Medical experts question wisdom of expanding IVF access
Progress Educational Trust06 February 2014
Fertility experts have warned that IVF is overused and is too often recommended to couples who may not need it.
Writing in the BMJ, Dr Esme Kamphuis and colleagues said that IVF should not be routinely used in the treatment of conditions such as unexplained fertility.
'As a society, we face a choice', said the authors. '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'.
The value of IVF for women with fallopian tube disorders and in severe male infertility is not disputed in the article. But the authors do suggest that IVF is associated with increased health risks for both mothers and children.
The article also states that IVF is a 'profit-generating industry that values the money brought in by immediate gains of pregnancy and live birth over long term considerations about the health of the mothers and children'.
Multiple pregnancies, which can arise if more than one embryo is implanted during IVF, have been linked to gestational diabetes, pre-eclampsia and fetal growth restriction. Single embryo transfer has been associated with birth defects and a 50-70 percent increased risk of preterm birth. The long-term health of children born through IVF has also been questioned.
'Until these concerns are resolved, there should be caution about using IVF in couples when the benefit is uncertain or the chances of natural conception are still reasonable', say the authors.
Unexplained infertility should not be treated with IVF, the authors say, unless all other avenues, such as trying to conceive naturally for a longer period, have been exhausted. One study cited in the article looked at 500 couples with an average of almost two years of unexplained infertility. Sixty percent conceived naturally after the initial assessment in the fertility clinic.
In the UK, the proportion of IVF cycles for fallopian tube problems has fallen from 19 percent to 12 percent between 2000 and 2011. In comparison, IVF cycles for unexplained infertility have tripled from just over 6,000 to over 19,500 cycles during the same time period.
'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', said Dr Kamphuis and co-authors. 'The paucity of high quality evidence on who should have IVF and when should be addressed'.
Reproduced with permission from BioNews, an email and online sources of news, information and comment on assisted reproduction and genetics.