IVF raises numerous ethical questions

Several doctors speaking at the Canadian Fertility and Andrology Society conference in Toronto Sept. 21-24 expressed their concerns about health risks associated with in vitro fertilization. The National Post was the only major Canadian newspaper to report these remarks.

Dr. John Barrett, a multiple births expert at Sunnybrook Health Sciences Centre, told attendees on Sept. 21 about the need to restrict IVF to decrease the rate of multiple pregnancies, which often result in serious health problems for newborns. “What the IVF industry is doing is creating a population of sick babies… that is impacting all society,” he told the National Post. “If it’s so obvious the practice is doing harm, why do people still do it? I haven’t got the answer to that.”

Multiple births are caused by doctors opting to implant more than one embryo into the mother’s uterus to maximize chances of pregnancy. This is leading some specialists to propose government funding of IVF, arguing it will control multiple births. Dr. Francois Bissonette, a fertility specialist from Montreal, reported that in Québec, where the procedure is funded by the government, they reduced the rate of multiple births from 28 to 5 per cent.

In Canada as a whole, the rate of multiple births resulting from IVF is 25 per cent. (That figure does not reflect the number of pregnancies with multiple babies as some patients will have a “selective reduction” abortion to control how many children they give birth to at one time.) According to Statistics Canada, the multiple birth rate in the whole population increased by 45 per cent from 1991 to 2008, while the rate of single births dropped.

Dr. Rosanna Weksberg, a University of Toronto geneticist who also gave an address at the conference, told the Post that there needs to be more studies of rare genetic disorders linked to the procedure, as IVF babies are ten times more likely to have these disorders. Among the risks, she mentioned Beckwith-Wiedemann syndrome (causing asymmetrical limbs, a bigger tongue, and higher risk of kidney tumours) and Angelmann syndrome (responsible for speech impairment and mental disability). She speculated this may result because of the treatment itself or the genes of the infertile parents.

Several reports have already been released about the health problems associated with in vitro fertilization. In a study led by Sunita Katari and Nahid Turan published in the October 2009 issue of Human Molecular Genetics, IVF babies have been found to have a “greater relative risk of low birth-weight, major and minor birth defects, and rare disorders involving imprinted genes.” Scientists suggested this might be due to changes in gene expression.

In March 2009, the Daily Mail reported that scientists from the US Centres for Disease Control and Prevention in Atlanta, using data from the National Birth Defects Prevention Study, found that IVF babies may suffer from heart valve defects, cleft lip, cleft palate, digestive system abnormalities, Angelmann Syndrome, and Beckwith-Wiedemann Syndrome. This, along with other findings, prompted the United Kingdom government’s fertility watchdog, the Human Fertilisation and Embryology Authority, to warn that IVF babies are 30 per cent more likely to have birth defects.

In October 2006, The Guardian reported on findings from Guy’s and St. Thomas’ hospital in London and the University of California in San Francisco. These indicated IVF children were four times more susceptible to autism and 30 times more likely to require additional postnatal care. As well, they had a 40 per cent greater chance of minor problems such as ADHD and increased risk of leukemia and brain tumours. Furthermore, they were 20 per cent more likely to have a low birth weight. Infertile women, meanwhile, had more complications before birth.

Researchers from the University Medical Centre in Utrecht, on the other hand, found that using less fertility drugs leads to a healthier baby and mother. Where the standard amount of drugs was implemented, five out of seven embryos had abnormalities. When the mother was given fewer drugs, only two out of four embryos had abnormalities, reported the Daily Telegraph in January 2007, although these are small sample sizes from which to extrapolate.

Fertility drugs that cause ovulation have also been linked to increased likelihood of uterine cancer. At Hadassah-Hebrew University in Jerusalem, a study led by Dr. Ronit Calderon-Margalit found that these women’s chances of cancer of the womb were three times higher. Meanwhile, Professor Didi Braat from Radboud University in the Netherlands identified in 2010 that the death rate among IVF women during pregnancy was three times higher than in the general population. “The high maternal mortality in IVF pregnancies is probably related to the high number of multiple pregnancies and to the fact that (donor egg) IVF is successfully used in women who are older,” says the study in the Human Reproduction journal. “The fact that only a few deaths directly related to IVF are reported in the literature whereas we observed six in the Netherlands indicates worldwide under-reporting of IVF-related mortality.”

Ottawa music station Hot 89.9 held a “Win a Baby” contest with a grand prize of up to three rounds of fertility treatment at a value of $35,000. Entrants had to explain why they deserved the treatment. The five finalists, all infertile couples, were to be judged by a panel and listeners had the option of voting for their favourite. In the end, all of the finalists won the prize.

Margaret Somerville, director of the McGill Centre for Medicine, Ethics, and Law, explained why even advocates of IVF were uncomfortable with the contest in the Ottawa Citizen. “First, a baby is being treated as a thing… it’s being reified and objectified, both of which are ethically wrong treatment of a human being,” she writes. “The radio station is putting a price on a baby’s head – up to $35,000. This breaches the foundational societal value that human life is priceless and ‘hors de commerce’ – it’s not commensurable in money and must not be commercialized.”

The issue of the increasing commodification of children also arose when Cyros International Sperm Bank in Denmark announced that it would not accept anymore sperm from redheads unless they also had brown eyes. Ole Schou, the agency director, explained that this was because the demand was not high enough.

Both advocates and opponents highlight the increasing trend of parents choosing physical and personality traits: IVF supporters say there is no reason to leave a child’s traits up to chance (nature) and opponents say by picking traits from a smorgasboard of choices parents and doctors are reducing human life to a consumer product and playing God.

Another consequence of the commercialization of children is the overabundance of spare IVF embryos to ensure pregnancy. Often, multiple embryos are implanted in the womb at once, or several are left over as a result of the treatment. LifeSiteNews reported that in 1991, over 3.1 million embryos have been created in the United Kingdom as a result of the Human Fertilisation and Embryology Act 1990. Of these, 1,455,832 were discarded, 1,252,526 were implanted, 101,605 were destroyed through research, and 764,311 were frozen. Only 94,090 gave rise to successful births, a three per cent success rate or, as The Guardian pointed out, around 32 embryos were created per birth.

A report by the American Society for Reproductive Medicine in 2010 also revealed very low numbers. At Shady Grove Fertility Center in Maryland, 7.5 per cent of embryos become children: 192,991 eggs were retrieved, 110,939 were fertilized, and 44,282 developed into “viable embryos.”

There are questions of what to do with leftover embryos. Advocates of embryonic stem cell research say it is better to use the surplus embryos than to leave them to be wasted.

A study led by Dr. Tarun Jain at the University of Illinois in Chicago of women at a fertility centre reported by ScienceDaily.com in 2008 found that 73 per cent of respondents wanted the embryos to be used for research, while 56 per cent were also in favour of having their embryos sold to other couples.

Yet there are also life-affirming responses including embryo adoption in which already created embryonic human beings would be implanted in parents who could not have a child themselves. An embryo donation program already exists in Canada and Mount Sinai Hospital in Toronto is planning to launch another one. Ellen Greenblatt, doctor at Mount Sinai’s Centre for Fertility and Reproductive Health Technology, told the Vancouver Sun that IVF patients’ “families are complete, the only other option for what to do with the embryos is either store them indefinitely, which is really just delaying a decision, having them destroyed, or donating them for use in research studies.” Besides saving “material that otherwise is sort of wasted,” she said, is good “for the couples that have extra embryos in the freezer that really can’t get their heads around not giving that embryo a chance at becoming a child.”

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