GESTIÓN EN SALUD PÚBLICA: Researchers criticise IVF ‘add-ons’

domingo, 10 de noviembre de 2019

Researchers criticise IVF ‘add-ons’

Researchers criticise IVF ‘add-ons’

Bioedge

Researchers criticise IVF ‘add-ons’

by Xavier Symons | 10 Nov 2019 |

IVF experts have criticised fertility clinics for selling expensive additional therapies to women receiving IVF treatment, arguing that many fertility add-ons have little or no scientific support.

Two new papers in the journal Fertility and Sterility argue that “clinical adjuncts” used during IVF treatment are being introduced into routine clinical practice in a hurried manner without any clear evidence of benefit in most cases. The authors — a team of international fertility specialists based in the UK, Australia, New Zealand, India, and the Netherlands — argue that strong evidence should be required before add-ons are introduced to the clinic, and that the risks and uncertainties of add-ons must be communicated to prospective patients.

One common procedure offered to women receiving IVF treatment is preimplantation genetic testing (PGT-A). Ostensibly, this test screens embryos for chromosome abnormalities with the goal of increasing the likelihood of achieving a successful pregnancy. Yet in practice, some evidence suggests that PGT-A might actually reduce the live birth rate.

Another common procedure is endometrial scratching, whereby a doctor takes a biopsy of a woman’s endometrium (the innermost lining of the uterus) so as to increase the chances of embryo implantation. Yet a recent international multicentre, randomized, controlled trial published in the New England Journal of Medicine found that endometrial scratching did not result in a higher rate of live birth than no intervention among women undergoing IVF.

“If you are going to prescribe [add-ons] you need to give the patient full informed consent”, Professor Luk Rombauts, president of the Fertility Society of Australia, told reporters last week. “Patients should be told what evidence the proposed treatment is based on, what the risks could be for both mother and baby, what the cost is and also what other alternative treatments there are”, Professor Rombauts said. Fertility add-ons will often amount to several thousand dollars of additional charges for patients.

The Fertility Society of Australia last week released guidelines in a technical bulletin that directed doctors to provide patients with information about the risks and evidence for and against any IVF add-ons that they prescribe.

Xavier Symons is deputy editor of BioEdge

It sounds like the premise for a Stephen King novel, but it’s real life. Benjamin Schreiber, a 66-year-old man, is serving a life sentence for murder in an Iowa prison. Back in 1996, he bludgeoned a man to death with an axe handle. In 2015 he suddenly became seriously ill, so ill that he lapsed into a coma and “died”.

But he recovered. Disappointed that he was still alive, he appealed to have his life sentence voided as it had already “expired”.

It’s an intriguing argument. Can you live two lives? Are you the same person after being resuscitated? Or are you literally a dead man walking?

Unfortunately for Schreiber, the court took a dim view of his request.

“We do not find his argument persuasive,” wrote a judge this week. She concluded: “Schreiber is either still alive, in which case he must remain in prison, or he is actually dead, in which case this appeal is moot.”

This ruling will allow the citizens of Iowa to sleep easier at night, but philosophically isn’t a bit naive in the way it addresses the problem of identity? Isn’t it possible that Mr (1996) Schreiber is dead and that Mr (2019) Schreiber is a different person? If S(2019) identifies as a dead person, shouldn’t we accept his carefully considered opinion?