Bioethics in Faith and Practice, Volume 4, Number 1

22 The Ethics of IVF be untangled. What happens when insurer and patient interests collide over when and how treatment should be carried out? For example, since multiple embryos are often implanted at once to increase the chance of pregnancy, IVF births have significantly greater likelihood of twins, triplets, etc. compared to traditional pregnancy. In fact, IVF patients constitute more than half of all total multiple births. 66 While covered almost entirely by insurance, these multiple births cost four to sixteen times as much as single births even without including the cost of IVF, 67 and may cause significant health risks to the mother. 68 Patients, wanting to reduce costs and minimize invasive procedures, are more likely to pursue aggressive treatment and implant multiple embryos; insurers, wanting to save money in the long run, are more likely to advocate single implantation, even if it takes more cycles to achieve pregnancy. Innovative solutions to this quandary have been proposed, but this is just one of many unforeseen policy questions that will have to be answered by practitioners, lawmakers, and ethicists alike. Concerns have also been raised over the commercial interests associated with IVF and other advanced reproductive technologies. For instance, feminist scholar Anne Donchin has criticized the role of fertility clinics, health care practitioners, and scientific researchers (all of whom have a financial stake in the use of IVF) in raising fears over the infertility ‘epidemic.’ Encouraging insurers and patients to consider infertility as a disease, in Donchin’s view, subtly leads couples struggling with infertility to consider themselves sick and in need of a cure, rather than fully considering all the options. This problem is compounded by the close ties that bind childbearing to family and identity, especially for women. Donchin writes, Repeatedly, from physicians and other professionals with related interests, infertile women are urged to fulfill their "full reproductive potential" regardless of economic, psychological or bodily cost. … The inability to produce a child at will, once deemed inevitable and accepted with resignation, is more likely to be regarded now as a surmountable impediment to personal self-fulfillment. Even adoption, once an obvious alternative for aspiring parents unable to conceive, is now more likely to be viewed as a last resort, to be pursued only after all medical approaches to the production of biologically related children have been exhausted. 69 Some have even suggested that fertility clinics are incentivized to promote costly IVF procedures over less expensive alternatives that could equally or better serve the patient’s interests. The Australian clinic Monash IVF’s code of conduct explicitly states that clinicians should recognize that their primary obligation is to the company and its shareholders -- not to patients. 70 While this is a broader topic than IVF itself, spanning the rising trend toward medical consumerism, the fertility industry is particularly affected as a sector that is 1) relatively immature, 2) debatably not treating ‘disease’ per se, and 3) closely tied to very expensive and currently trendy treatment options. It is worth carefully considering what kind of behavior we incentivize, and what those incentives say about our society and human ontology. How does IVF affect the relationships among patients, practitioners, and 66 Barton Hamilton et al., "Health Care Access, Costs, and Treatment Dynamics: Evidence from in Vitro Fertilization," American Economic Review , no. 108 (2018), 3725-3777 . https://doi.org/10.1257/aer.20161014 . 67 Barton Hamilton et al., "Health Care Access, Costs, and Treatment Dynamics: Evidence from in Vitro Fertilization," American Economic Review , no. 108 (2018), 3725-3777 . https://doi.org/10.1257/aer.20161014 . 68 Niederberger, "Forty Years of IVF," , 185-324 69 Anne Donchin, "Health Care Access, Costs, and Treatment Dynamics: Evidence from in Vitro Fertilization," Journal of Medicine and Philosophy 21 (1996), 475-498. 70 Christopher Mayes et al., "On the Fragility of Medical Virtue in a Neoliberal Context: The Case of Commercial Conflicts of Interest in Reproductive Medicine," Theoretical Medicine and Bioethics 37 (2016), 97-111.