Hard questions need to be asked about the steep rise in IVF around the world, says the Evidence Based IVF Group. In a stinging rebuke to commercial IVF in the BMJ, they write: “IVF has allowed many infertile couples to have a family. Its early pioneers persevered in opposition to scientific, societal, and religious dogma. Similar determination is needed in attempts to evaluate the extension of IVF to new indications.”.
The big issue is the exploitation of patients with unexplained sub-fertility. Most of the rise in the use of IVF is driven by unexplained subfertility. “Unexplained subfertility accounts for 25% to 30% of all couples presenting for IVF, many of whom will conceive before treatment.” If this is the case, IVF may not be cost-effective.
The Group has other concerns as well. While some countries are promoting single-embryo transfers, multiple embryo transfer is common in the US and in Asia. This is clearly risky, as “Multiple pregnancies are associated with maternal and perinatal complications such as gestational diabetes, fetal growth restriction, and pre-eclampsia as well as premature birth.” Furthermore, researchers have misgivings about the long-term health of IVF children. “Otherwise healthy children conceived by IVF may have higher blood pressure, adiposity, glucose levels, and more generalised vascular dysfunction than children conceived naturally. These effects seem to be related to the IVF procedure itself rather than to underlying subfertility.”
The Group concludes sombrely: “As a society we face a choice. We can continue to offer early, non-evidence based access to IVF to couples with fertility problems or follow a more challenging path to prove interventions are effective and safe and to optimise the IVF procedure. We owe it to all subfertile couples and their potential children to use IVF judiciously and to ensure that we are first doing no harm.”
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