Will we finally start regulating the IVF industry?

DATE: February 24, 2009

Some of the more disturbing aspects of contemporary western culture all seem to have converged in the recent birth of octuplets to Nadya Suleman, a single mother in California: voluntary single parenthood via sperm donors, manufacturing of babies in Petri dishes, freezing live human embryos indefinitely, a renegade scientific and medical community. It’s hard to get one’s head around the situation and address it directly because nothing about it is normal or natural, from beginning to end.

Let me be quick to preface my thoughts, however, by asserting my gratitude to God for the lives of these eight tiny babies, all unique human individuals whose gift of existence we welcome and cherish. We pray for them and for their mother.

That said, a case like this reminds us that in the brave new world, the bizarre is quickly becoming the new normal -- underscored by the fact that countless observers were arguably more stunned by images of Suleman’s supersized, pre-birth abdomen than by the consideration of the choices she made.

Space and time limitations don’t allow me to touch on all of the aspects of the octomom phenomenon which demand our reflection. I might mention in passing two questions we should be asking.

First of all -- as Kay Hymowitz asked in last Friday’s Wall Street Journal -- ‘Where in the World is Octodad?’ While other countries have banned sperm donor anonymity, the U.S. leaves an easy out, allowing clinics to pay men an average fee of $200 per deposit of ejaculate, to “suggest” that they volunteer to be identified to their eventual offspring, but reassuring them in the end that responsibility ends at conception.
Secondly, why did Suleman, in an interview on the Today Show, describe in vitro fertilization (IVF) as her “only option” for having a “big family”? Traditional marriage did not end up on her short list of options. Call me utterly naïve, but I would like to know her reasons.

Notwithstanding the chaotic plethora of social disarray all combined into the Suleman incident, there is one common thread here that invites vehement and immediate public scrutiny from multiple sectors and across all ideological lines: the billion-dollar artificial reproductive technology (ART) industry.

Suleman was the poster child of Beverly Hills infertility specialist Michael Kamrava. Only 33, Suleman is single and unemployed. She has had six pregnancies resulting from fertility treatment by Kamrava. Four of her pregnancies were of single children, one pregnancy resulted in twins, and the last pregnancy resulted in octuplets. Single women longing to have children are no problem for the ART industry.

Nor is it a problem for the unregulated ART industry to spawn renegade physicians -- like Kamrava -- who take the industry’s normal disregard for human life to new extremes. The octuplet birth is about as close as you can get to a medical miracle. Multiple gestation pregnancies are fraught with danger for both the mother and the children: maternal risks include preeclampsia, miscarriage, high blood pressure, and stroke. Fetal risks include premature birth, low-birth weight, cerebral palsy, still-birth, as well as the long-term health problems associated with premature birth or low-birth weight.

According to Nadya Suleman, her doctor transferred six embryos in the procedure that led to her octuplet pregnancy (and if this is true, two of the embryos each gave rise to a twin). Of course, transferring multiple embryos in the face of unacceptable risks is perfectly legal in the wild west of ART medicine. There is no legal regulation on the ART industry beyond physician certification and certain lab standards. There are no professional sanctions, and the “suggested” guidelines certainly do not prevent physicians from doing the unthinkable.

The process begins when doctors hyper-stimulate a woman’s ovaries to prompt the release of dozens of eggs at a time (a process that is itself fraught with serious, and potentially deadly, health risks). The eggs are mixed with sperm (either from the woman’s partner, or -- in the case of Suleman -- from an anonymous friend) and by the hand of a laboratory technician, a small cohort of living human embryos comes into being. The doctor, in consultation with the mother, determines how many of these to implant, and how many to freeze for potential future implantation.

Some European countries try to minimize the human loss involved in ART by limiting the number of embryos that can be created to two or three, and requiring the transfer of all living embryos, so none are consigned to the absurd fate of being frozen for potential future “use.” In the U.S., however, it is not uncommon for doctors to transfer as many as 3 or 4 embryos in fertility treatment in the hopes that one embryo will survive and grow. When two or more embryos implant and grow, the physicians routinely recommend “fetal reduction”: abortion of one or more of the growing babies to lessen the compound health risks associated with multiple gestation. (According to Suleman, her doctor implanted six embryos for each of her successful pregnancies.)

It’s no surprise that even proponents of IVF are crying foul. “I find it a huge ethical failure that she was even accepted as a patient,” University of Pennsylvania bioethicist Art Caplan told the New York Times, given that Suleman was already a single mom with six children.

The ART industry is fiercely defended on the grounds that it helps desperate, infertile couples bring “wanted” children into the world who otherwise might not exist. This defense wholly embraces the idea that the ends justify the means. In ART, the “means” are the deliberate creation and destruction of some human beings in favor of others. And for this completely unregulated, very powerful, billion-dollar industry -- where “success” is defined as the birth of a child and innovative techniques move quickly to clinical practice without oversight -- no cost, it seems, is too great.

Suleman’s doctor profits from her “success” because his clinic gets to report successful pregnancies that result from treatment. The information about clinic success rates is public, gathered and reported by the Centers for Disease Control (CDC). The higher the success rates, the more attractive the practice. Therefore, in the highly competitive, highly lucrative and completely unregulated field of ART, there is tremendous incentive to implant multiple embryos to increase the chances of a pregnancy.

In the United States, out of the more than 138,000 treatment cycles reported in 2006 (the most recent data available), almost 90% of treatment cycles involved the transfer of more than one embryo; 44% involved the transfer of three or more embryos. Clinics are supposed to report the number of embryos that implant along with the subsequent number live birth babies that result from the treatment. But the CDC doesn’t publish information on number of babies in the established pregnancy, so the number of babies that are destroyed by “selective reduction” -- likely thousands a year -- is not publicly available.

Taking a step back, it’s hard to deny that the ART industry is almost solely responsible for the current social climate where a living human embryo is now regarded more as a product or resource than as the individual human being that it is. Through ART, the scientific and medical community has been able to create, manipulate, study, and destroy hundreds of thousands of human embryos. And currently, about 400,000 are frozen indefinitely in the United States alone, according to the most recent, reliable data. Additionally, these frozen individual human embryos have been targeted for years now by researchers who want to cull new lines of human embryonic stem cells from them.

To say that ART has opened a Pandora’s Box of cultural ills is among the grossest of understatements. But perhaps the octomom episode will constitute a watershed moment ushering in the long overdue era of regulation for an industry that feeds on innocent human life in the name of fostering it, thinly concealing unbridled greed with a veneer of putative compassion.

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A note to my readers: First of all I want to thank Michelle Gress, our Director of Programs for her collaboration in this column. Secondly, I want to thank all of you for your prayers during these past couple of weeks -- I assure you they have been very felt, and I have tried to reciprocate. Finally, after nearly three years of writing “With Good Reason” on a weekly basis, I have made the decision to cut that back to a monthly column which I will be publishing on the first Tuesday of each month: same solid content -- and maybe even a bit more to sink your teeth into. I look forward to continuing to put my two cents into the public discussion of key moral issues of the day. I hope you will continue to find it enriching. God bless you.

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