Fertility specialists are calling for minimum qualifications for doctors offering assisted baby-making procedures, saying some people are being treated by doctors who don’t have the proper training to perform the procedures.
In a new position statement, the Canadian Fertility & Andrology Society (CFAS) says any physician offering assisted reproductive care should have the fellowship training and skills needed to care for patients safely and to recognize the “potential pitfalls and complications” that may occur.
“These complications may include severe ovarian hyperstimulation syndrome, high order multiple pregnancy, injury to internal organs, massive hemorrhage and even death,” it says.
Assisted procreation is highly lucrative. What’s more, with more women postponing motherhood, demand for infertility treatments is on the rise.
“This is about physicians training physicians to provide the highest quality of care that we have available,” said Dr. Roger Pierson, professor and director of research in the department of obstetrics, gynecology and reproductive sciences at the University of Saskatchewan, Saskatoon.
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One of the biggest concerns involves the use of injectable fertility drugs, known as gonadotropins.
The drugs stimulate a woman’s ovaries to produce multiple eggs. However, in some cases, the woman “over responds,” producing so many egg follicles her ovaries grow big, fat and swollen.
Fluid can leak into the chest and abdomen. In rare cases, ovarian hyperstimulation syndrome can lead to blood clots, kidney failure or death.
Gonadotropins are frequently used with intrauterine insemination (IUI), where sperm is injected directly into a woman’s uterus; experts say the procedure is being widely practised outside fertility clinics. Last year, Ontario alone paid for 22,806 insemination cycles performed on 8,725 women.
‘If you can’t do it safely, you don’t do it’
“It’s in a load of different places,” said Dr. Carl Laskin, a Toronto fertility specialist and past CFAS president.
“[Gonadotropin IUI] is easy to do. The problem is it’s also easy to do unsafely and easy to do wrong.”
The risk of a multiple birth — twins or more — can be as high as 30%.
Blood tests and ultrasounds are required to measure hormone levels and determine how many eggs are maturing. If the woman produces too many eggs, the cycle should be cancelled.
“IVF [in vitro fertilization] clinics have the option to convert those patients to IVF,” said Dr. Jason Min, chairman of the clinical practice guideline committee of the Canadian Fertility & Andrology Society.
With IVF, the eggs are removed and fertilized in a lab dish, and the resulting embryo transferred back into the uterus.
“Outside an IVF clinic, their only recourse would be to cancel the cycle,” said Dr. Min of Calgary’s Regional Fertility Program.
But, “it may be very difficult for you to say to a patient who has just spent X number of dollars on so much medication that, ‘I have no choice but to cancel your cycle.’ ”
Egg retrievals also carry risks. “The big one is sticking your needle into an artery,” said Dr. Pierson.
“You have to have the proper sedation. You have to have the ability to recognize an ovary on ultrasound and interpret ultrasound images. You have to have the ability to use the ultrasound probe and needle.
“These are all technical skills that you don’t learn by reading a book.”
Added Dr. Laskin, “The overriding principle is always, you want to get the woman pregnant, you want her to keep the pregnancy and you want all of this done safely. And if you can’t do it safely, you don’t do it.”