Nothing strikes fear in the heart of infertility patients quite like the thought that the wrong embryo or gamete was used during their procedure. I linked to the switched embryo story right after it hit the news and quickly received several poignant comments. “I’m going to have my transfer next week and now I’m terrified. I have waited so long for this, and the thought that I could end up carrying someone else’s baby is almost unbearable.” “We did an IUI last week, and I can’t stop thinking now that it wasn’t my husband’s sperm.”
This screw up, and the resulting fears, hits at the heart of infertility—lack of control. Procreation isn’t supposed to be this way. Control is central to the way we are taught that babies should be made. We should be selective about a partner and use protection until we are ready to parent. Selecting and protecting requires control. Infertility strips away control and replaces it with fear, and this story of switched embryos plays to this fear.
Mistakes happen, it’s true, but it is important to keep things in perspective. This story of innocent babies and anguished parents is ready-made for the mass media, so of course we’re seeing a slew of coverage, both local and national. What is not being reported is the frequency of these type mistakes. Remember that about 140,000 IVF cycles are being done each year. The number of errors being reported is very few.
Also remember that you aren’t powerless. There are things you can do to help prevent these mistakes. You can’t take back all the control, but there are absolutely things you can do to increase the odds that these mistakes won’t happen to you. I’ve listed the Top Ten Things to Do to Prevent Mistakes in Your Infertility Treatment at the bottom of this blog. Also, listen to the Sept 30, 2009 Creating a Family show on “Switched Embryos and Other IVF Errors and How to Avoid Them”. Our guests were Dr Jacob F Mayer, Embryologist at the Jones Institute for Reproductive Medicine and Professor of Obstetrics and Gynecology; Dr. Elizabeth Ginsburg, President of the Society for Assisted Reproductive Technology, Associate Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard, and director of the IVF program at Brigham and Women’s Hospital; and Jessica Berg, Professor of Law and Biomedical Ethics at Case Western Reserve University School of Law and Associate Director of the Law-Medicine Center.
And by the way, before I close, let me vent about a major linguistic pet peeve that rears its head every time the press reports on an IVF story. Here’s a news flash for the media: the correct verb to describe an embryo being inserted into a woman’s uterus is “transfer” not “implant”. And no, this is not just me being pedantic and going all English major-y on you. OK, maybe a little pedantic, but words matter and they especially matter here. “Implant” is the word used to describe what we hope happens after the embryo is transferred. Depending on the age of the egg, the viability of the sperm, the quality of the embryo, and plain old luck, implantation happens anywhere from about 18 to 46 percent of the time. Transfer means moving something from one place (lab dish) to another (uterus), which is exactly what is being done. Using the word “implant” fuels the misconception that there is an easy fix to infertility. “Why make such a big deal about infertility. All you need to do is grow some embryos in the lab and implant them, right?” Oh, if only it were that easy. “Implant” is within the realm of the divine, “transfer” within the realm of medicine.
- Is your doctor a member of the American Medical Association and board certified in an area of specialty that relates to infertility.
- Is the embryology lab accredited by either the College of American Pathologists (CAP) or the Joint Commission, a voluntary accreditation program for hospitals and other health care organizations? You can find this information by asking the clinic and it is also on the Center for Disease Control statistics table for each clinic.
- Is the clinic a member of the Society of Assisted Reproductive Technology? Membership is voluntary and SART has very limited enforcement authority, but membership is at least an indication that the clinic will follow the SART guidelines for practice. You can find this information by asking the clinic and it is also on the Center for Disease Control statistics table for each clinic.
- Check the Center for Disease Control statistics on the clinic to see not only their pregnancy rate, but also their live birth rate, and multiple birth rate. Triplet and more pregnancies are another form of IVF mistake.
- Ask the clinic about their labeling protocol for sperm, eggs, and embryos? (They should use at least two, and preferably more, unique identifiers such as bar-coding, color-coding, name, number, etc.)
- Ask the clinic what safeguards are used to make sure that the correct eggs, sperm and embryos are used for each procedure? (For example, more than one person doing the identification of both the embryo or gamete and the patient, multiple times for comparing patients identification with the gamete or embryo, handing off sperm sample to the person in the lab who will be processing it rather than to a secretary or assistant, etc.)
- Check to see if there have been any complaints or disciplinary actions against your doctor. You have a couple of options:
- Search “medical board” and the state name in your favorite search engine to find the Medical Board for your state.
- Use a commercial service, such as HealthGrades to provide a report on your doctor.
- Ask the clinic if a nurse is available to work with you individually if needed to make certain you understand how to administer the medication? Not all mistakes in infertility treatment are by the clinic itself. Infertility medications can be confusing to administer.
- Does the clinic have a specific policy of disclosing all mistakes or errors to a patient?
- During your procedure, ask questions. It’s OK to appear paranoid. Have you double checked to make sure these are my embryos? May I see the storage vial for the sperm before or after insemination?
Related posts:
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- A Bit of Adoption and Infertility Humor ‘Tis the season of light, so let’s lighten things up...
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This is an absolutely wonderful post! As someone who will be using donor eggs very soon, this is timely for me personally. I am going to print this list and use it when I go to my doctor’s office or when I’m calling and talking to the nurses. Thank you so much!
Thank you for this post and especially for the radio show on this topic. I just listened to it and the timing couldn’t have been better for me. I felt reassured but I immediately called my clinic and felt a whole lot better once I talked with them. I had no idea what questions to ask until I listened to the show. Now that I’ve read your Top Ten Tips for Avoiding an IVF Mistake, I will follow through on some of your suggestions, but I’ve already asked about the labeling and identifier suggestions that I was most worried about. Thank you, thank you, thank you.
Amen. I correct the newscasters from my couch whenever I hear them using the term “implant”. Makes me crazy.
As for medical mistakes, ask questions. Lots and lots of questions. Make the doc repeat everything he says to you. If it sounds questionable, ask again. Go to each and every appointment, ER, and ET with a list of questions.
Yeah, the misuse of transfer and implant drive me nuts too, but I haven’t been able to articulate why very well. Mind if I borrow your explanation.
I look at my kids now and wonder if a mistake could have happened, but I really wouldn’t want to know. Now we want a third and we are planning to adopt because it having a genetic connection doesn’t matter to us anymore. We hope to adopt two. I’ve been hearing you talk about special needs or older kids and we are int he process of listening to all your old shows on the topic. We are leaning that way now. Some of those shows are real gold mines of information. I’m loving them all. My husband doesn’t want me to listen without him so that we’ll stay even on the information front, but it’s pretty hard. I cheat every once in awhile.