August 20, 2012 | Posted By Lisa Campo-Engelstein, PhD

A recent New York Times article shares the story of Debra Demidon, who developed severe ovarian hyperstimulation syndrome (OHSS) after undergoing IVF. This potentially life-threatening condition caused her to gain more than 30 pounds of fluid and have trouble breathing, and ultimately landed her in the hospital for 5 days. OHSS is much more common in the US and UK than in Europe and Japan because the former countries rely on high-dose hormones for IVF where the latter countries use lose-dose hormones. Although rare, OHSS following high-dose hormone IVF is now one of the leading causes of maternal mortality in parts of the UK. OHSS is not the only adverse side effect of high-dose IVF for women; there are myriad other possible side effects including increased cancer risk, memory loss, and liver disorders.  Furthermore, there can also be increased risk for children born from high-dose IVF, such as low birth rate. 

Knowing these serious potential health-related outcomes, why is high-dose IVF the dominant and default method used in the US? The main reason is that high-dose IVF produces many more eggs (often 20-30 eggs and sometimes even more) than low-dose IVF produce (8-10 eggs). Given that most insurance companies do not cover infertility treatments (only 15 states have laws mandating insurance companies to cover infertility treatments and there are many exemptions and caveats), many people pay out of pocket for IVF. In order to save money – IVF costs $15,000 - $30,000 a cycle – people are often willing to increase their risks to themselves (choosing high-dose IVF or low-dose IVF) if it means they’re likely to generate more eggs. Individuals in time pressure situations who may only have one shot at gathering eggs, such as cancer patients wanting to preserve their fertility before undergoing treatments that will hopefully save their lives but may render them infertile, may also opt for high-dose IVF.  

But many infertility patients are never informed about the differences between high-dose and low-dose IVF and given the choice between them. Assisted reproductive technology is a billion dollar industry and there is fierce competition among infertility clinics for clients. Clinics’ success rates are published online by the Society for Assisted Reproductive Technology (SART). The belief that there is a direct relationship between the number of eggs collected per cycle and many of the key success metrics used by SART (e.g. implantation rates, probability of a live birth baby) encourages clinics to be aggressive in their treatment and use the most high yield ovarian stimulation drugs available. 

While there is no doubt that the women using high-dose IVF may be willing to incur some negative side effects in order to have a biological child, it is ethically troubling that many women are not told there is a safer alternative to high-dose IVF.  It is also troubling that high-dose IVF is the standard in the US despite all the health risks to women and potential babies. So long as the fertility industry continues to remain largely unregulated – often referred to as the “wild west in medicine” – it is unlikely that there will be a mass shift to low-dose IVF anytime in the near future.

This blog was also published with the Oncofertility Consortium.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.