BSc, MD, PhD writes in her article “Jumping to Premature Conclusions” in the October 2008 issue of Virtual Mentor there are both financial and human health risks to the way ART is practiced in the United States and Canada. It is all related to the incidence of multiple births and premature births associated with ART leading to the need for neonatal intensive care management and incidence of complications and permanent disabilities of the premature infants. The risks are also related to the tendency for women to wait to their later years to try to become pregnant because of the need for job income and difficulty in managing both a profession and becoming a mother. It is then in these later years that women turn to ART to become pregnant and because of their older age, multiple births and the tendency toward premature deliveries complications arise for both the mother and the babies. Dr. Janvier writes “When a woman decides to have children in early adulthood, does the government provide generous maternity leave, social and economic support for their education, and subsidized, universal childcare services when the child is young? The answer, unfortunately, is no. Society rewards performance, work, and wealth, creating an incentive to delay childbearing. The same women who would receive very limited financial incentives were they to become pregnant at an earlier age when the risks of prematurity were lower end up paying for expensive ART services years later and increasing their risks.”


One of the issues that Dr. Janvier points out is that there is a tendency for multiple embryo transfer in invitro fertilization (IVF) procedures in order to increase the possibility of at least one live birth more promptly so as to avoid the expense (related in part to physician financial self-interests) and physical burdens of repeated attempts. She writes that she “calculated that 17 percent of [neonatal intensive care unit] admissions were multiple gestations following ART. Most of these could have been avoided by rigorously controlling the clinical practices relating to the treatment of infertility. It's easy to envision a public policy to decrease multiple births. Unlike Canada and the United States, some countries—Sweden, Belgium, Finland, and Denmark, for example—regulate and reimburse ART services. In these countries, single-embryo transfer during IVF is the norm. Where financial conflicts of interest related to ART are avoided, patients and physicians seem far less willing to take the unnecessary risk of multiple births in order to become pregnant as quickly as possible. Having children with the least risk for the mother and infant seems to be the morally responsible position.”


Please go to Virtual Mentor and read the entire article and express your opinions here as to the merits of women postponing pregnancy until later years at which time they may need ART to become pregnant. I would also like to read about your views of societal demands on women and the need for change in the way ART is performed and paid for in the United States and Canada as examples. ..Maurice.