As far as experts know, in the past ten years, there have been no more than three cases of embryo transfer errors in China. However, around the world, mismatches in IVF have been repeatedly exposed, which has also led to a series of medical disputes.
Written by Wang Hang
8 years after the birth of IVF, Zhang Fan (pseudonym), who was over fifty, was surprised to find that his son was not related to himself and his ex-wife!
In 2011, Zhang Fan and his wife gave birth to their son through embryo transfer in the First Affiliated Hospital of Anhui Medical University (hereinafter referred to as "Anhui Medical Affiliated Hospital"), and now the results of paternity testing show that the child is not their real offspring. Zhang Fan is still campaigning for this matter. In November 2022, the court found that the hospital had medical fault, assumed full responsibility and compensated more than 640,000 yuan. But Zhang Fan still couldn't let go, he wanted to know, did he and his ex-wife have embryos that combine sperm and eggs? If so, where did the embryos go?
On February 20, the "medical community" called the medical office and outpatient center of the Ann Medical Affiliated Hospital, but the calls were not answered. On the evening of the same day, the staff of the Anhui Provincial Health Commission told "Cover News" that the investigation of the relevant incident was underway, and the results of the investigation would be released in due course.
Regarding what happened to Zhang Fan and his wife, Dong Xi, chief physician of the Reproductive Medicine Center of Zhongshan Hospital affiliated to Fudan University, speculated, "It may be that the wrong person was made before the transplant, and there should be another couple who were transferred the wrong embryo, which is a very serious low-level mistake."
The "medical community" combed and found that the mismatch of IVF in the world is not unique, including the confusion of oocytes, sperm or embryos. These medically rare errors have led to various medical lawsuits in various countries.
IVF is not biological, where do the embryos go?
According to "Upstream News", Zhang Fan is 60 years old this year, 11 years ago, he and his ex-wife wanted to have a child after marriage, but because the woman suffered from blocked fallopian tubes, she could not give birth normally, so the two chose to go to the Reproductive Center of An Hospital for IVF.
The treatment history presented to Zhang Fan by the center showed that the two were treated at the fertility center in September 2010 and did not conceive during the fresh embryo transfer in the same cycle in October 2010. In February 2011, she went to the center for treatment, and in March 2011, she was transferred to fresh embryos in the same cycle and became pregnant. In June 2011, she went to the center for another freeze-thaw embryo transfer and obtained a singleton pregnancy.
After becoming pregnant, his ex-wife gave birth to a healthy baby boy in the Anhui Provincial Maternal and Child Health Care Hospital. Zhang Fan told Upstream News that he is a third-generation single transmission and has a son after the age of 50, so the whole family regards him as a meat. However, as his son grew older, he suspected that the child was not his own based on his appearance.
In March 2020, Zhang Fan went for a paternity test, and the results ruled out Zhang Fan as his son's biological father, and the two were not related. The son also conducted a paternity test with his ex-wife, and there was also no blood relationship. Zhang Fan said that if the son is not born to the two people, there are only two possibilities: wrong embryo transfer or wrong holding after delivery.
Subsequently, Zhang Fan and his ex-wife listed the Reproductive Center of Anhui Hospital and the Anhui Provincial Maternal and Child Health Care Hospital as defendants for violating their reproductive rights and the right to know. During the litigation, the court entrusted a judicial appraisal institution to evaluate whether there was a medical fault and "whether there was a causal relationship between the fault and the consequences".
The identification report shows that according to the available materials, the probability of the child being held by mistake during the birth process is extremely low; In embryo cryopreservation, there are problems such as duplicate numbers, imperfect embryo thawing records, failure to reflect the verification process, and there are medical errors, and the causal relationship between the fault and the consequences cannot be clear, but there is a high degree of certainty between each other (possible but not necessarily of a nature).
In November 2022, the court of first instance determined that there were faults in the diagnosis and treatment and nursing processes of the Affiliated Hospital of An Hospital, and based on the analysis of the fault situation, combined with daily life experience, it was highly probable to presume that there was a causal relationship between the medical fault and the actual consequences; The hospital bears 100% compensation for the damage consequences claimed by the two people, and compensates for various losses totaling more than 640,000 yuan.
But Zhang Fan said that compensation does not mean anything to him, he has passed the childbearing period, and what he wants to know more is who is his son's biological parents? Where did the embryos he "collaborated" with his ex-wife go?
On February 17, Director Wei of the Reproductive Center of An Hospital said in an interview with the "Cover News" reporter that he had repeatedly searched for (embryos), but could not find it, "The embryo operation in the operation is signed by two people, so you don't dare to say 100% that it is our fault when you look at the court." Because as you follow the operation, it's right. ”
Director Wei believes that the two do not need to care about whether they are biological or not. "Life is just these decades, and in the end, it is all open-minded. Many families are holding children, and people are very happy. I would be happy if I had such a child raised so big. ”
IVF mismatch, what links may go wrong?
According to public information, the Reproductive Medicine Center of An Hospital was founded in 1998. In October 2000, the first IVF case in Anhui Province was born here. In 2003, it became the first reproductive medicine center officially approved by the Ministry of Health in Anhui Province. In Anhui Province, the center is a large-scale reproductive medicine center with the largest number of IVF cycles, the most complete projects, the highest technical level and the strongest scientific research strength, and has also given birth to the third case in China and the first "frozen egg IVF" in Anhui Province.
IVF is the abbreviation of "in vitro fertilization embryo transfer", which is the technology of taking the eggs and sperm of infertile couples out of the body, completing fertilization and developing into embryos in vitro, and then transferring the embryos into the uterine cavity to achieve pregnancy, which is the core technology of assisted reproduction.
According to a national reproductive health epidemiological survey, between 2007 and 2020, about 300,000 IVF babies were born annually in mainland China. According to this, Dong Xi, chief physician of the Reproductive Medicine Center of Shanghai Zhongshan Hospital, told the "medical community" that the work of the reproductive center must not allow mistakes, "even if the error rate is a few ten-millions, because it is related to people's lives." ”
Dong Xi introduced the general process of IVF, which is divided into five steps: sperm retrieval, egg retrieval, insemination, embryo freezing and resuscitation, and embryo transfer. Sperm and eggs are retrieved from the parents, artificially inseminated in a laboratory to form embryos, which are cultured in an incubator for several days until the best quality embryos are selected, which need to be transferred or frozen.
In the case of frozen embryos, they need to be replaced, placed from the dish to cryovials, and then numbered and placed in a liquid nitrogen flask. When embryos need to be transferred, the embryos in the liquid nitrogen flask are removed to thaw and transferred to a culture dish to wait for transfer into the mother.
"In the laboratory, embryos are constantly being changed, and the transfer is operated by clinicians, the cycle is long and there are many links, and errors in any place will lead to serious consequences," Dong Xi said, adding that the process and supervision of the reproductive center are very strict, and identity confirmation is the top priority.
For example, in vitro fertilization can not add the wrong sperm, must ensure that the source of sperm eggs is a couple; In the process of eggs and embryos from the retrieval tube to the culture plate to the cryogen, the transfer tube, the operator cannot write the parents' names wrong; Before transplantation, it cannot be transplanted into other people's uteruses, and such links involving identity require multiple people and multiple checks.
"Our department collects and archives couples' fingerprints, palm prints, avatars and other information through the identification system. In the later process, whether it is egg retrieval, sperm retrieval or embryo transfer, the ID cards and fingerprints of both parties need to match. She introduced that the fiber operation table used in some laboratories also has the function of identifying the label of the culture disk, which is an electronic verification system, which is also aimed at eliminating errors.
Since 1998, Dong Xi has been involved in the work of IVF and is one of the earliest medical personnel in mainland China to master the technology. She recalled that when informatization was not developed, "singing right" was an important way to check both parents of IVF, "In the past, it was all by hands, eyes or mouth, such as the staff calling a number, and the husband and wife needed to shout their names loudly, answer correctly before proceeding to the next step." ”
In the above-mentioned IVF non-biological event, Dong Xi, based on more than 20 years of experience in reproductive centers, believes that the greatest possibility is that "the embryo has moved to the wrong person".
"For example, there were many transplants that day, his ex-wife was going to have a transplant, the window and the laboratory were also ready, because the toilet needed to go before the transplant, so the patient left, and another patient rushed over at this time, was mistaken for the party, and the staff also missed the verification process", Dong Xi said, whether the laboratory staff is sufficient, fatigue and staff busyness are also important reasons for errors.
IVF mismatch events are not an isolated case, how to avoid them?
There are very few published cases of errors in IVF embryo transfer in the mainland. As far as Dong Xi knows, in the past decade, there have been no more than three cases of this error in the domestic assisted reproduction industry, she said, "Of course, it is not ruled out that some have been solved privately or have not been discovered." ”
According to the combing of the "medical community", from the world, there have been many public reports of cases of IVF embryo confusion. ABC News 2021 that a couple in the United States had IVF at a fertility clinic in California, and after the birth of the child, the couple found that its skin was darker and did not look like it was born to them, and in subsequent DNA tests confirmed that the embryo was confused with another family.
After the incident, one of the couples took the California Reproductive Health Center and another third-party embryology to court for "medical malpractice, breach of contract, negligence and fraud." The two babies were subsequently swapped back.
USA Today reported in 2019 that a couple from Glendale, California, sued the CHA Fertility Center in Los Angeles, claiming their embryos were mistakenly implanted into a New York woman who gave birth to their son, as well as another couple's son. The New York couple, who are Korean-American, gave birth to two boys who are not Asian, and neither of the DNA matches the couple's.
In this IVF confusion incident, although two families filed lawsuits, three families were affected. The New York couple said they paid $120,000 for IVF and other fertility-related expenses, while citing "misconduct" at CHA Fertility Center. Lawyers representing the case called it "one of the worst fertility center tragedies in U.S. history."
Others have terminated their pregnancies early after discovering that the embryos were confused. In 2021, after discovering that the embryos transferred into her body were not genetically related to her, a woman in Massachusetts terminated her pregnancy conceived through in vitro fertilization before the birth of her child, fearing a custody battle.
In 2022, Israel also reported the first case of "embryo confusion" detected before IVF was born, raising doubts among local residents about assisted reproductive technology. The Azuta Medical Center in Rishon Lezion, Israel, notified the Israeli Ministry of Health on September 14, 2022, that a woman who underwent an embryo transfer after IVF and genetic testing in her third trimester found that the fetus was not related to her, Bionews reported. In a subsequent statement, the center said the true mother of the embryo had been found.
How to avoid errors in embryo transfer during IVF? Dong Xi said that this involves strict control in every process, such as double checking before and after each movement of eggs, sperm, and embryos, in addition to the number and QR code, the laboratory will also choose a color before the operation, and all subsequent checklists will use this color to repeatedly verify the parties.
"Before embryo transfer, doctors, nurses and staff should repeatedly check the parents' names, remove the embryos from the incubator, put them under a microscope, and carefully determine the information on the dish," she said, suggesting that assisted reproductive institutions should strictly implement processes such as identification systems, two-person verification systems and computer checks.
Even if embryo mismatch events are not unique, the probability of mismatch is still extremely low compared with the number of about 300,000 IVF births in mainland China every year. Dong Xi said, "Other couples do not need to doubt the reliability and accuracy of IVF. ”
Mentor experts
Dong Xi, Chief Physician of the Reproductive Medicine Center of Zhongshan Hospital Affiliated to Fudan University
Resources:
1. Upstream news: The children are ten years old to find out that the hospital that did the test tube misplaced the embryo! The court decided
https://mp.weixin.qq.com/s/mY3tmO987nlwVJv9aw4iqQ
2. Cover news: IVF was found to be not biological 8 years after birth, and the hospital responded: There is no need to be open-minded
https://mp.weixin.qq.com/s/MAs2l8eoRPrJWiqGDOSF1w
3. People's Network: About 300,000 IVF babies are born in mainland China every year: get out of the misunderstanding of reproductive assistance
https://baijiahao.baidu.com/s?id=1705150705480722132&wfr=spider&for=pc
4、IVF mix-up: Babies born to NY couple in alleged clinic mix-up are back with their biological parents
https://www.usatoday.com/story/life/parenting/2019/07/10/ivf-mix-up-second-couple-involved-alleged-baby-mix-up-sues-clinic/1694269001/
5、Woman discovers fetus she’s carrying after IVF is not genetically hers
https://www.timesofisrael.com/woman-discovers-fetus-shes-carrying-after-ivf-not-genetically-hers/
6、Judge awards birth mother custody of twins after Italian IVF mix-up
https://www.progress.org.uk/judge-awards-birth-mother-custody-of-twins-after-italian-ivf-mix-up/
Source: Medical community
Responsible editor: Tian Dongliang
Editor: Zhao Jing
![Remember the "5 to 5 don't" of IVF, but you can take a lot of detours~[fig]](data:image/gif;base64,R0lGODlhAQABAIAAAP///wAAACwAAAAAAQABAAACAkQBADs=)