An economic model of amniocentesis choice

Abstract

Medical practitioners typically utilize the following protocol when advising pregnant women about testing for the possibility of genetic disorders with their fetus: Pregnant women over the age of 35 should be tested for Down syndrome and other genetic disorders, while for younger women, such tests are discouraged (or not discussed) as the test can cause a pregnancy to miscarry. The logic appears compelling. The rate at which amniocentesis causes a pregnancy to miscarry is constant while the rate of genetic disorder rises substantially over a woman's reproductive years. Hence the potential benefit from testing - being able to terminate a fetus that is known to have a genetic disorder - rises with maternal age. This article argues that this logic is incomplete. While the benefits to testing do rise with age, the costs rise as well. Undergoing an amniocentesis always entails the risk of inducing a miscarriage of a healthy fetus. However, these costs are lower at early ages, because there is a higher probability of being able to replace a miscarried fetus with a healthy birth at a later age. We develop and calibrate a dynamic model of amniocentesis choice to explore this tradeoff. For parameters that characterize realistic age patterns of chromosomal abnormalities, fertility rates and miscarriages following amniocentesis, our model implies a falling, rather than rising, rate of amniocentesis as women approach menopause.