A 59-year-old woman gives birth to twins--when should a fertility specialist refuse treatment?

Objective: To review cases of infertility where despite extremely low odds of success and potential risks to the woman if she became pregnant or to the fetus, the couples elected to take a chance to fulfill their dreams of having a baby.

Materials And Methods: Six cases are described: case 1, a 59-year-old woman with hyperstimulation and intramuscular fibroids compressing the uterine cavity who wanted to be a donor egg recipient; case 2, a 59-year-old woman desiring a second transfer of sibling frozen embryos who had previously conceived with donor eggs at age 57; case 3, a 33-year-old woman with a subseptated uterus and cervical abnormality from intrauterine diethilstibesterol exposure plus hemoaphilia trait, and only 25% of her liver remaining from a previous partial liver resection; case 4, a woman with an unicornuate uterus refusing reduction of her twins to a singleton; case 5, a 39-year-old woman willing to try again to have her first live born child with a history of a large macroprolactinoma that was resected but markedly enlarged in her previous pregnancy despite bromocryptine therapy; and, case 6, a woman willing to try a unique experimental therapy with extremely high thyroid stimulating immunoglobulins to inhibit severe intrauterine growth retardation and potential premature synostosis for her condition of Hashimoto's disease.

Results: Cases 2-5 all had successful outcomes. Case 1 was never given the chance for donor oocytes since she was rejected by a majority vote of our physicians because of the fear of a malpractice suit.

Discussion: If a couple understands the potential risks and the low odds of success, they should be given the opportunity to fulfill their dreams of having a baby. However, treating physicians are under no obligation to take malpractice risks.