The Dangers and Limits of the Reproductive Arts
Last month the world’s first “test-tube baby” celebrated her 20th birthday. Two full decades have passed since Louise Brown arrived in Britain courtesy of a grateful mother and a medical miracle. Not long before Brown was born, 20 was considered a good age to think about starting a family. A woman of 20 is, after all, in her reproductive prime. But if Brown is anything like most young women in the developed world today, she’s putting motherhood on hold--maybe for a few years, maybe far longer. And if Brown is like most young women, she is largely ignorant of the considerable risks of delayed childbearing.
In the years since Brown was born, high-tech infertility treatments such as in vitro fertilization have produced many happy families, and not a few startling images of grandmothers with newborns and Iowans with septuplets. But technology has not cheated time. Despite its successes, assisted reproduction is both unreliable and extremely unpleasant. IVF procedures, for example, require daily blood tests and intramuscular injections with drugs that cause weight gain, moodiness, bloating and cramping. Egg retrieval and embryo implantation are painful and emotionally wrought. The costs--about $10,000 per attempt--could land a couple in bankruptcy court, and the cycles of hope and despair put many women in therapy. Women who conceive over age 40 have an increased risk of diabetes, high blood pressure and other serious ailments. And half of all women who undergo IVF do not get pregnant, no matter how many times they try
But it is the children of IVF who suffer most. For them, the techniques of assisted reproduction are downright dangerous. Infertility treatments pose risks to the unborn that would be deemed unconscionable in any other context. With fertility drugs, for example, the chance of multiple pregnancy is 25 times higher than normal. Babies born of such pregnancies are usually premature, and extraordinarily susceptible to birth defects, blindness, cerebral palsy, kidney failure, mental retardation and a host of other developmental problems. Their risk of dying in the first year of life is far greater than that of a singly born child. Would we allow doctors to perform any other procedure that so endangers the well-being of children?
Recently, two independent groups have issued calls for greater regulation of infertility clinics and fuller disclosure regarding the hazards of assisted reproduction. A team of medical ethicists at the Illinois Institute of Technology, writing last month in the journal Science, argued for a federal law that would require independent oversight and review of clinic procedures and set minimum standards for record-keeping and informed-consent practices. Earlier this year, a New York State task force released a landmark report on assisted-reproduction technologies that also decried the lack of regulation, standardization and disclosure. Both groups emphasized that infertility specialists need to spend more time informing patients of the risks and modest success rates of treatments.
But if women are to make truly informed choices about childbearing, doctors will need to talk to them long before they show up in the clinic--in some cases 10 to 20 years before. From a medical perspective, the most responsible decision a woman can make is to have children while she’s still young.
This is an unpopular and unprofitable truth. No one wants to tell it or hear it. When Brown was born, there were at most 30 fertility clinics in this country; now there are more than 300. Though rates of infertility among women of all ages seem to have gone up slightly in recent years, the growth of fertility clinics can be ascribed to sociology, not biology. Most of the business comes from women who have put off starting families until their 30s and 40s. These are women who, usually unknowingly, have chosen to risk their own health and the health of their children.
Several years ago, a medical researcher and OB/GYN at Harvard Medical School decided to study how children born to women of advanced age were faring. Her findings were published in the New England Journal of Medicine. The study showed that, in spite of tremendous improvements in obstetrical care over the past few decades, women older than 35 had twice as many stillbirths as younger women. She thought her study underscored the persisting dangers of delayed childbearing. But the press and even some of her peers interpreted it differently. The message never got out.
Soon after, the doctor and her husband began trying to conceive, with no success. They tried IVF for the first time when she was 34 years old. Twice she had five embryos transferred to her uterus. None survived. By the third IVF cycle, she asked her physicians to transfer six embryos. They refused. It was just as well, for this time all five implanted.
Well aware of the dangers of multiple pregnancies, the doctor chose to abort three of the fetuses--a routine part of assisted reproduction. The abortions were performed at 12 weeks of gestation. She began bleeding after the procedure, and the bleeding never stopped. Confined to bed at 15 weeks, hospitalized three times, the doctor finally gave birth at 24 weeks and two days. One baby survived. He weighed almost one pound, four ounces.
The baby spent his first five months of life in a neonatal unit. Now he’s a year old, healthy and beautiful. But he still needs a stomach tube, and fusses over regular feedings. His hospital bills total more than $300,000, and his special day-care arrangements are costly. The doctor and her husband love their baby beyond words. But they learned a grim lesson. “This is no way to bring someone into the world,” says the doctor. “Women have been duped into thinking they can wait.”
Some can. For many others, the consequences will be extreme. Women should know that, better than they know it now.
Make no mistake: primitive, powerful, mysterious and marvelous, the urge to reproduce is also selfish. The development of assisted reproduction technologies has made this truth more obvious than ever before. It has gauged the lengths that people will go to and the price that they will pay to have biologically related babies, rather than adopt one of the desperately needy children who already inhabit the planet. Where in this brave new world is the concern for children--our own, and all the rest?
“Family planning” used to mean making sure you didn’t have too many kids too early. These days family planning might be better construed as making sure you have your children early enough to have them healthy. That might require sacrifice, and in our society it still means that women will have to sacrifice more than men.
But perhaps we should try to change society rather than female biology. Would-be parents might also keep in mind that sacrifice is a big part of the job. Science has not changed that, and it never will.*
