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Even pregnancy and birth rates, moreover, don’t tell the full story of success, because recent research indicates that children conceived via IVF may carry a higher risk of birth defects. One Australian study, for example, found that IVF babies were twice as likely as naturally conceived infants to have multiple major birth defects. [59] Others report higher rates of rare urological defects and increased risk of early childhood cancers. [60] IVF also leads to a much higher rate of multiple births— 37 percent, according to one recent study—which itself leads to more complicated pregnancies and a greater chance of premature or underweight births. [61]

How much of this information should Dr. Welby relate to Sally? Under the law, virtually none is required: his only obligation is to report the pregnancy and birth rates of his clinic to the Centers for Disease Control (CDC), which then aggregates the data and publishes it in an annual report. If a particular clinic chooses not to reveal its data, the CDC has virtually no powers of compulsion; in 2000, for example, twenty-five clinics made no report to the CDC, including Genetics & IVF Institute, one of the nation’s largest centers. [62] Under ASRM guidelines, meanwhile, Welby need only get informed consent from his patients, use medically acceptable techniques, and follow informal guidelines with regard to the number of embryos transferred at any time. [63] Even at a personal level, the landscape is murky, because Sally, after all, doesn’t care about aggregate statistics. She just wants the chance to have a baby. [64]

As Dr. Denny Sakkas of Yale IVF explains, “Infertility is a hit or miss business If you end up with a baby, nothing else matters. Unfortunately, a negative result is more likely than a positive one.... It’s a strange area to be in. Sixty to seventy percent of patients’ treatment will fail. And you know that.” [65]

Dr. Welby and his real-life counterparts therefore face what Dr. Richard Berkowitz, a reproductive specialist at New York’s Mount Sinai hospital, describes as a “real Catch-22.” “The doctors want to get the patients pregnant,” he recounts. “The patients want to be pregnant. So the patients shop for the doctors who have the best pregnancy rates.” [66] This dynamic pushes fertility clinics, almost inexorably, to put the most positive spin they can on their technologies and data, touting procedures that frequently have a low probability of success and an unknown potential to do harm. As Dr. Mark Sauer, a leading expert at Columbia-Presbyterian Medical Center, puts it, “Our mission is to make a woman pregnant, with almost a whatever-it-takes attitude.” [67] Stories from the popular press drive this attitude even further, glorifying “miracle” babies and the doctors who produced them. [68] Stories from the other side—of couples undergoing round after round of expensive but ultimately futile treatment—are considerably less common. [69]