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It's a busy time to be a fertility ethics specialist. While the TV news, tabloids, and blog-pundits were still frothing about the mother of six who had given birth to octuplets*, word came from western Canada that 60-year-old Ranjit Hayer had had twins. (For what it's worth, Hayer doesn't hold a record. That may belong to Carmela Bousada, a Spaniard who had twins six days before her 67th birthday.) These stories may be at the sensational end of the fertility treatment spectrum, but the questions they bring up will probably last long after the national gaze has turned to other spectacles.
What regulations, if any, should limit fertility treatments? Should they be based on age? Or the number of implanted embryos? Or the potential parents' ability to support their children? If you're one of the millions of women who have sought infertility-related medical help, what has the last month looked like through the lens of your own experience?
*In a sign of the uncharted territory we're entering, "octuplet" may be in our working vocabularies now but it's not yet in our dictionaries. My American Heritage and the browser's spell-checker both stop at "sextuplet" — two babies away.
GUESTS:
- Marna Gatlin: Former infertility patient and founder of Parents Via Egg Donation
- Paula Amato: Associate professor and reproductive endocrinologist at OHSU and OHSU Fertility Consultants
- Patricia Backlar: Research associate professor of bioethics at Portland State University
- Shawn Vandor: An author currently working on a memoir about being the biological son of an anonymous sperm donor
Tagged as: fertility · parenting
Photo credit: Bies / Flickr / Creative Commons
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For those out there struggling with infertility, it may pay to read the fine print on your insurance. Certainly it may be less and less the option but upon review of my insurance, I found IVF to be covered with a lifetime max of 30K which is about enough for 2 - 3 tries. We had written off the notion of becoming parents after 5 years of 'trying' and surgery to combat endometriosis and fibroids that lessen your chance of successful pregnancy. Our insurance offered a supplemental policy that covered 80% of IVF and I believe also egg donation, and even adoption. We were fortunate to have a successful first try with two embryos transferred; one took and we now how a beautiful healthy little girl who will turn 3 in March. I was 35 at the time of the delivery and we are thrilled to have one and have donated the remaining embryos.
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It isn't just fertility treatment that needs to be regulated, but reproduction in general. American law in this regard makes no sense whatsoever. We have to be 18 to legally have sex but can have children at any age. Responsible and economically sound parents have to go through mountains of paperwork, interviews, visitations, etc. to adopt a child but an unemployed couple on welfare with four children already can have another with no questions asked. Where is the logic?
People recoil at the idea of the government telling them when, where, and how many children they can and can't have. The argument is that family planning is a personal matter - a basic human right - and the government has no place interfering. But is not quality of life also a human right? What about the quality of life for the poor kids born into families who can't support them, or where they're competing with 13 siblings for affection, as in the present case? What about everyone's quality of life when the country, continent, or planet is overpopulated? Many argue that the Earth is already past its carrying capacity for human population.
It seems to be a thorny issue that no one wants to touch, but hopefully this extreme case of the octuplets will spur some legislation in the right direction.
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I would take the concerns addressed by Celticwarlord to another extreme.
There is no question that the human population is too large. It is a fact.
Having children, especially by those in the "first world", is morally reprehensible and selfish. If a child must drop from your body for you too love it, you have no real love and should not be raising children. If you have love and resources to give, then adoption is the only sane, rational, long-view choice.
BUMPER STICKER PHILOSOPHY: 6 billion miricales is enough.
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I am 62 years old. When I was in grade school there were 2 billion people in the world. Today we are fast approaching 10 billion. This is log phase population growth. Perhaps some infertility is nature's way of controlling an uncontrolled population growth. We need to be limiting our population, perhaps even shrinking it if we expect the environment to continue to support us. I have no children, but there are plenty of children in the world that need my care. Perhaps that should be enough.
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I feel like the octuplet case is not the norm -- it's the exception to the rule --and 99% of the Reproductive Endocrinologist's do follow the guidlines set out by ASRM. The woman in question clearly has a screw loose, and my question is who did her psych screen and why was she passed?
I think that this is really a slippery slope because I don't want legislatures to tell me what I can do or not do to my own body reproductivley.
You are right -- it'sa thorny issue that no one wants to touch and there is no easy answer. -
While my initial reaction to the octuplets (plus 6) was one of horror and disgust steeped in judgement, further reflection leaves me sad. Sad for the tens (hundreds?) of thousands of children who are not adopted every year, sad for the women whose desperate need for a child outweighs all else, and (as a teacher of at-risk youth) sad for a society that does a mediocre job of caring for the children already on this planet.
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I've been struggling with fertility issues for years. In Vitro Fertilization (IVF-ET) is hardly affordable for us, but even if it were I would hesitate simply because I fear ending up with a 'litter' of babies. I suppose it should be left up to the family to decide if multiples is possible for them to care for, as long as their choice doesn't cost me as a tax-payer. If they cannot afford to raise their brood, they should not be allowed to bring so many of them into the world.
However, I can understand trying as an older woman; my clock is ticking and I don't want to give up. I've always wanted to be a mother. I will try as long as I can.
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I believe the US should mock a similiar standard that the UK has. In the UK only one embryo can be used for an IV treatment, so this avoids the opportunity for many embryos to take.
Joel - Ann Arbor, MI
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The US needs to pay for IVF treatment like the UK does for it's citizens. In the US less than 20 states provide any sort of IVF insurance for patients, and infertility is classified as a disease like Cancer, Diabetes, Cardio Vascular disease, and Alcoholism.
To take this a step further, then perhaps we need to regulate cigarrettes, sugar, bacon, sausage, butter, and alcohol. All of which are contributors to cancer, diabetes, cardio vascular disease, and alcoholism.
Do you see how much of a slippery slope this can be?
Where do we draw the line?
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My wife and I tried for four years unsucessfully to have kids. We tried IVF and they implanted two and we got twins. They are now three years old and just last october we had a caboose baby. I would agrue that the doctor whom put 8 back did not use moral obligation considering the current situation with the woman. Now it seems that we are going to pay for it since she will be living off the system even longer.
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After trying to get pregnant for nearly 15 months, my wife and I finally conceived and now have an amazing 5 year old boy. We've been trying for four years for child #2. My wife has been on clomed for several years and we've tried insemination half a dozen times with no luck. We can no longer afford the treatment any more. Nearing 40, we are both saddened that we do not have more kids-we both grew up in families of 6. What doesn't make any sense to us, is that insurance pays for most birth control, but does not see infertitily as a medical problem. Plus it's very expensive to do further fertility treatments-with no garauntee-or to adopt a much wanted child. For now, we live day by day hoping for another child to come into the family.
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You have a partner and a kid. I have neither, nor do I have money for in-vitro. And though I think kids are happier with one healthy parent than two fighting ones, I've always struggled with the idea and stigma of knowingly bringing a kid into a single household.
I guess we all have to take our lumps where we get them. Imagine not being able to create any family at all. Probably brings perspective to one's situation.
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Please mention that "alternative" medicene's such as acupuncture and ayurveda are the most healthy and least invasive place to start with issues of infertility. If this does not work then move to the more invasive treatments.
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I'd like to hear some discussion of the ethics of "egg donation," a process during which the body of a young woman who will not become a birth mother is subjected to extreme biochemical interventions-- hyper-stimulating her ovaries with injected hormones to produce as many as dozens (?!) of eggs in a single cycle.
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I think the conversation needs to backup a bit to consider the bigger picture of infertility and freedom in this country. First, we have a working definition of infertility as inability to concieve after one year of unprotected intercourse. I have done a loose poll of the older women in my life and found that more than half of those women who bore children, did so after 2 to 6 years of childlessness. And they did not run to their doctor and get shot up with hormones, nor consider it abnormal to have to wait for things to happen.. My husband's grandmother had three children after 6 years of trying. Our notion of freedom leads us to believe that we should have absolute control over aspects of our lives and many women feel duped when their plan for children doesn;t quite jibe with nature.
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My wife and I were able to harvest 11 embryos (12 total, one didn't take). We used two embryos the first time we tried IVF and were unsuccessful. We moved and had the remaining 9 embryoes transported to OHSU. AFter another year we tried again. They thawed out 4 embryos, two of which were damaged. We used all four and got one perfect little girl.
Out of 12 embryos, it took 7 to get one child. Any amount of the remaining 5 could be damaged. We plan on using the last five sometime in the future to try and have another child (or however many we get).
These are wanted, planned pregnancies. There are hundreds of thousands of unplanned pregnancies every year. Regulate those before you regulate planned pregnancies for people who really want to have children.
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You are correct, and there are thousands of children *already here* who need the kind of home you and your wife can offer.
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Annie - Adoption isn't for everyone. I'd no sooner judge somone who chose to remain childless than I would someone who would rather adopt.
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My husband and I were give a 3% chance of ever having children without intervention. We tried one round of artificial insemination which was unsuccessful and then went on to IVF. Our fertility doctor was very direct and clear, the most embryos she would implant was 4, but not until I ws over 40 years old. At the time I was 37. We went through 3 rounds of IVF, getting pregnant and losing the 1st pregnancy, having no success with our second attempt and finally with the third, at age 38, I became pregnant with triplets. One of the 3 just stopped growing (much to our relief) and we became parents to fraternal twins. I spent 3 months on bedrest and we spent $60,000 dollars. It was worth the heartache and financial investment to have these babies but my husband and I were clear that the third attempt was our last, after 40 the risks were too high and we knew we didn't want a special needs baby.
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And for less than $60,000 and no bedrest (no lost pregnancies, no associated heartache, not to mention the stress on your body) you could have offered a loving, stable, deserving home to two children whose only needs were to be chosen and loved.
I would be interested in a conversation among people, like you, who have gone to such great lengths to have their own children -even in the face of great financial, physical and emotional stress -rather than consider adoption.
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I'm curious about the counseling that clients of fertility treatment recieve regarding what happens AFTER the baby is born. Especially regarding possible difficulties with breastfeeding. Many mothers I know who have undergone IVF had no idea that they might continue to face their fertility challenges in the postpartum.
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I have always felt that there needs to be more offered in the way of counseling, or support regarding those women who go through IVF.
Once a woman becomes pregnant through IVF and is released to from her RE to her OB, she then becomes a regular pregnant woman in the OB practice of her choice.
Not all women who go through IVF have issues with birth or breastfeeding, but I think on a whole there needs to be more support during pregnancy and after. Post Partum Depression is wicked.
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Having many children (octuplet lady and others) is exploitative of the system but primarily exploitative of the children. Who will bear the economic costs over the years unless she puts the children up for economic gain. Most important is the many-facted cost to the children who always loose in these exploitative games.
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I'm adding to the conversation late but I have some important info to have.
My husband and I are starting our family through surrogacy and are getting our IVF through a donated cycle, arranged through a non-profit called INCIID.
It's important to know there are people out there who feel so strongly that this is not frivolous that they would help others go through this procedure.
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Why are we not talking about adoption???
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We took one call from an adoptive father, and have asked a number of questions about adoption to our guests.
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I admire the caller who decided that adoption was the best option.
From an evolutionary perspective, it makes sense that you'd be most altruistic to children that carried your own genes. While such selfishness is not very pleasant, reproduction is the most self-centered act (in a literal sense, not a judgment) of all.
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I have a single son via IVF. During my fertility treatment I felt there was a sort of "fertility fence" that divided me from other women and men that had not undergone fertility treatment -- they simply could not understand and just thought we should adopt, and I finally gave up trying to explain my efforts to have a child. As far as this conversation goes, I am concerned that this unusual octuplet case and other highly publicized cases will cause unnecessary interference in the relationship between women and their doctors. I was well educated by the doctors, and was given the choice of transferring all four of my surviving embryos, and I chose to just transfer two, happily resulting in my son's birth. The downside is that a subsequent transfer of the remaining two embryos (frozen) a couple of years later failed, and sadly I was not able to have a second child and sibling for my son. I suppose in theory that had I transferred all four fresh embryos in the first IVF, I might have had a multiple birth. But I am glad that I had just one child so that I could give him all the attention he needed. Being a parent is very hard, and kids need their parents' full attention. My son is a happy healthy boy, and I am a happy mom (at last!).
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Another item to add, and sorry--I wish I could have called in. I wanted to respond to Mark, who asked a question I find very painful--are we just not aware of the adoption option?
I know he doesn't intend it this way, but that is just a stupid question. Of course we are aware of it. Just as his reasons for starting his journey with adoption are deeply personal, our decision not to start with adoption is deeply personal.
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Would we be having this discussion if the mother of 8 were giving the babies or 7 of them to other families who wanted babies?
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Good point, and likely we would not. Though that would bring up another host of ethical questions: surrogacy is one thing, but a baby factory?
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I deal with infertility for 9 years. It was a sad and stressful time in our lives. Now we have 4 kids whom I love with all my heart. 3 were born via Invitro fertilization. Thanks to OHSU fertility consultants. And 1 was a great surprise! Thanks for talking about this it affects too many people.
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An argument that has not been addressed is the world overpopulation problem. From that view it seems incredibly selfish to use tech to make more people when nature has said no.
And from a religious view, if "God" doesn't want you to have a child, aren't you sort of flipping him off by using tech to get around his "plan" for you?
Sometimes you have to think that even if you can do something maybe you still ought not do it.
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Amen.
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I understand the hospitalization costs of these octuplets was 3.5 million dollars. That is a tremendous burden on our healthcare system and something we all end up paying a part of.
I think the IVF doctors should be held financially responsible for the delivery and post-partum costs of their malpractice, and make no mistake 4, 5, 6, 8-multiple births are malpractice. Holding them financially responsible will address a few problems. It will effect their insurance costs which would get passed on to IVF patients, rather than the general public. It will force repeat offenders out of practice due to being uninsurable. Insurance companies will pressure doctors and the medical system to review and adopt safe guidelines for embryo implantation at the outset.
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Hi Caroline -- I'd be really interested in learning more about acupuncture and the benefits regarding infertility. I wonder if acupuncture can help with things like Diminshed Ovarian Reserve, Premature Ovarian Failure, or PCOS?
I know that acupuncture is advocated as a treatment during IVF cycles, focusing especially before, and after the transfer of embryos.
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My wife and I have two adopted sons. We tried conceiving by artificial insemination using my own sperm but were unsuccessful. We had no interest in using either third party gametes or IVF. I don't believe that children should be deliberately conceived with a biological parent that will not raise them, nor do I believe in creating "spare" human embryos to be stored indefinitely in a laboratory deep freeze. I'm appalled at the depravity of our culture that treats children as commodities and at the narcissism exhibited by the compulsion to produce biological offspring by any means available, particularly with so many children already in need of loving adoptive homes.
I think reasonable regulation of the fertility industry is badly needed. For starters, we should implement two sensible restrictions that are common in other countries: ban payment to so-called "donors" of sperm and eggs, and end the practice of granting them anonymity.
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Hi Mike -
I hear what you are saying -- however, my concern is for those of us who resort to the use of egg donors or sperm donors to create our families banning compensation is going to decrease the egg donor and sperm donor pool greatly.
As far as ending the practice of granting egg donors and sperm donors anonimity -- in the US you can't make anyone meet anyone. And so requiring a mandatory registry for egg donors or sperm donors to be eligible to donate isn't making much sense to me because who's to say they aren't going to move, change their phone numbers, or what have you after they register. Who's going to be the watchdog to make sure they keep up with their information?
I think a voluntary registry is a great thing -- we have lots of those already in place.
Most egg donors and most sperm donors don't give a second though to the tissue they donated. And really that's what an egg and a sperm are -- tissue. And I can tell you from experience they don't sign up for this to known as fathers or mothers. That's our job as parents.
There is no easy answer.
I have a son via egg donation and I am so thankful, and happy we went that route -- he's amazing.
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I realize that banning compensation would reduce the "donor" pool, as it should. This would ideally result in more adoptions and less shopping for remote parents.
As for anonymity, children conceived through gamete donation should have the right to learn their biological background, just as adopted kids do. If donors want nothing to do with the offspring they beget, then they should not procreate.
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Biology over all seems to be the prime directive in our country. When I was in graduate school I was approached by a nurse of a doctor who said someone was interested in me becoming a sperm donor. She offered a free physical examine and a $25.00 for each attempt. I gave it serious consideration for a few days. I was honored that someone thought I had the qualities they wanted in their child. I was married. If the nurse had disclosed an obligation to be available to the child at some future point I would have said "hell no" on the spot.
The author, Shawn, should be careful comparing what happened in one country/culture as indicative of what would happen in a completely different country/culture. The U.S. is far from Swenden in distance and culture. Americans are very protective of their privacy. Just as the ACLU or former President Bush. The initial drop in donors in Sweden and raise 5 years later fails to say anything about the quality and types of donors, whether additional incentive were involved or just what caused the rise in donors five years later. Weather ? Significant drop in fertile males or increase in infertile women ?
Whether we like it or not, agree with it or not, frequently parents are called upon to make decisions which later have dramatic impacts upon their child or children. I sincerely regret the situation in which you find yourself with respect to your biological father. But what about his rights ? Does it come down to a battle of who has the greater rights ? How can this possibly be fairly resolved ?
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Good points which bring up other ethical questions... I knew a man who supplemented his financial aid in college with the help of the payment he received from sperm donation. At the time, he was young and healthy and, evidently, unaware of the mental illness that plagued both sides of his family. Years later, he suffered from crippling (and violent) depression and has never notified the sperm bank.
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Our daughter considered donating eggs when she was in college, in order to make money ($2500). She needed to get background information from us concerning medical/genetic information and at that point, fortunately, we talked her out of it.
Someone that age doesn't really think of the consequences years later. Maybe she would become infertile, and know that she has a biological child out there somewhere. Maybe her biological child would meet another of her children and date each other, not knowing. Maybe her parents (us), would prefer to know their biological grandchild.
It's all about biology, isn't it? How would you like to know that you were carrying one of Diane Downs embryos???
I think we need to focus on the reasons that fertility rates are going down and fix those, not obsess about everyone's "right" to bear a child, no matter what the reasons or consequences may be.
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What does Diane Downs have to do with this? There are plenty of people who are perfectly "normal" and perfectly "sane" who have children who grow up to be perverted, demented, or plain ol' psychopathic. Who are we to assume that just because an embryo came from a convicted felon the embryo will grow up and become the successor to the mother's (or father's) career in crime.
Jeffrey Dahmer was a nut-job, but that doesn't mean his parents were. John Wayne Gacy killed little boys, but that doesn't mean his father did. Ted Bundy (who did some of his most infamous deeds here on the West Coast, as well as in Florida) was somebody's son, but that doesn't mean that Mr. and Mrs. Bundy were psychopaths, too.
As for knowing that you are carrying the embryo of any specific person, you would never know. Administrative controls are in place to prevent anyone from knowing whose egg and whose sperm is being used, when a couple turns to artificial insemination. This is mainly to prevent a couple (or a parent) from pursuing the tissue donor for child support. (Picture if you will...Brad Pitt (for example) donates his sperm, which is later used by Mr. and Mrs. Average to have a baby. Some time thereafter, Mr. and Mrs Average discover whose sperm they got and see dollar signs, with the expectation that they will be successful with their paternity claim. If they do succeed, then it will have a chilling effect on the Artificial Insemination Field, as well as on organ and tissue donations.)
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Can you people hear yourselves! How ego centric all of you sound about NEEDING to have a genetic link . To procreate and have a genetic tie to your child. A child is a child and is yours no matter what the GENETIOC link is. My favorite comment today was by the woman who tried 10 times to IVF. If it didn't work they should get a dog or adopt. Equating an adopted child with a dog was definitely indicative that they aren't reproducing for a reason. This world has an overpopulation of needed children. Maybe this is the way mother nature is telling us to take care of the children that are all ready here. Maybe you people aren't supposed to reproduce. Maybe your supposed to be adopting to help the world rather than thinknig about yourselves. With so many people thinking like this no wonder the rest of the world looks at America as imperialistic and selfish!
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Maybe nobody should have genetic children, and we can all adopt! Bearing a child from 50% of the parent couple's genes, does not make them selfish and/or morally obligated to adopt compared to a parent couple using 100% of their genes.
That is not to say that adoption is not noble. But to anyone asking "why not adopt?" - If you are parents of non-adopted children, you could easily ask yourself the same question. -
Hi Charlo -
I was the woman on Think Out Loud who said to my husband "If this doesn't work I want you to get me a dog." I'd like to clarify what I said -- I wasn't equating or comparing adoption to owning a dog.
You have to understand this was my tenth try at having a baby. I wanted to become a mother in the worst way -- to anything at that point. My comment to my husband was in exasperation at the enormity of this last cycle not working. And so when I made my comment to my husband I meant just that. If this technology wasn't going to work for us then I'd become the mom of many many dogs.
In regards to adoption, I think it's a beautiful thing, I think it's one of the most unselfish, amazing, and loving things anyone can do. However, it's a very personal decision like choosing to carry a child to term, and birthing. There are many many women in this world who don't feel compelled to carry a child as I do. But for me it was very important to carry a pregnancy to term, regardless of it was carrying my partners genetics or not.
I guess I don't understand what you mean by telling me that I am not reproducing for a reason. My reason for wanting a child is to be a parent, and a mother. I also felt strongly I wanted to have a child with my husband who I love very much. And I don't think there is anything wrong with that.
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Good point -- genetics only makes you a sperm donor or an egg donor. Caring for the child is what makes one a Mother or a Father. Deep, unconditional love and being there -- through thick or thin; accepting one's child for who they are -- gay, straight, lesbian, or transgendered; good times and bad; winning the soccer tournament or finishing the season 1 and 15 -- makes one a Mommy or a Daddy.
Please consider adopting a child (and not just the babies -- the older kids need someone to love them before they "age out" of the system, too). Every child needs someone who will love them, and teach them how to love and teach them all the things that they need to know to be a successful human being. (The things that aren't found in any textbook.)
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I have had a question for a number of years and now am wondering how to advise my daughters. Is there any data about the number of years a woman has taken birth control pills and resulting infertility in later life? If a person started taking BCPs in her teens and then is trying to have a pregnancy in her 30's, that is half her life surpressing the natural hormonal processes. Comments?
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Thank you so very much for this discussion! I am a 41 year old woman who made choices throughout her most fertile years to pursue carreer and adventure. I am now newly married to an amazing man who, like me, very much want to parent a child. I quite literally would give my right arm to give birth, so like many, I am seeking medical fertility support for pregnancy.
I am also someone who is passionate about making healthy choices for the sustainability of our environment. Neither my husband or myself have had children before. I would support legislative limits to fertility practices that look honestly at the human footprint on the planet. I would not support fertility treatments for couples who already have two children. This seems like a fair and legitimate limit.
In general, it feels irresponsible to reproduce using fertility treatments when those new children are adding either to the burden of a family or the planet. I have never understood the choice to have many children when one cannot support those new lives. Even as I personally understand the deep desire to give birth, I strongly support the filters of wisdom, responsibility and consciousness in making reproductive choices.
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I am 33. I did not know about my infertility until a few months ago, before that, I diligently took my birth control pill, assuming I was ovluating regularly and everthing was fine. What a surprise it was to find out otherwise. Until this was my reality, I also found it easy to judge people who decided to do IVF. There are so many children that need homes right? But, strangely, when intfertility gave us less than 2% chance of getting pregnant on our own, I realized down deep that I wanted to try to get pregnant with the help of ART. I am not sure someone that does not have fertility issues can really comment on a women's choice to persue ART. It is personal choice afterall and I am glad of that.
We are at the beginning of our efforts, and I do not know what will end of happening. But, I can say, that I feel so grateful to live in a time when getting help is an option.
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Comments are now closed.
What are the National Guidlines for the number of embryos to transfer?