Although I definitely do not want eight babies and have no desire to be Angelina Jolie (I’m a Clooney kind of gal, not a Pitt one), I still want to understand the position of Nadya Suleman and other women who have opted to have multiple births. What might lead a mother to even make twins or quadruplets—or more—possible? And who is responsible when in vitro fertilization produces more babies than intended?
Although fertility technology has been around for decades, the ethical conundrums and ambiguous regulations leave much to be figured out.
How Did We Get Here?
It’s been thirty-one years since the first test tube baby was born in England. Little Louise Brown was front-page news. Her birth was the thing of science fiction. It was the first time an embryo had been fertilized outside a mother’s womb, transferred back to the mother, and then produced a healthy baby—one who is still very much alive and who had her own child in 2008. Since 1978, more than three million babies have been born using the technology. Gradually, the term test tube baby gave way to the Latin variation in vitro, or IVF. No matter its name, the procedure is no bed of roses.
It all starts with shots. Plenty of them. During her period, a woman starts getting injections of a fertility medication for a course of about ten days. After enough follicles have developed in the ovaries, between ten to thirty eggs are retrieved using an ultrasound-guided needle that pierces the vaginal wall. Next, the woman can breathe easy as the work moves to the lab, where the eggs are incubated with sperm. It takes between two to five days for embryos to develop, after which the best ones are selected (yes, we judge each other even at this earliest of stages) and transplanted through a plastic catheter through the vagina and cervix and into the uterus.
No bed of roses, as I said. And yet there are more than 60,000 IVF cycles performed in the United States every year, at a cost of up to $10,000 per cycle—if you’re American, that is. In many European countries, as well as Canada, nationalized health plans cover IVF. It’s no coincidence that these countries also regulate how many embryos can be implanted in the last stage of the in vitro process. In the United Kingdom, for example, only two embryos can be transferred.
Lax Control, Lots of Babies
In the U.S. there are guidelines from the American Society for Reproductive Medicine (ASRM) regarding the number of embryos that can be transferred. For women under thirty-five, it’s two; for women over age forty, no more than five transfers should be attempted. These, however, are guidelines, not regulations, and a woman can ask her doctor to do more. Many doctors comply: the guidelines are so widely disregarded that the Centers for Disease Control and Prevention report that only 20 percent of clinics follow the ASRM guidelines.
Obviously, IVF pregnancies and healthy births are significantly more common now than in the years just following Louise Brown’s arrival. According to the Canadian Press, 36 percent of embryonic implants result in pregnancies—a decent number but not high enough for people paying a significant amount of money. The discrepancy between the cost of IVF and the statistical probability of a successful birth is what leads people to ignore the guidelines.
More Embryos, More Cost and Risk
Does it matter? Yes, say many ethicists, parents who have experienced IVF, and medical experts. As photographs of the octuplets born in California this January show, multiples often result in premature births and various medical complications, even in less sensational cases. The European Society of Human Reproduction and Embryology Research has reported that triplet pregnancies cost more than eight times as much as singleton pregnancies and twin pregnancies cost more than three times as much. The current trend in the U.S. for multiple transfers, which has resulted in Americans leading the world in the births of multiples, has become an ethical issue.
Some doctors and fertility organizations, as well as many parents who have been through the in vitro process, are wondering if Americans need laws, not guidelines, to bring down the number of multiple transfers. In Sweden, where the law prohibits the transfer of more than two embryos at a time, nearly three-quarters of all transfers are of single embryos—that’s compared to only 11 percent in the U.S.
Others think that insurance is the key. Only fourteen states currently bind insurers into covering some infertility treatments. Naomi Cahn, a law professor and author of Test Tube Families, has written about the need for regulation and insurance. Demanding that insurers cover infertility treatment, she argues, could reduce the motivation for multiples, which will save on the expenses of premature babies.
Fertility is big business in the U.S., bringing in around three billion dollars. It is also a business that appears to be more than ready for some outsider regulation from the government. After all, nail salons and massage therapists have licenses, but many states do not regulate egg and sperm donor clinics and accreditation is voluntary. With the stakes so high, a few good laws may not be a bad thing.