Archive for March 6th, 2009

Ahem. Now that I’m over my little hissy fit from last night. And, um, this morning. And, um, this afternoon… Have I calmed down over the proposed Georgia legislation? In a word? Not so much. It turns out, I’m a wee bit, shall we say, opinionated.

Let’s review this proposed legislation, shall we? In plain English, the Georgia so-called “Ethical Treatment of Human Embryos Act” (the title makes me want to vomit a little, how about you?) seeks to do the following:

1. Limit the number of embryos transferred in an IVF cycle to 2, if under 40 (3 if 40 or over).
2. Limit the number of eggs fertilized (and therefore the number of embryos created) per IVF cycle to the number of embryos the woman is planning to transfer. (e.g. no more than 2 in a woman under 40, 3 in a woman 40 or over). If more eggs than that were retrieved in a cycle, those additional eggs could not be fertilized.
3. If extra embryos are created, they may not be cryopreserved or destroyed; they must be transferred. (In other words, if 2 are created, a woman may not opt to transfer a single embryo and cryopreserve the remaining embryo, she must transfer both of the the embryos to her uterus).
4. The bill also bans all financial compensation for donor gametes (sperm, eggs, embryos). This would seriously limit the donor pool in Georgia. It may, in fact, eliminate it entirely.

Note, of course, that the bill does not propose any financial relief or mandated insurance coverage (Georgia does not currently have an insurance mandate either) to help with the added financial burden of using less effective treatment. Patients will still have to pay out of pocket for less effective treatment.

Here’s the first thing, and let’s get this out of the way right off the bat: I am never going to support legislation that attempts to regulate what I believe needs to remain a discretionary decision between a doctor and a patient. Should, under most circumstances, 2 embryos transferred in an IVF cycle be an appropriate course of action? Absolutely. Do most doctors today follow that guideline? Statistics are showing that, yes, doctors are trending that direction quickly. But are there ever circumstances of patient history, embryo quality, etc. that might suggest a different course of action may be appropriate? Certainly. And that’s when legislation like this is inappropriate. Think about it: If a legislator can dictate how a doctor practices his/her field in infertility then there is no telling what may happen down the line with other specialties. Would you want a politician telling your cardiologist when it’s appropriate to do a cardiac catheterization? Or when your neurologist can prescribe beta blockers? Maybe only on alternate Thursdays?

So now that we’ve got out of the way that I have a blanket opposition to any sort of legislation like this, let’s move on, shall we?

Let’s think about the provisions a little more.

Limiting the number of embryos transferred. Sure it seems sensible. Gosh, I sure don’t want to continue this epidemic of octomoms and HOMs, do you? I mean, do you remember all those sextuplets that were all born a couple years ago? Oh. RIGHT! Those were all from IUI! That’s RIGHT! Octomom just happens to be the first case of octuplets born as the result of IVF well… ever. And sextuplets? Right, also generally IVF. In fact, most cases of quads and triplets even are the result, not of IVF, but of IUI. Even twin statistics in IVF are going down because with the increasing popularity and success rates with eSET when used in an appropriate patient population, you can reduce your twin risk from upwards of 40% down to as low as 1%, without lowering your overall success rate. So this epidemic of HOMs that the great state of Georgia is so concerned about happening in their state? What was it Ralph T. Hudgens said? “Nadya Suleman is going to cost the state of California millions of dollars over the years; the taxpayers are going to have to fund the 14 children she has … I don’t want that to happen in Georgia.” Oh because Nadya Suleman’s pregnacy was, what? Contagious? Um. No.

In fact, limiting the number of embryos transferred in an IVF cycle may seem quite sensible. And, in fact, the ASRM and SART do have guidelines that recommend doing exactly that. They have, over the years, been dramatically lowering the number of embryos they recommend transferring in an IVF cycle and are recommending eSET with increasing frequency these days. While they are guidelines, the statistics do show that by and large, doctors in the industry are following them. And doctors who are found to be consistently in violation of these guidelines can have their SART membership revoked. Think that’s not such a big deal? Well, think again, because many insurance companies will only cover doctors who are members in good standing with SART. So legislation? Just not necessary, and, honestly? Quite possibly harmful because it takes away the discretionary ability of the doctor for the case-by-case determination of a patient’s needs.

Now what about this fertilization/embryo creation business? I’m sorry, but this is utter crap. The bill proposes limiting doctors/embryology labs to only fertilizing up to 2 eggs per IVF cycle for women under 40 (3 for women 40 or over). The politicians/Right to Lifers who wrote this bill clearly have no grasp of the medical science at play here. There is generally an attrition rate on embryos and it can be as high as 50-75%. What do you do then? It’s too late now to make another, so now you’re stuck.

So I’ll give you a personal example. In my last IVF cycle, I had 10 eggs retrieved, 9 were mature and miraculous, all fertilized and were 2 celled embryos the next day. By Day 3 I had 7 crappy looking Embryos. On Day 5, I had 4 “meh” looking morulas. On Day 6 (transfer day), I had 2 decent looking blastocysts. I transferred one. The other didn’t make it to freeze (and neither did the other ones that had been lagging behind). My cycle failed. The Georgia politicians who were so worried that if I fertilized all 9 of my mature eggs I’d end up with 8 little human beings (and make no mistake, the language of the bill makes it clear that they believe that my embryos are living human beings) on ice indefinitely after I transferred my one blastocyst on day 6? Needn’t have worried. Nothing made it to freeze. If I’d only fertilized 2 eggs in the first place? I may never have even made it to transfer, but I would have probably blown about $10K for nothing.

Note, the bill provides for no additional financial relief, such as insurance coverage to help with the added financial burden of using less effective treatment.

Further, note that if I made two embryos in the hypothetical scenario, and miraculously, both survived until transfer day – I would have to transfer both embryos to my uterus. I would not be allowed to destroy it, per the language in the bill (actually, it’s so poorly written, that there’s a loophole there, but the INTENT of the bill is to keep people from destroying embryos, so let’s go with that for the sake of argument, for the moment). Nor would I be allowed to cryopreserve the embryo. So me, who cannot under any circumstances risk having another multiple pregnancy, would have to transfer two embryos because of the way this law is written. OR I would have to simply have fertilized only one egg in the first place, again risking that my one embryo ever made it to transfer.

And banning all compensation for donor gametes? That’s just tacky.

What I hadn’t realized was that there was a second bill being considered this morning. SB 204/HB388 is an embryo adoption bill. It would subject embryo donation to all the same provisio
ns as required by law for adoption of a child. This would subject infertility patients needing an embryo donation to go through the judicial proceedings, home visits, and other procedures required for an adoption. Do you really think this is appropriate? Is this really what you want?

But back to SB169…. there’s a lot of disturbing language in the bill: In disputes arising between any parties regarding the in vitro human embryo, the judicial standard for resolving such disputes shall be the best interest of the in vitro human embryo. Yeah, what? That’s a custody standard used for custody disputes involving children. How exactly is the judicial body going to apply that standard to an embryo?

Another example of disturbing language: Nothing in this article shall be construed to affect conduct relating to abortion as provided in Chapter 12 of Title 16; provided, however, that nothing in this article shall be construed or implied to recognize any independent right to abortion under the laws of this state. To hell if this isn’t a reflection on abortion stance. And this bill was written, in part, by the Georgia Right to Life Campaign. You think that this wasn’t written as a right to life issue? WHATEVER.

More disturbing (emphasis mine): A living in vitro human embryo is a biological human being who is not the property of any person or entity. The fertility physician and the medical facility that employs the physician owe a high duty of care to the living in vitro human embryo. Any contractual provision identifying the living in vitro embryo as the property of any party shall be null and void. The in vitro human embryo shall not be intentionally destroyed for any purpose by any person or entity or through the actions of such person or entity.

I’ll let you figure out why that one bothers me.

Let’s be clear…. either the politicians who drafted this law understand NOTHING about the medical science behind IVF and how it works and didn’t care enough to consult a single doctor or embryologist while drafting this bill. OR, alternatively, they DO understand the science, and they seek, instead, simply to eliminate IVF from Georgia entirely. And in doing so, they’ll shut down a $50million dollar (give or take) industry in Georgia and they don’t care that they’re doing so.

I don’t want another set of HOMs. I’d like to see fewer HOMs resulting from fertility treatment. Truthfully, I think this piece of legislation could potentially INCREASE the number of HOMs because it will make IVF so difficult to effectively obtain in Georgia that people will instead turn to IUI with injectible gonadotropins. And guess what happens then?

So… have I calmed down over this proposed piece of crap? Not so much. But I’m quite glad that it was sent to subcommittee for “further research.”

Read Full Post »