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.


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.


CONCLUSIONS
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.
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D000328:Adult; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000523:psychology / Q000628:therapy; D007258:Informed Consent; D008318:Malpractice; D008875:Middle Aged; D009774:Obstetrics / Q000331:legislation & jurisprudence / Q000592:standards; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk / Q000523:psychology; D016079:Refusal to Treat; D018570:Risk Assessment; D014427:Twins