In Vitro Fertilization: Too Much of a Good Thing?

Talking whether or not to have children in contemporary American society seems as fraught with danger as talking about religion, politics, or sex itself. First of all, the act of reproduction is now largely perceived as a matter of choice rather than an accident, a chance occurrence, or a reflection of the will of God.

For this reason we tend to view reproduction almost exclusively as an activity within the individual's control, You want to have a child; check when the female partner is ovulating and have fun. You don't want to have children: have fun but don't forget the birth control. This reductive either/or thinking makes it all to easy to forget how vulnerable we humans still are to flawed genes, the curve ball of disease, and the threat of infertility that increases as we defer parenting to our late thirties or forties.

New reproductive technologies have offered one form of reassurance to those who have trouble conceiving, especially those who have deferred the choice to have children until infertility presents a serious impediment. They also make it possible for lesbian couples to conceive and for gay male couples to have children as well if they can find a female surrogate.

But while new technologies like in-vitro fertilization offer solve a number of problems for these couples, they also raise serious ethical questions that medical practitioners and those seeking such treatment are often ill-equipped to answer.

For example, the ability for infertile couples to use in-vitro techniques as an alternative to adoption has fostered a situation in the United States in which large numbers of children remain locked into the foster care system, often seen as “unadoptable” by the very families who might once have taken a closer look at them. Moreover, infertile couples are not simply choosing to conceive one or two embryos that might be born as their biological children but are choosing a technology so costly that many choose to risk multiple births rather than lose the opportunity of becoming pregnant at all.

The case of Nadya Suleman, the single mother who chose to have so many embryos implanted in her womb that she gave birth to octuplets, merely writes large the ethical dilemmas that such unregulated reproductive technologies have generated.

The cost of in-vitro fertilization is high, and since few have health insurance to cover the cost, the incentive is even greater to try to get the most “bang for your buck” by having as many embryos implanted in the womb as possible.

The problem is that the human womb is not designed for more than one or two occupants at best, and the situation of multiple births automatically presents high risks and higher medical costs for both mother and babies, some of which may persist for the life of the children who survive. In fact, the ugly underside of potential multiple births is the real possibility of multiple deaths as the survival rate lessens dramatically for twins, triplets, quadruplets, and higher multiples. (For an excellent overview of these issues,read Liza Mundy, Everything Conceivable: How Assisted Reproduction Is Changing Our World).

The other side of this reproductive superabundance is also reflected in the dilemma of what to do with the embryos that are not implanted. In almost every in-vitro situation, there are “left over” embryos that a couple may want to use for future births. By one estimate, there may be half a million of these potential babies.

Unfortunately, once a couple has the number of children they desire, many cannot face the ethical dilemma of what to do with the embryos they no longer need. Do they donate them to other infertile couples? Do they allow them to “expire”? Do they offer them for scientific research? A growing number of people, unable to decide, simply stop paying the fees to keep their embryos frozen, but doctors are often too afraid of legal problems not to continue keeping them in this reproductive limbo.

Which brings me back to Nadya Suleman. The public is quick to condemn her for choosing to give birth to children she cannot afford to raise and has not the means to care for, but the same public says little about the many couples who abandon their unused embryos, leaving them in a legal and physical limbo, a financial charge to the labs that helped create them.

Indeed, the amount of vitriol directed at this woman rivals that provoked by Ronald Reagan's mythical Welfare Queen, and reflects the resentment of an American public that can barely afford to feed, house, educated and provide health care for its own children, much less subsidize a woman who appears to have her children at “taxpayer expense.”

But we don't see nearly the same amount of outrage directed at the doctors and hospital that agreed to provide this infertility treatment to Ms. Suleman, even knowing full well that she already had six children from previous treatments. The real scandal that Ms. Suleman's multiple births has revealed is that of a medical profession operating under “wild west” conditions guidelines but no clear rules that might have immediately rendered Ms. Suleman an inadmissible candidate for further in-vitro fertilization treatments.

The medical profession that practices these techniques needs to take a hard look at itself and ask some pressing questions such as: What role does the profit motive play in decisions to offer in-vitro fertilization services? Under what conditions, if any, should a doctor refuse to provide in-vitro fertilization? Rich or poor, there may well be an ethical limit to the number of children that any medical professional should help a couple conceive by these means.

Certainly, as a society, there is a public interest in determining to what degree tax payers should subsidize the infertile when we already underfund housing, education, and services for children who do not have families to care for them.

And we should also be asking those who provide the technology for the infertile to conceive to make sure that these same couples fully comprehend the implications they face in making the decision to create multiple embryos or undertake multiple births. We cannot allow those who make the choice to create multiple embryos simply to walk away from those choices when they become inconvenient or superfluous.

Nor should we sweep under the table the negative effects of reproductive technologies' effects on women's health, on the ability of families to cope with the economic, emotional, and physical stresses of raising multiple babies at once, and the many costs to society of providing care to these children, who are often more vulnerable to disease and disability than their singleton counterparts.

In-vitro fertilization has offered many couples the opportunity to turn the dream of having a child into a reality, and I fully support the efforts of any couple, straight or gay, to have a child who shares at least some of their own unique genetic makeup.

But as Nadya Suleman's tragic situation demonstrates, an unregulated and unquestioning field of reproductive technology also poses the nightmare scenario of a society subsidizing one woman's unrealistic obsession that has turned into the grim reality of fourteen very young and very vulnerable children, who are dependent on one mother and an increasingly fragile safety net for their very survival.

That fact alone should have the medical community and the public large asking the question: Can in-vitro fertilization be too much of a good thing?