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11/04/2015

Bias and the safety of IVF

An article last week on Medscape reported that the results a new study on IVF were announced at the American Society for Reproductive Medicine 2015 Annual Meeting. The president of the ASRM was reported as saying the study findings “provide a lot of reassurance that the kinds of treatment that some couples need to conceive, including in vitro fertilization, are not risky.” However, this statement appears to reflect some bias. ASRM is the professional organization of people who make their living doing IVF. They have a vested interest in showing that what they do is not risky. When the person making a statement is biased it is good to evaluate the evidence for what is being said.

From the statement made by ASRM the study was done by comparing the birth weight and length of gestation between children born by IVF and children conceived spontaneously by the same parents after adjusting for such things as maternal age and parity. The conclusion that they reported was that “our findings suggest that factors inherent in the woman, rather than those attributable to infertility treatments, may explain the lower birth weight and shorter gestation associated with assisted reproductive technology.”

Since one of the significant ethical concerns about IVF is the concern about the risks to the child conceived by IVF, it is important to decide whether the findings of this study actually support the conclusion that IVF is not risky. It seems to me that this study does not adequately support that conclusion. Even if it could be determined that the process of doing IVF does not cause any increase in risk compared to the risk caused by factors present in the parents conceiving the child, the use of IVF may allow parents who are at high risk for having a child who is premature or has significant birth defects to have a child when their risk factors would prohibit them from conceiving a child naturally. There can be an ethical concern about choosing to conceive a child who is at increased risk for significant problems even if the technique used to conceive the child does not cause those risks. One of those risk factors is age which was controlled for in this study. Age increases the risk for many serious problems for children born to older parents, but also naturally decreases fertility, thereby reducing the chance of having a child with those problems. The use of IVF can circumvent the natural protection against conceiving children with a serious abnormality even if IVF is not causing the abnormality to occur. That still raises an ethical issue about whether IVF should be used in that situation. Those with a bias toward promoting the use of the technique by which they make their living have failed to make that clear.

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