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September's RE of the Month Tarun Jain
Tarun Jain, M.D., F.A.C.O.G.
Advanced Reproductive Health Centers / Chicago IVF
Warrenville, IL 60555
“I’m a huge patient advocate, from every angle. There are so many people out there who need treatment and so few people getting it.”
Those are his own words and they’re exactly why we honoring Dr. Tarun Jain as our RE of the Month this month. Dr. Jain “wows” us with his research on contemporary “social” fertility issues (Do women really want to select the sex of their baby? Are they willing to donate their embryos for stem cell research? Are women of all ethnicities and socioeconomic levels getting infertility treatment?) Overall, he’s an outstanding patient advocate.
SART and Single Embryo Transfer
Dr. Jain treats patients at the Advanced Reproductive Health Centers / Chicago IVF but he’s also actively involved in RESOLVE, as a member of the Advocacy Committee, and the Society for Assisted Reproductive Technology (SART).
At SART, he’s a member of a five-person ART Validation Committee charged with monitoring whether clinics are reporting data correctly. As such, he “selects 50 random charts a year” and visits those clinics, examining their data documentation and their reporting process. The good news? “For the most part, their reports are valid. No one’s fudging the data.” But, he admits, “they can do better.”
The ART Validation Committee is “concerned with how many embryos are being transferred” in order to achieve higher statistics. But while “Octomom shook things up,” Jain claims, “clinics for the most part, have done a good job following the [ASRM] Guidelines.” Proof that the Guidelines work? Currently only three percent of all IVF cycles result in triplets, a percentage that has dropped dramatically since guidelines were updated in 2004.
Jain doesn’t believe there’s need for further regulation. “In any field, you can never achieve perfection. Yes, a few people are practicing outside the mainstream, but even if you have laws, a few people will still break them.”
Twins and Patient Education
Though, as a whole, "Fertility practitioners are doing well following the Guidelines,” Jain says doctors face “patient-driven pressure” for twins. While he and many doctors would like more pregnancies to result in single live births, the out-of-pocket cost of fertility treatment and the fact that mothers “feel they have one chance, one shot at a baby” boosts the number of embryos transferred during IVF. He notes that when insurance covers IVF treatment, patients frequently opt to transfer fewer embryos.
Jain’s currently involved in a study dealing with effects of patient educational intervention on the outcome of IVF. Patients who say they want twins, he theorizes, frequently don’t fully understand the implications of the greater risks involved to both fetus and mother. While it’s true that the initial risk of a single pregnancy is relatively low, according to Jain, patients don’t really realize that with twins, “the risks involved are two to five times greater.”
Jain’s theory is that better education in the doctor’s office or clinic can result in more single embryo transfers, which means a “more successful treatment outcome.” Of course, for most doctors time is elusive. “It’s a challenge, but we need to spend more time educating patients,” he concludes.
With the availability of PGD (Preimplantation Genetic Diagnosis) and possibility of sperm sorting looming on the horizon, Jain has studied whether sex selection would be widespread. His conclusion? “Most women would be unlikely to seek it out.”
It’s a “controversial issue that poses a legitimate concern” and "we should keep following it closely,” he says, but his research has shown that it “would not be used routinely.”
“In the general population, 10 percent said they’d want to select the sex of their child. For women undergoing treatment this number was somewhat higher,” a difference Jain attributes to the cost of treatment and the fact that these women may feel “like they’ve only got one shot.” An interesting aside of the studies is that patients who did not have children had no greater desire for boys over girls. (Fertility and Sterility, February 2006 (Vol. 85, Issue 2) and Fertility and Sterility, March 2005 (Vol. 83, Issue 3)).
Jain’s concerned about the growing allure of fertility tourism. “It's becoming more popular because of the cost issue,” he explains. “Clearly, the best outcomes can be had in the U.S., but it’s just very expensive here.” Jain advises his patients against going outside the country for treatment.
“When my patients ask, I tell them they may not come out ahead financially. Treatment in India or China may be half the price, but you may need to go through the process two or three times before you’re successful. There’s just more risk.”
Plus, Jain says, “more embryos are transferred” during foreign IVF and this just ups the riskiness of the procedures. Fertility tourism would “go away if treatment was given insurance coverage here in the U.S.,” he states.
Ethnicity, Socioeconomics and IVF
Jain laments that there’s not “more funding support from NIH [the National Institutes of Health]” to do needed studies. He’s already studied the demographics of those getting treatment, showing "the vast majority of patients seeking IVF treatment were Caucasian, highly educated and wealthy compared to the general population.” Of the 561 respondents in his study, “nearly half of the patients had advanced degrees and more than 60% had an annual household income over $100,000. None of patients had less than a high school diploma.” (Fertility and Sterility, April 2006 (Vol. 85, Issue 4.)
Jain would like to do even more studies along these lines with the goal of making treatment accessible to all who need it. In particular, he’s interested in the “ethnic and cultural barriers to IVF, particularly with African-American and Hispanic women.”
He’s puzzled and troubled by studies that show that African-American women have a lower success rate with IVF than Caucasian women. “Even when African-American women use donor eggs their success rate is lower,” he says. “[African-American and Hispanic women] are not getting the care they need and it’s taking them longer to be successful yet we don’t know why.”
He’d like to find out.
We hope he does.