I met with nine other RE’s and embryologists last night in Pasadena for our almost bi-monthly journal club. I was reminded then by one of the attendees that these journal club meetings originated from my own idea over a year ago. I don’t really care if I get credit for these meetings but I must say I love the fact that we have them. We are friendly competitors in a sense, but yet, we come together for the purpose of intellectual debate and the sharing of information and experiences, all to further hone our clinical decision-making skills.
The official topic of discussion was PGD, especially with respect to how PGD is sometimes used as a way to avoid the implantation of genetically abnormal embryos. I’ll make a note to possibly write here someday on this topic. But I’ll just share our conclusion that in general, it is NOT a good idea to use PGD in the hopes that it will increase pregnancy rates, because it just doesn’t work well that way. There are other good reasons for doing PGD, but the evidence shows that trying to use it to raise pregnancy rates doesn’t work. Basically, the bad outweighs the good.
One thing that I’m reminded during these meetings is the high dedication to innovation we have in our field, especially from the embryology sector. As clinicians, the people who deal directly with the patients, we can tweak our protocols here and there in an attempt to find better ways to do things, but the most significant advances in our field which have led to a huge jump in IVF success over the years, come not from the clinical side, but rather from the people in the lab. Every day, there are many people who never have contact with patients, but who are diligently working, coming up with better ways to nourish embryos so as to boost success rates. We all know that the better the value of the product that we can offer to our patients, the more business we will earn. This benefits our practices AND it benefits our patients. I can tell you that this would not be happening as successfully if there were no economic incentive to do so. If we had socialized medicine in a way that would give little financial incentive for new discoveries, then sure, scientists would still be trying to make new discoveries, but they would be like government workers, clocking in and clocking out, doing their time to collect their benefits and paychecks, but they would NOT be furiously burning the midnight oil, busting their butts to competitively get these improvements out there for the people as soon as possible. Look at how much postal service and public education has improved (or not) over the past twenty years. Compare this to how much cell phones and computers have improved. Regardless of your political beliefs, I would invite you to ask yourself – do people work harder when there is also a personal incentive driving them or do they work the same as when they are doing something solely for the so-called “public good”?
Inevitably during the evening, after a few glasses of wine, the conversation turned to the topic of the octuplets. Some of us, specifically the RE’s from West LA, knew the doctor better than the rest of us. We discussed our experiences with this doctor and his brother, who is also an OB/Gyn. Some of us also shared our own “war stories” of our own cases in which we transferred five or more embryos. No, none of us ever came close to getting octuplets. Our most somber conclusion, at least in my opinion, is the very real worry that the California government will overreact to this outlier event by taking our ASRM guidelines on number of embryos to transfer and turning them into strict laws. For years, things have been good the way they are. But now, because of this one incident, we could find our hands tied and forced to practice medicine as dictated by politicians and not as dictated by our years and years of medical experience and training. It’s as if someone committed gruesome serial murders with a bowling ball and now the government will outlaw bowling balls. Who suffers as a result? Well, we RE’s will suffer with respect to having our autonomy curtailed, but we will also end up doing more cycles as the success rate drops. So in my opinion, the real victims will be infertility patients. Consider this sobering thought. Several years ago, if these guidelines would have been turned into strict inflexible law with no leeway for wise clinical judgment, then many happy children laughing in playgrounds today would never have been born. I am 100% certain of that.
