Mosaic Embryo Transfer Could Help Families Save Thousands—Why Are Doctors Avoiding It?
More than 10% of women ages 15-44 in the US have difficulty getting pregnant or carrying a pregnancy to term, according to The Center for Disease Control and Prevention. With those numbers, it's not surprising that millions of would-be parents have sought the assistance of reproductive specialists and fertility clinics to help them reach their parenthood goals—often draining their savings accounts, refinancing their homes, and going into massive amounts of debt to fund their treatments. And now, many folks trying to conceive are taking a physical and financial gamble on mosaic embryos.
Previously, embryos were thought to fall in one of two categories: normal or abnormal. But some embryos, termed "mosaic," are just that: an interlinked mosaic of both normal and abnormal cells. In the past, mosaic embryos were immediately ruled out of the running for implantation because they do contain abnormal cells. Now, however, research is showing that those cells may correct themselves after implantation; still, this is certainly not a guarantee. As new testing and technology emerges, scientists and doctors are finding that, in some cases, mosaic embryos are viable for transfer and could even result in a healthy baby.
The whole idea of whether and when these embryos should be transferred is a hotly debated topic in the fertility community. Much is still unknown, and research is ongoing and evolving to determine the risks and success rates of transferring mosaic embryos. But there comes a time in many patients' IVF journeys when they are willing to take that risk; they have run out of "desirable" embryos and are faced with an impossible decision: Give up and walk away empty-handed, or hop back into another round of IVF. For those who are otherwise facing the proverbial end of the road, mosaic embryos could be a game-changer. And yet...
The fertility industry is a multibillion-dollar sector that is largely cash pay. With that much money at stake, some patients are wary that doctors may have questionable motives when making recommendations about whether to transfer mosaic embryos—and the inherent risk that comes with them.
Doctors and patients may not always be on the same page with mosaics, and in some cases, may even be monetarily incentivized to do opposite things. Patients who've depleted their finances or who are limited by other factors such as age are eager to use their mosaic embryos because it may be their last chance if they cannot afford another round of IVF. On the other hand, because of the extraordinarily complex and uncertain nature of mosaics, doctors may be motivated to advise patients to take the more well-known path—which would usually necessitate another (very expensive) round of IVF. Additionally, since transferring a mosaic is higher-risk than using a "normal" embryo, doctors may steer clear for fear of a malpractice lawsuit if the mosaic embryo doesn't work out as hoped.
Many of the IVF patients I spoke with reported encountering a physician or clinic that made them suspicious or pressured into undergoing additional costly IVF rounds. Several of them also reported physicians and fertility clinics employing contrived sales tactics or marketing strategies that made them feel uncomfortable when making such sensitive decisions. Vivienne S., 44, described doctors preying on the emotional vulnerability that comes with infertility; she recounted how she was made to feel beaten down and worse about her situation—in what felt like an effort from the doctor to sway her in a certain direction about her embryos.
Rose M., 42, first investigated mosaic embryos after exhausting all other efforts. "Given our back-to-back IVF cycles that failed, we were at the end of our IVF journey at five cycles over the course of five years," she tells Health. "I wanted to exhaust all my choices and not always wonder if my mosaic would have worked. It was our last shot at having another baby and I was extremely hopeful."
Throughout seven years of fertility struggles, Vivienne says she has seen her fair share of doctors; she went on dozens of consultations and spoke in depth with 10 different doctors from the US, Hong Kong, and the UK until she eventually found the right fit. She viewed the consultations as interviews, and quickly became adept at filtering out the ones who really knew the science deeply and took the time to think through her situation medically and offer solutions.
"I interviewed so many doctors who tried to convince me to do things I wasn't comfortable with," she tells Health. "It was obvious some of them simply focus on the procedures as a high-value business, and I felt very much like a number in their formula. Some doctors forget that we are humans going through something exceedingly difficult."
So, how can you find a trustworthy physician who will present you with all your viable options—including the (risky but real) possibility of embedding mosaic embryos?
Do your homework
Vivienne spent copious amounts of time conducting research on each potential doctor before she ultimately committed. She stresses that being educated about the doctor, about mosaics in general, and about the associated procedures is crucial.
"The majority of fertility doctors are great and do care about their patients, but there are definitely a few who are clearly financially motivated," Vivienne says. "Finding one you trust and who is able to look at your medical situation uniquely is critical. Knowledge is power, and the more informed you are, the better. The entire fertility journey is highly emotional, but try to set emotions aside and look at the information from an analytical perspective so you will not be easily swayed."
Plus, it's worth remembering that many pharmaceutical companies and doctors are financially intertwined. "Which," Vivienne adds, "is another reason it is imperative to do your research to ensure the care you receive is on par with your medical and ethical standards."
There is a plethora of resources that provide reliable information and statistics to ensure patients make informed decisions about mosaics—and when choosing a fertility provider in general. Resolve is a great place to start for care options and to search for support groups, and the Society for Assisted Reproductive Technology (SART) is helpful for finding vetted mosaic embryo research as well as birth outcome data.
Be patient and take your time
As with any doctor, finding the right fertility fit—especially if you want to consider using mosaic embryos—may take time. Mosaics are certainly not one-size-fits-all, and just because someone has an MD behind their name doesn't necessarily mean they are the right doctor to help you explore this approach. Finding a fertility clinic that already has experience with mosaics is also key.
For Vivienne, visiting clinics where she witnessed seemingly greedy motives was productive because it helped her to pinpoint what she didn't want. This is why doing your due diligence by interviewing several doctors will pay off in the long run. Vivienne likens the process to dating: "Sometimes, it takes a few tries to find what you're looking for. Don't give up, and don't be afraid to get a second, third, or fourth opinion, or even find an alternative approach." And mosaic embryos can be just that.
Find support and share recommendations
Both Rose and Vivienne developed wide networks of those who were also struggling with fertility, thanks to support groups on Facebook and beyond. They found it immensely helpful, not only emotionally, but logistically; they were able to exchange and share information and advice with others who had been in similar situations. Vivienne states that the majority of patients in the online IVF support group have encountered at least one clinic that made them feel pushed into spending. So, Vivienne made a habit of interviewing others in her network to find out where they had a positive experience—before she would even consider a clinic or doctor.
Rose got a recommendation on a clinic from a contact who had a bad experience with a doctor in the area and changed clinics to one she really liked. She is glad she trusted her friend's advice, because it led her to a doctor who was compassionate and honest, and who allowed her to use her last-chance mosaic embryo. Rose is now the mom to a healthy and beautiful six-month-old baby girl.
"I'm thankful for her and cannot imagine not having her in our life," Rose says. "She completes our family, and I am so grateful that I was persistent in trying."
Be your own advocate
Vivienne exhausted much of her savings and even delayed buying a home for seven years to fund her fertility journey. Because she had so much invested financially and emotionally, she wanted to be smart and make the best decision. "As much as doctors claim to have a mutual goal with patients, some have other motives," she reminds other IVF patients. "And it's important to find a worthy doctor that aligns with your wants and needs. You are the only one who is going to stand up for yourself at the end of the day."
Although it was time-consuming and sometimes onerous, all of Vivienne's research and advocacy, like Rose's, paid off. She ultimately found a reputable and knowledgeable fertility specialist who was able to facilitate the transfer of a mosaic embryo—that resulted in a healthy baby boy, who is now eight months old and the love of her life.
If you, too, are tapped out on IVF—be it emotionally, financially, physically, or all of the above—and are interested in taking a calculated risk and transferring a mosaic embryo, that decision should be up to you, not left to a doctor who wants to pressure you into more rounds of IVF and thousands more dollars. So empower yourself with knowledge, and take the necessary steps to find a physician you trust, who has experience with mosaic embryos. It could pay off in more ways than one.