The gift of life: the price people readily pay

Doctors say the good done by their industry creating new families outweighs the bad

Machines forced air into the infants’ lungs. Tubes delivered nourishment. They were so small her husband’s wedding band fit around an entire baby foot. Having a family had been an elusive goal for Jeff and Kerry Mastera, a blur of more than two years, dozens of doctor visits and four tries with a procedure called intrauterine insemination, all failures. In one year, the Masteras spent 23 per cent of their income on fertility treatments.

The couple had nearly given up, but last year they decided to try once more, this time through in-vitro fertilization. Pregnancy quickly followed, as did the Mastera boys, who arrived at the Swedish Medical Centre in Denver on Feb 16 at 3 pounds, 1 ounce each. Kept alive in a neonatal intensive care unit, Max remained in the hospital 43 days; Wes came home in 51.

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, Colorado, the USA. Like many other twins conceived through in-vitro fertilization, the Mastera boys will go down in the record books as a success.

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 per cent 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.

Major healthcare problem
The fertility industry creates preterm infants with in-vitro and other fertility treatments even as government and nonprofit groups work to fight the US’ 12.7 per cent rate of prematurity, regarded as a major national health care problem. A study released last week by the March of Dimes cited fertility treatments as one of the main reasons for a 36 per cent increase in prematurity in the last 25 years.

The government estimates that caring for premature infants costs $26 billion a year, including $1 billion for IVF babies, expenses that eventually get passed on to businesses and consumers.

The American Society for Reproductive Medicine and its affiliate, the Society for Assisted Reproductive Technology, have succeeded in reducing the number of larger multiple births from in-vitro fertilization over the last several years.

The two medical organisations and the federal Centres for Disease Control and Prevention (CDC) have been promoting the use of single embryos in many cases to reduce the number of twins. But that has not translated into major action at the 483 fertility clinics across the country.

“You can’t convince a couple that having twins is a bad thing,” said Dr Maurizio Macaluso, who runs the CDC’s women's health and fertility branch. “That’s a major communication problem.”

Most fertility doctors acknowledge the potential problems with twins, whether conceived naturally or through fertility treatments. But many say that the good done by their industry — creating new families — outweighs the bad, and that twins are not such a risky bet because most are healthy.

“At the end of the day, when you dissect the statistics out, our patients are interested in establishing a family and a pregnancy,” said Dr Michael Swanson, a Colorado fertility doctor who treated Mastera.

It is a tricky cost-benefit analysis, however, and one that potentially involves the worst kind of collateral damage, the type that figures in the nightmares of expectant parents.
Erin and Scott Hare of Houston lost their twin daughter, conceived through in-vitro fertilization. Her surviving brother, Carter, who was born at just over 24 weeks, is doing well but needs therapy for lingering problems.

Pressure for success
In the competitive marketplace for fertility medicine, success rates are the metric by which in-vitro clinics thrive or fail. The rates — meaning the chances of producing a baby at each clinic — are published by the CDC and are widely used by couples to choose a doctor.

After trying unsuccessfully to conceive for more than a year, the Masteras consulted two fertility specialists in 2007 and spent more than $15,000 on four rounds of intrauterine insemination.

In-vitro fertilization was the next logical step, but the price tag was even more daunting. Depending on the clinic, its location and the extra services included in the treatment, the procedure can run from $12,000 a cycle to more than $25,000.

In 2008, the Masteras consulted their third fertility expert, Swanson at Conceptions Reproductive Associates of Littleton, Colorado. They chose him partly based on his clinic’s high success rates as published by the CDC.

Mastera’s insurance would cover about $8,000 for the procedure and drugs. Frequently, insurance does not cover anything. Almost $18,000 in clinic fees and other costs remained for the couple.

Like many families, the Masteras could not afford a second cycle. So when the couple was given a choice by their doctor of implanting one or two embryos, they decided to increase their chances with two.

“This was our Hail Mary pass,” said Mastera, now 33. “We thought, let’s just do it. At the time, it was like, twins, they can be fun. They are fun, but holy cow.”