Clinical Guidelines and Standards · Guidelines by Issuing Body
Provision of fertility services for women at increased risk of complications during fertility treatment or pregnancy: an Ethics Committee opinion
Ethics Committee of the American Society for Reproductive Medicine
Committee members:Judith Daar, Jean Benward, Lee Rubin Collins, Joseph Davis, Leslie Francis, Elena Gates, Elizabeth Ginsburg, Barbara Koenig, Andrew La Barbera, Laurence McCullough, Richard Reindollar, Mark Sauer, Sigal Klipstein, Rebecca Sokol, Sean Tipton, Lynn Westphal, …
Ethics Committee of the American Society for Reproductive Medicine (2016). Provision of fertility services for women at increased risk of complications during fertility treatment or pregnancy: an Ethics Committee opinion. Fertility and sterility. https://doi.org/10.1016/j.fertnstert.2016.08.015
Ethics Committee of the American Society for Reproductive Medicine. Provision of fertility services for women at increased risk of complications during fertility treatment or pregnancy: an Ethics Committee opinion. Fertility and sterility. 2016. doi:10.1016/j.fertnstert.2016.08.015
Ethics Committee of the American Society for Reproductive Medicine. "Provision of fertility services for women at increased risk of complications during fertility treatment or pregnancy: an Ethics Committee opinion." Fertility and sterility, 2016.
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RRM Academy Synopsis
Fertility clinicians may treat or decline high-risk women, ASRM says
A 2016 ASRM Ethics Committee opinion holds that doctors may ethically treat a woman at higher medical risk once she is carefully assessed and fully informed. The committee also holds that doctors may decline. The assessment of danger must be unbiased and evidence-based. The opinion covers women whose health conditions raise risk during fertility treatment or pregnancy.
Key Findings
The committee holds that clinicians may treat a woman at elevated risk after a careful assessment, with specialist input as appropriate, once she understands the risks, benefits, and alternatives.
The committee holds that clinicians may decline, and calls that "ethically acceptable" when the refusal rests on unbiased, evidence-based judgments of high risk to the woman or her children.
The committee says counseling should include alternatives such as oocyte and embryo donation, a gestational surrogate, adoption, or choosing no fertility care.
The committee says a decision to decline needs careful review of the medical facts and must be made "without bias." A second opinion "should be considered."
The opinion cites Turner syndrome with a 2% risk of mortality in pregnancy, and one report of a maternal mortality rate as high as 33% with primary pulmonary hypertension.
Interpretation
The document is a committee opinion. The opinion states ethical positions and holds no new patient data. The risk figures are examples the opinion draws from outside reports on specific conditions. The committee says the document reflects its members' views and does not dictate one course of treatment for every case. The opinion covers what clinicians may do and how they should decide. The opinion says the best decisions come from careful deliberation involving the patient, her physician, and, when warranted, outside experts.
RRM Context
Restorative reproductive medicine puts a full look at a person's health before treatment. The opinion shares that starting point. It calls for a risk check first and for lowering risks a woman can change, such as weight, smoking, and blood sugar. The committee also advises encouraging a high-risk woman to involve her partner, if she has one, while protecting her autonomy.
Our editorial summary of this paper, not the article's abstract.
Abstract
This opinion addresses the ethics of providing fertility treatment to women at elevated risk from fertility treatment or pregnancy. Providers ethically may treat women at elevated risk provided that they are carefully assessed; that specialists in their medical condition are consulted as appropriate; and that patients are fully informed about risks, benefits, and alternatives, including oocyte and embryo donation, use of a gestational surrogate, not undergoing fertility care, and adoption. Providers also may conclude that the risks are too high for them to treat particular patients ethically; such determinations must be made in a medically objective and unbiased manner and patients must be fully informed of the decision. Counseling of women who wish to initiate fertility treatment with underlying medical conditions that confer increased risk during treatment or pregnancy should incorporate the most current knowledge available, being cognizant of the woman's personal determinants in relation to her reproductive desires. In such a way, both physician and patient will optimize decision making in an ethically sound, patient-supportive context.
Ethics Committee of the American Society for Reproductive Medicine, 2018
Clinical Guidelines and Standards › Guidelines by Issuing Body › United States Professional Societies · Ethics and Policy › Reproductive Ethics › Access to Treatment
Judith Daar, Jean Benward, Lee Rubin Collins, Joseph Davis, Leslie Francis, Elena Gates, Elizabeth Ginsburg, Barbara Koenig, Andrew La Barbera, Laurence McCullough, Richard Reindollar, Mark Sauer, Sigal Klipstein, Rebecca Sokol, Sean Tipton, Lynn Westphal, 0000-0003-0284-2845
J Daar, J Benward, L Collins, Joe Davis, Joey Davis, J Davis, L Francis, E Gates, Liz Ginsburg, Beth Ginsburg, Betsy Ginsburg, E Ginsburg, Barb Koenig, B Koenig, Andy Barbera, Drew Barbera, A Barbera, Larry McCullough, L McCullough, Rick Reindollar, Dick Reindollar, Rich Reindollar, R Reindollar, M Sauer, S Klipstein, Becky Sokol, R Sokol, S Tipton, L Westphal
PMID 27530060 27530060 DOI 10.1016/j.fertnstert.2016.08.015 10.1016/j.fertnstert.2016.08.015 Ethics Committee of the American Society for Reproductive Medicine et al. 2016, Ethics Committee of the American Society for Reproductive Medicine 2016
