Should in-vitro be regulated?

November 20, 2008 8:43:25 AM PST
Earlier this week, the Centers for Disease Control revealed that babies conceived through IVF, in-vitro fertilization, were up to 4 times more likely to have birth defects. That report has set off a ripple in many circles, with some calling for regulation of the procedure.

Like a growing number of couples who turn to fertility treatments, Eric and Elizabeth Hayes got more than they bargained for when they became the parents of three sets of multiples.

On top of the two gallons of milk they need to quench the thirst of their 10 kids every morning and the eight loads of laundry per day it takes to keep them in clean clothes, the Hayes family must also deal with the medical difficulties that often come with multiple births.

Children born in multiples are almost always premature, which can lead to problems, such as mental retardation, blindness, cerebral palsy and learning disabilities. With more couples turning to fertility treatments, a doctor's decision to implant multiple embryos in infertile women causes anguish for both doctor and patient.

The Hayes family is no exception: on top of their everyday expenses, they also must provide special care for Rebecca, one of their sextuplets born with cerebral palsy.

Eric and Elizabeth, though, still say they are blessed, despite their travails. "We were just going to go for one more and try for another girl, and hit the jackpot," Elizabeth said on ABC's "Good Morning America."

Fertility experts told ABCNews.com that doctors struggle to strike a balance between the demands of infertile couples, who often ask to have large numbers of embryos implanted to increase their chances of conception, with the inherent risk that more than one of those embryos will take, leading to multiple births.

Multiple births carry a much higher risk of death for the infants, according to the U.S. Centers for Disease Control. The CDC says twins are five times more likely than singletons to die within a month of birth and triplets nearly 15 times more likely to die. Exact numbers for higher multiples aren't available, but the death rate is exponentially higher.

"It's a very, very difficult situation," said Dr. Richard Paulson, chief of reproductive endocrinology and infertility at the University of Southern California. "Here comes a young couple who took a second loan on their home so they could afford fertility treatment and they're very motivated to be successful."

"They'll tell us that that they want to implant as many as possible because this is their last chance," said Paulson. "And if we don't do it they'll just go to another doctor who will."

And evidently, couples do. According to the CDC, multiple births have increased greatly in the last 20 years, thanks to fertility drugs. In 2005, 68 sets of quintuplets or more were born, compared with 13 in 1990.

Arthur Caplan, director of the Center of Bioethics at the University of Pennsylvania, believes that ethically, doctors must do whatever they can to prevent multiple births.

"I have long argued that nobody should be putting more than four embryos into any woman because of the high risk of super multiple pregnancies which are hugely dangerous to newborns," said Caplan.

"We know that usually every one of these cases has the kids in a neonatal unit, that disability and learning disorders are common and death can even occur," he said. "In my view, the ethical thing to do is to control against the possibly of super multiples occurring."

But unlike in many European countries, where the number of embryos that can be implanted in women is kept to a maximum of three, the U.S. has no such regulation, said Caplan. That makes it harder for doctors to resist parents who want as many embryos as possible implanted.

Even without new guidelines, insurers could help reduce multiples, he added.

"If insurance companies would say that they won't pay for complications resulting from transfers beyond four at time - that would have teeth," Caplan said. "People are doing it because some insurance companies will say they'll only pay for two cycles, which leaves people to transfer multiple embryos at a time because they think it's their only shot."

Occasionally parents have moral objections against freezing embryos and not using all of them, leading them to argue that all of them should be implanted. Once high numbers of embyos are implanted and become viable, patients often also have moral reasons not to cull or selectively reduce them.

In addition to more specific guidelines by professional medical organizations to inform parents of the risks of high-multiple births, Caplan says he'd like to see insurance cover more IVF treatments with a limit on the number of embryos that can be transferred.

With families like the Hayeses and Jon and Kate Gosselin, who have one set of twins and sextuplets featured on their own reality television shows, doctors worry that the glorification of their hectic lives might add yet another obstacle for doctors in trying to avoid multiple births.

"The media is presenting the side of the story that is fun because that is what people want to hear," said Paulson. "It would certainly take away from the show if they began each episode with a disclaimer about the horrible effects multiple births can have on children -- who wants to hear that?"

Paulson says that this "slice of life" viewers get is far from the reality of raising a family of multiples.

"Unfortunately, the media thinks it's just a great blessing to have multiples because fertility is good and lots of fertility is better," said Paulson. "But the reality is that, with six babies, the probability of there being a major issue is very, very likely."


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