Fertility Drugs and Social Costs

The recent birth of octuplets in Houston is being celebrated in some quarters, as was the birth of septuplets last year in Iowa. In that case, the husband exclaimed gratefully, “God could have given us one, but God’s entitled to give us seven.”

It wasn’t all God-given in either case. Because doctors had dosed the women with fertility drugs, their ovarian follicles released many eggs. Most infertility experts recommend that when more than three or four egg follicles develop, doctors stop treatment and begin a new cycle with lower dosages.

However, because infertility treatments go unsupervised and unregulated in the United States, safe and effective boundaries are often ignored. Procedures like ultrasound and estrogen level monitoring, for example, are too often not used to detect an overabundance of ripe follicles. In the case of in vitro fertilization, doctors sometimes implant more than four embryos in a woman. When pregnancy occurs, the extra embryos often take hold.

The Houston babies were more than three months premature, and doctors were giving them an 85% chance of surviving. Because babies in multiple births tend to be premature and underweight, they often die or are afflicted with severe lifelong disabilities. The costs to society, for intensive hospital care and long-term support, can be substantial, especially in cases less remarkable than octuplets. And the lives of the children involved may be stunted.

Germany last year prohibited doctors from implanting more than three embryos in any woman. That’s not a solution likely to be accepted in the United States, but Congress and the Clinton administration shouldn’t ignore the issue.

Physician groups like the American Society of Reproductive Medicine need to develop training and credentialing requirements for doctors performing advanced reproductive treatments. And patients demanding aggressive fertility therapies should be required to acknowledge the dangers, including miscarriages, stillbirths and multiple children with severe disabilities. One current response to multiple pregnancies is abortion of some of the fetuses. That’s another issue no one wants to touch--but again, more conservative use of drugs and implantation is a solution.

Infertility treatments can bring the joys of parenthood to the infertile and to older baby boomers who delayed having children. But in addition to celebrating such promise, government and society need to openly debate the resulting problems. Irresponsible use of fertility technology carries costs to more than the would-be parents.