ATLANTA - Fertility clinics are overusing a laboratory technique and costing infertile couples and some insurers hundreds of extra dollars, a new study suggests.
At issue is a procedure that injects a single sperm into an egg. The method is considered the best option for couples in which the man has defective sperm or extremely low sperm counts.
But many clinics are using it for other infertile couples, even though it often doesn’t work as well as the standard lab dish method, according to a study in Thursday’s New England Journal of Medicine. ...
“This paper is particularly troubling because we’ve got a major shift in practice that isn’t evidence driven. The paper suggests it may be driven by money,” said Arthur Caplan, director of the University of Pennsylvania’s Center for Bioethics...
The study’s lead author, Dr. Tarun Jain of the University of Illinois at Chicago, said more research is needed and he couldn’t be certain money explains the findings. But the study does indicate routine use of the technique does not benefit many couples, he added. ...
The research team reviewed a decade of results that hundreds of fertility clinics reported to the federal government. In 2004, about 58 percent of treatment attempts included sperm injection — up from 11 percent in 1995.
But the proportion of couples who have trouble conceiving because of the man’s sperm has stayed constant, at around 34 percent. This suggests that the sperm-injection technique is being urged on many couples who do not need it and might be better off with traditional lab dish, or in vitro, fertilization, Caplan said. ...
Sperm injection does not increase overall success rates for healthy births. The researchers found that among infertility treatment attempts with successful egg retrievals in 2004, about 31 percent of those involving sperm injection resulted in a live birth. The percentage was higher — 33 percent — for those that did not use the sperm injection.
Perhaps nature is better than doctors at selecting the right sperm to produce a healthy baby, Jain said. ...
They also noted that sperm-injection rates were higher in three states — Illinois, Massachusetts and Rhode Island — that mandate coverage of the technique than in states without such a requirement. ...
Art Caplan has been all over stories like this for decades, correctly pointing out that assisted reproduction is the (largely unregulated) Wild West of contemporary medical practice.
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