Proposed changes aim to reduce prematurity rates by relieving financial pressures that lead to choosing treatments more likely to result in multiple gestations.
Six changes in policy and practice aimed at reducing the odds of multiple births and prematurity have been proposed. The recommendations, outlined in Fertility and Sterility, come from experts at the Hastings Center and Yale School of Medicine that included fertility experts, representatives from the insurance industry and professional associations, and bioethicists.
In particular the authors urge that insurance coverage for in vitro fertilization (IVF) be expanded. They reason that because of the high price of IVF, patients feel financially compelled to maximize pregnancy chances by implanting multiple embryos.
- Policy changes, including improving insurance coverage
of IVF treatments,
are needed to reduce the odds of multiple births and prematurity.
- Physicians must better communicate all the risks associated with carrying multiples with patients seeking fertility treatments.
"Failure to cover these services causes harm to patients in addition to leading to multiple births," said Pasquale Patrizio, MD, professor in the Department of Obstetrics, Gynecology & Reproductive Sciences at Yale School of Medicine, and one of the authors, in a news release.
The experts also believe improved communication is warranted between doctor and patient so that women are fully aware of the risks associated with twins and higher-order multiples. Twins and higher-order multiples are more likely to be premature, which places babies at risk for death, neurological problems, and respiratory issues and costs the US health care system more than $26 billion per year.
"When patients are better informed of the risks of multiples, and relieved of the financial pressures, research shows that they are more likely to choose to transfer one embryo at a time," Patrizio said.
The recommendations from the group include the following:
- Expanding insurance coverage for infertility.
- Altering the definition of an IVF cycle so that two consecutive single embryo transfers is equivalent to one double embryo transfer. This change would apply to both the calculation of success rates and the determination of insurance benefits, the authors suggested.
- Altering clinic, insurer, and state policies to better enable patients to choose low-risk protocols for addressing infertility.
- Changing insurance policies to reduce the number of controlled ovarian stimulation (COS) cycles required before IVF is covered.
- Investing in research to improve fertility treatments.
- Improving communication between patients and physicians about the risks of multiple births and prematurity.