Fertility, In Vitro Treatments Becoming More Common and Costly to Healthcare

ART procedures are most common in California, which claims one in seven procedures performed in the U.S., followed by New York, Illinois, New Jersey, and Massachusetts.

A case in point is the well-publicized case of Nadya Suleman, or "Octo-mom," who was on welfare and Medi-Cal, California's version of Medicaid, when she underwent fertility treatments and subsequently gave birth to octuplets.

The cost of caring for her and her babies was estimated at $1 million.

Past president of one professional society of reproductive medicine, David Adamson, MD, of Palo Alto, CA says the "Octo-mom" incident was an unusual one. "Nobody in our field is arguing for multiple pregnancies as an ideal outcome," he says, adding that endocrinologists have reduced by a factor of four the number of triplet births between 1996 and 2006.

Not all patients are ideal, he adds, explaining that legal issues make the situation more complicated. "I'm not going to tell you there's not tens of thousands of cycles (procedures). But quite frequently patients demand more embryos be transferred. Legally, it's not possible for a doctor to refuse that demand without being sued. The doctor does not have the legal right to tell the patient what to do with her embryos."

CDC officials who authored the report advise stricter counseling and warning for women or couples who want to risk the procedures.

"Assisted reproduction technology-related multiple births represent a sizable proportion of all multiple births nationwide and in selected states," the CDC report said. "To minimize the adverse maternal and child health effects associated with multiple pregnancies, ongoing efforts to limit the number of embryos transferred in each ART procedure should be continued and strengthened."

The authors added that adverse maternal and infant outcomes should be explained thoroughly when counseling patients considering ART.