Published by Web MD
July 12, 2019
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July 12, 2019 — The recent fertility clinic mix-ups involving three families have sparked lawsuits against a Los Angeles center — and concern among those seeking fertility treatment or hoping to do so. […]
WebMD reached out to three top fertility specialists to learn more, discuss how the mistakes could have happened — and find out what potential parents seeking fertility care can do to find a reputable center. None of the doctors treated the couples involved in the lawsuits.
Perspective: IVF Babies vs. Mistakes
While the recent cases are tragic, they are also rare, says Mark V. Sauer, MD, chair of obstetrics and gynecology at Rutgers Robert Wood Johnson Medical School and a veteran fertility specialist. “IVF has become a fairly common procedure,” he says. “We know 1 to 2% of American babies are the result of IVF or some spinoff,” says Sauer, who for 21 years was director of IVF and the IVF lab director at Columbia University.
“It’s usually a happy story, because it is the miracle of IVF,” he says. However, ”it is medicine and it is human, so of course there will be breakdowns in the system, there will be errors.”
IVF is short for in vitro fertilization. In this complex procedure, eggs and sperm are combined outside the body. Once an embryo forms, it’s put into the mother’s uterus.
More than 284,000 cycles of assisted reproductive technology, or ART, were performed at 448 reporting fertility clinics in the U.S. during 2017, according to the CDC. These resulted in nearly 69,000 live births (delivery of one or more living infants) and more than 78,000 babies.
It’s a Complex Procedure
The logistics of IVF programs may surprise people, Sauer says, and they play a role in mistakes. Fertility doctors are dealing with microscopic life. “There is no way to put a nametag on an embryo,” he says. “Embryos are stored in a petri dish until put into a person, or they are stored. If stored, they are put in a tiny straw, about the size of a cocktail straw, which is labeled and put in liquid nitrogen for storage. The embryos are just 100 cells under the microscope, and they all look alike. The embryos are not labeled; the dishes are labeled.”
IVF centers use many safeguards, he says. But even with the common practice of the buddy system — with two people verifying the embryo belongs to a specific patient by noting unique identifiers such as date of birth or the last 4 digits of a Social Security number — mistakes can happen, Sauer says.
The mistakes may be more likely, he says, in smaller labs with only a single embryologist. The buddy system is key, he says, so no one ever works alone. “Working in teams makes a huge difference.”
While the doctor who implants the embryo often gets the blame when things go wrong, Sauer says, the mistake actually may happen much earlier in the process, such as when the petri dish was mislabeled.
Yet, there have been mishaps and tragedies. In 2018, a liquid nitrogen storage tank at a fertility center in the Cleveland area heated up, jeopardizing more than 2,000 frozen eggs and embryos. In 1995, a scandal at a University of California Irvine fertility center involved multiple cases of egg and embryo swapping. And a Dutch fertility doctor was accused of using his own sperm to father 49 children, without the women’s knowledge.
Today’s IVF vs. Early IVF
Another thing that may lead to mistakes is the increasing complexity of in vitro treatments, says Richard Marrs, MD, a Los Angeles reproductive endocrinologist and founding partner of California Fertility Partners. He set up the second IVF program in the U.S. and achieved the first pregnancy from a thawed frozen embryo in 1986. He compares those early treatments to the Model-T era, and today’s treatments to the space age.
“A lot has changed in the lab,” he says. For instance, pre-implantation genetic testing is common, he says, with 76% of his center’s patients opting for it. “The genetics lab is offsite,” he says, so that adds more steps — and more error potential.
For the last 5 or 6 years, he says, most centers have been freezing embryos, not using fresh ones, again adding another process. That is because the ”live baby” rate is higher with frozen than fresh, Marrs says.
Vetting a Center
Finding a reputable center requires some homework, says Richard Paulson, MD, a professor of reproductive medicine and director of the fertility program at the University of Southern California Keck School of Medicine.
Choose a center that is accredited by the Society for Assisted Reproductive Technology (SART), he says. The organization sets up and helps maintain standards for assisted reproductive technology.
Find out how successful a center is. Fertility clinics in the U.S. report and verify data on ART cycles in their clinics. Details about individual clinics can be found on the CDC’s ART website and on the SART site, such as services provided, types of patients seen, and success rates.
“I think it’s fair to say, ‘Go with the reputation,’ ” by asking the people who have had fertility treatment which doctors they had good experiences with, Paulson says.
Centers that “put up nice websites may not be the best doctors,” he says. He suggests finding a center with academic ties to a university, although he says, ”there are very solid private centers.”
Seek a fertility doctor who is board-certified in reproductive endocrinology and infertility, says Paulson, a past president of the American Society for Reproductive Medicine. The society sets practice and ethics guidelines.
Look for a center with good communication among doctors, staff, and their patients, Sauer says. “If physicians aren’t giving you answers, or the answers don’t sound right, I would not be hesitant to move on from that group,” he says.
Ask the tough questions, Sauer says. You can directly ask the center’s staff: “How do you prevent mixing up our sperm and eggs, and embryos, with others?”
Patients who are having fertility treatments should expect to be asked for their identification many times before a procedure, Sauer says, just to be sure everything is accurate.
Move on from staff who seem dismissive, Sauer says. For instance, if a center says, “Why do you keep asking that? That never happens,” it’s a bad sign, he says.
Ask if the center uses individual tanks or community tanks for storage, since individual tanks are better, with less potential for errors, he says.
Forget about a tour of the entire lab, Sauer says. “You can’t; it’s a sterile environment. By definition, you can’t see what is behind the curtain, so there has to be a certain element of trust.”
As tragic as the recent cases are, he says, litigation may be making those who run the fertility centers more careful. “There is that effect of policing the profession,” he says.
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