The biggest worry in every IVF patient’s mind is the possibility of a mix up in their eggs and / or sperms and /or embryos with someone else’s, meaning that the baby that they are carrying is not their own. When a woman naturally conceives, the fertilization occurs inside her body and there is a guarantee about the genetic materials that has made the baby. In IVF, the fertilization occurs outside the body and the embryo is implanted surgically into the womb. Though the possibility of a mix us is very rare, we have all heard of horror stories of when this has happened. This is possibly the worst nightmare for the intended parents as well as for their doctors. If a mix up does happen, then it is likely due to human / procedural error. Having said that we are faced with the question – Should all IVF babies have a paternity or maternity test? Before we answer this question, it is important to understand how IVF clinics work towards avoiding such mishaps. All eggs, sperm and embryos look the same. It is the container that carries them that needs to look different. IVF labs will label all paperwork, dishes, test tubes, pipettes i.e. everything that will be used in one patient’s case with identifiers that are unique to you. Both the partner’s names, date of birth, unique identifier number are used as identifiers. Most labs will plan procedures with an adequate gap between receiving samples and making sure the working surface is cleared of all used materials before new materials and samples are dealt with.
Patients with similar sounding names are usually kept first and last on the list for the day to avoid mix ups. Colour coding over and above the preceding precautions add a further layer of security against mix ups. This system works particularly well even in the embryo freezing and storage program. A unique combination of numbers and colors is assigned to each couple. All of the above is further documented in the patient’s internal file. Over and above this at Cocoon Fertility we have a stringent ‘Witness Protocol’ for every procedure. This includes 3 members of the staff confirming the identity of the patient, checking the identifiers for each item in use. This is done every time the gametes or embryos are handled, almost making the system foolproof. Abroad radio frequency tagging and bar code tagging are also available. We are in the process of installing one such system at Cocoon Fertility. So, coming back to our question, mix-ups are extremely rare but not impossible and the worry if the baby is indeed our own is understandable. If there is reason to believe that there may have been a mix up, the patient will be within their rights to get a DNA test done. DNA testing involves taking swabs from the mouth of the baby and the parents and sending these to a specialised genetics testing lab. Such a decision is especially difficult because it is about a baby that you have carried, felt it kicking you in the womb and gave birth to. If you decide to get testing done then counselling is a must and it might be worth speaking to someone to help you decide and later deal with the results. We often see families where a baby looks different when small and grows up to be a spitting image of the parent. The emotional, psychological, social implications of testing are immense. Also, routine testing may set a culture of distrust in the doctor – patient relationship. Counselling is vitally important before deciding either way – to test or not to test. So, to sum it up, DNA testing should be an individualized decision.
The author is a Consultant IVF Specialist and Reproductive Surgeon, Cocoon Fertility, India
