Fertility clinics are under fire after a Pasadena clinic allegedly transferred an embryo that had previously tested positive for a deadly cancer gene. Now, some patients may hesitate to seek conception assistance from fertility clinics or worry that their potential benefits are overshadowed by the potential risks.

“The biggest risk is decreased trust in fertility clinics and labs, as well as increased stress during fertility treatments,” says Parijat Deshpande, a somatic trauma professional, consultant, and author who works with people experiencing high-risk pregnancies. “Not only are people and couples worried if the cycle will work, but now they have to worry about whether the clinic and lab have been careful enough to manage their embryos appropriately.”

The current lawsuit involves a California couple and HRC Fertility, a Pasadena-based fertility clinic. According to Reuters, the couple sought treatment from HRC Fertility while conceiving their son, who is now two-years old and carries a deadly cancer gene. The father in the couple carries this gene, causing him to develop hereditary diffuse gastric cancer, which was treated with a total stomach removal procedure in 2018. 

The couple sought treatment from HRC Fertility to reduce the chances of their child carrying this gene, they say. The clinic previously claimed that they had provided the couple with an embryo without this gene but had not done this, the couple says.

When acting appropriately, fertility clinics can have high success rates. According to the Centers for Disease Control and Prevention’s (CDC) 2020 Fertility Clinic Success Rates Report, Assisted Reproductive Technology (ART) that took place in 2020 resulted in a total of 79,942 live-born infants, and about 23 percent of all ART cycles resulted in a birth (of one or more living babies).

Centers for Disease Control and Prevention. ART Success Rates.

Deshpande works with people experiencing high-risk pregnancies and says about two-thirds of the people she works with use fertility clinics to help them try to conceive. She is also a former patient of fertility clinics, having used them to help her conceive. 

“They hold a special place in my heart, as I would not have children without them,” Deshpande says of the clinics. “Access to fertility clinics allow for choices and opportunities to grow a family for people and couples who cannot conceive naturally.”

However, fertility clinics do not guarantee conception. And alleged malpractices aside, people who undergo fertility treatments can already be at increased risk for complications. This is often due to underlying health complications that may have led to their decision to pursue fertility treatment in the first place or stress during their treatment that causes physiological changes in the patient, says Deshpande. 

Deshpande follows a trauma-sensitive approach in patient conversations about fertility clinics. She recommends other doctors do the same.

“I don't just advise on whether they should do it or not, but instead, I guide them through a conversation to help them identify what's best for them,” says Deshpande.

If guiding a patient through their decision to pursue or not pursue treatment from a fertility clinic, Deshpande recommends approaching them in a non-judgemental tone and consider the following questions:

1. What is the patient’s family-building goal? How many children do they want, and what sacrifices are they willing or not willing to make for this?

2. What are the patient’s personal, religious, moral, spiritual, physical, or emotional values? How might these guide what types of fertility treatments they are open to trying and ones they know they would not want to try?  

3. Why are they considering fertility treatments? Are they aware of their current health situation, and if not, how can you help inform them?

Deshpande also suggests reminding patients that consultations do not imply commitment, and if they want to check out a fertility clinic, they should feel capable of doing so even if they ultimately do not go through with the process.

“I remind them that they, the patients, get to choose the timeline and how fast or slow they want to proceed,” says Deshpande. “If, after the consultation, they want to take some time to think about it, that's ok. If they want to jump into bloodwork, that's ok. If they're ready to start on a cycle, that's ok. There's no right or wrong, and they are in control of these choices.”

If your patient starts a cycle of ART, encourage them to be vocal about their wants and needs during the process—and ask questions. You may also want to advise them to stay on top of their care, double-check that the nurses have correctly labeled their blood draws, or connect directly with the embryology lab so that they know where and how their embryos are being stored. Depending on your relationship with your patient, you may be able to help them out with some of this process—or suggest they call in a trusted friend or partner to help sort things out. 

But, regardless of whether a patient asks all the questions or checks all the tubes, it is not their responsibility or fault if a fertility clinic treatment goes wrong, says Deshpande. Part of care can be reminding them that they are not at fault if things don’t go as planned and that they are entitled to as many answers about their care that you or the clinic can give them.