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Comment and Controversy

Make the mother and doctor culpable for IVF multiples

September 2005 · Vol. 17, No. 9
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I applaud Dr. Barbieri’s efforts to address the troublesome issue of iatrogenic multiple gestations. Like him, I would hate to see government regulation of assisted reproduction, but it seems clear something should be done to limit the number of preventable multiple gestations. I have 2 suggestions, either of which would result in a dramatic decrease in multiple gestations:

  • Women usually pay for assisted reproduction themselves because few insurance companies cover IVF. When they do become pregnant, they use health insurance to cover the costs of the resultant pregnancy. If insurance companies were allowed to deny coverage for costs associated with high-order multiple gestations (3 or more) resulting from IVF, few women would allow their doctor to implant multiple embryos, and the rate of multiple gestations would immediately drop.
  • If the implanting doctor were required to indemnify the woman and pay for the maternity expenses of any high-order multiple gestation (3 or more) resulting from embryo transfers, you would see an immediate drop in the number of transfers.

Self-regulation is the surest way to prevent government interference. Too often patients and doctors are insulated from the economic consequences of their decisions. Either one of these measures would remove that insulation and make doctors and patients financially responsible for their actions regarding embryo transfer.

Michael Robinson, MD
Fountain Valley, Calif

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