Saturday, October 10, 2009

Beginning-of-life care is also costly

While a much smaller factor than the explosion of healthcare spending that happens in the last few months of Americans' lives, expenditures for premature infants--including those who are born as the result of fertility treatments--contribute to the high cost of healthcare in the U.S.

A story of twins who were conceived via in vitro fertilization, born prematurely, and hospitalized for a month and a half after birth illustrates the problem:

By the time it was over, medical bills for the boys exceeded $1.2 million.

Eight months later, the extraordinary effort seems worth it to the Masteras, who live in Aurora, Colo. The babies are thriving and developing their own personalities — Wes, the noisy and demanding; Max, the quiet and serious. Like many other twins conceived through in-vitro fertilization, the Mastera boys will go down in the record books as a success — both for the fertility clinic that helped create them and the neonatologists who nursed them to health.

But an exploration of the fertility industry reveals that the success comes with a price. While IVF creates thousands of new families a year, an increasing number of the newborns are twins, and they carry special risks often overlooked in the desire to produce babies.

While most twins go home without serious complications, government statistics show that 60 percent of them are born prematurely. That increases their chances of death in the first few days of life, as well as other problems including mental retardation, eye and ear impairments and learning disabilities. And women carrying twins are at greater risk of pregnancy complications.

In fact, leaders of the fertility industry and government health officials say that twins are a risk that should be avoided in fertility treatments. But they also acknowledge that they have had difficulty curtailing the trend.

Many fertility doctors routinely ignore their industry’s own guidelines, which encourage the use of single embryos during the in-vitro fertilization procedure, according to interviews and industry data. Some doctors say that powerful financial incentives hold sway in a competitive marketplace. Placing extra embryos in a woman’s womb increases the chances that one will take. The resulting babies and word of mouth can be the best way of luring new business.

Several years ago I heard a report on NPR about the increased birth defects that have been associated with in vitro fertilization. Because most IVF clinics do not receive government funding, there hasn't been a lot of research in this area. But one of the speakers on the program made the observation that in some cases, there's a genetic reason why couples can't conceive: nature handles those situations by ending the pregnancy early on, and we ignore that fact at our peril.

A lot more information on these issues here, including information on a study that shows that IVF and other fertility treatments more than double the risk of birth defects.

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