In the long-run, insurers may save money by steering more women to IVF instead of using gonadotropins, Grainger says. But "even some states with mandatory insurance for IVF still require couples to undergo three cycles of ovulation induction and artificial insemination before IVF. You would think the payers would be all over this. There is a big disconnect."
Couples who risk a multiple gestation pregnancy may also have to face the difficult prospect of selective reduction, in which the doctor aborts one or more of the fetuses to improve the likelihood that the remaining ones will be born healthy.
According to news reports, both the Morrisons and Masches were offered selective reduction but declined.
Selective reduction is an uncomfortable issue for doctors and patients, says Lyerly, an associate professor of obstetrics and gynecology at Duke University. ACOG's ethics committee statement urges doctors and patients to discuss pros and cons of treatments that may result in a multiple gestation pregnancy including selective reduction.
But, she says, "There are tremendous challenges .... When you're trying to become pregnant, it's really hard to think about bad or truly tragic outcomes."
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shari.roan@latimes.com
