Is it Time to Regulate Infertility Clinics?

Posted on | February 10, 2009 | 1 Comment

The curious case of Nadya Suleman

If you’ve turned on the TV in the past few weeks, you couldn’t miss one of two sets of images. The first is our new president attempting to weave his way through a long list of complex issues to stir the country down a different financial path. The second was Nadya Suleman, a young divorced parent of six who just gave birth to eight more children, with the aid of a reproductive specialist. What do these two stories have in common? In both cases, the roles and responsibilities of individuals, communities, and society are up for grabs. Putting it bluntly, who should be allowed to do what?

The focus of the government for now is clearly on the financial sector, and new rules or regulations to deter the types of behavior that got us into this mess. I’ll let the experts deal with that.

As for our young mother of 14, I have to agree with medical ethicist, Arthur Kaplan, who thinks that the idea of a physician being allowed to implant 8 embryos in a young women with 6 children is "ethically bonkers". Dr Jamie Grifo, director of the NYU Fertility Clinic, in a joint appearance with Kaplan on the Today Show, reaffirmed the voluntary standards of a maximum of 2 embryos implanted at one time in women under 35 of the American Society of Reproductive Medicine, and seemed to suggest there was not much more that could be done to control occasional "crazy" cases.

This aversion to placing into law protective rules that would assure some logical limits to human misbehavior I find bizarre. If something is clear enough and defensible enough to be the basis for a national organization’s endorsement as a "voluntary guideline", why not have the guts to do it right? If the American Society of Reproductive Medicine had been as focused on supporting legislation to assure sane limits as they likely were in preventing unwanted government intrusion in the private practice of medicine, would we be wondering this week what will be the destiny of these 8 new lives, let alone the other 6 and their mother who, with the support of her doctor, played out her dream unencumbered and free?

This is not the first time the issue of regulation and the practice of US Reproductive Specialists has been front and center. I’ve covered it several times in the past.

The most common risk associated with IVF is multiple births. While 1% of natural pregnancies result in twins, approximately 1/3 of parents who have live births after IVF have twins. Twins from IVF are more common in the US than in many other nations because laws in other countries prohibit implanting more than one embryo at a time. The US has no such laws but increasingly, fertility specialists are voluntarily not implanting more than two embryos at a time.

Twins do have higher rates of preterm birth and low birth rate. Mothers giving birth to twins require more bed rest, and are more vulnerable to premature labor, hypertension, birth hemorrhage and the Caesarean section delivery. Triplets and beyond up’s the ante with much greater risk for mother and child. To their credit, most US programs fully inform parents of these issues prior to deciding to proceed with IVF, and parents are often more than happy to make whatever sacrifices necessary.

According to Nadya Suleman, her reproductive specialist fully informed her too. Technically everyone followed the rules. But that doesn’t mean that either doctor or patient here were playing with a full deck. The time has come for professional organizations of all types to encode legally broad terms of responsible behavior. "Voluntary guidelines" in this instance and in so many others provide little protection, except to those in charge who lack the wisdom to do what is right.

Comments

One Response to “Is it Time to Regulate Infertility Clinics?”

Juan Torres
May 18th, 2010 @ 12:58 pm

Fertility Clinics really helped a lot in getting my wife to conceive a child. Just make sure you get a reliable one.;'”