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The Slippery Slope of IVF

A 60-year-old Canadian woman gives birth to twins. Her pregnancy was a result of in vitro fertilization performed in India. That news comes on the heels of octuplet + six mom Nadya Suleman talking on "The Today Show" about her multiple IVF procedures in which six embryos were transplanted. "The Today Show" is running a three-day series with Suleman that ends tomorrow.

Sixty-year-old Ranjit Hayer isn't the oldest person to give birth recently via IVF performed in India. Indian woman Rajo Devi, who says she is 70, gave birth in December to a little girl. Devi's husband is 72. Regulations for infertility procedures are more lax in India than in other countries, particularly Britain, where a law requires that infertility treatments should not be provided unless the doctor has taken into account the welfare of any child born as a result of the treatment.

IVF along with other infertility treatments can be a miracle for plenty of wanna-be parents who can't get pregnant without the procedures. The pain of trying and trying and trying to get pregnant, only to feel disappointment for years can depress even the most optimistic folks and ruin relationships. From the beginning days of the procedures, infertility treatments have walked an ethics tightrope.

Given that crossing an ethical line is so difficult to determine, will we know when we've gone too far in helping otherwise infertile people have children? Is there a point when doctors should reject potential parents because they are too old and what age really is too old? And if a patient wants to implant six embryos that belong to her instead of the recommended 2 or 3 depending on the age of the mother, is the doctor required to perform the procedure or can he reject the request because of the potential consequences?

The ethics committee of the American Society of Reproductive Medicine says that it "believes that the well-being of offspring is an overriding ethical concern that should be taken into account in determining whether to provide infertility services." However, the committee also points out that federal anti-discriminatory laws apply to infertility treatments. "Indeed, the federal Americans with Disabilities Act, which applies to private fertility clinics, prohibits denying persons with disabilities access to infertility services if the denial is based on ill-founded doubts or stereotypes about their ability to rear and parent," says the committee's statement on child-rearing ethics. Given that, who's to say that denying a patient a chance to have a baby at age 60 or 70 isn't age discrimination?

In a Chicago Tribune story last week about the ethics of implanting six embryos in Suleman, infertility and bioethics experts were universal in their outrage. They called it "a medical catastrophe" and irresponsible.

Even so, one doctor in California willingly performed the procedure multiple times, just as doctors in India are willingly giving women of post-menopausal age a chance to become moms.

What lines do you think need to be drawn involving infertility treatments? Do you think these procedures need more regulation? Or do you think that personal choice about when and how to have a family is too individual to put laws around?

By Stacey Garfinkle |  February 9, 2009; 7:30 AM ET  | Category:  Newsmakers
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Comments


"The Today Show" is running a three-day series with Suleman that ends tomorrow.

"ends tomorrow."

Thaaaaank God! I am sick to death of Suleman and her annoying stuff.

Posted by: jezebel3 | February 9, 2009 7:46 AM | Report abuse

I think it's a personal choice.
Don't ask me to pay for it and I'm good with whatever you do.

To those who'll howl and possible costs of raising said children I say, once they're here then it's all moot.

I find it hard to believe that 70 y/o will suddenly become a parent-age category.

Posted by: RedBird27 | February 9, 2009 7:51 AM | Report abuse

This is a pretty easy one. The fertility treatments are meant to approximate what would happen naturally. A 70 year old woman would never get pregnant naturally. Similarly, no one gets pregnant with 8 babies naturally. I don't see why this is an ethical dilemma. The number one rule of a doctor is "First, do no harm." 8 implanted embryos violates that for both mother and child. A 70 year old woman is much more at risk of injury or death from pregnancy. I do not agree that people who can't have children shouldn't. However, I do not understand why these people won't adopt. There are plenty of children in this world ready for loving parents. The industry needs more regulation. Can I go to an orthopedic surgeon and say "hey, I don't like this leg. Can you amputate it for me?" or go to a plastic surgeon and say "I've always felt like a cat and would like the 6 breasts to go with it." Those may seem extreme examples, but really, why are they any more extreme than what these people asked for?

Posted by: lafilleverte | February 9, 2009 8:20 AM | Report abuse


or go to a plastic surgeon and say "I've always felt like a cat and would like the 6 breasts to go with it." Posted by: lafilleverte | February 9, 2009 8:20 AM

The answer to that is, apparently, yep.

http://blogs.discovery.com/news_animal/2008/09/people-who-unde.html

I don't think that there is any question but that implanting 6 or 8 embryos at a time is an ethical violation. Like lafilleverte, I find it hard to believe that there is debate on this.

Posted by: VaLGaL | February 9, 2009 8:59 AM | Report abuse

I am with 8:20. I don't understand why this is so complicated. There are restrictions on adoption. In most cases, you are not allowed to go and adopt 8 infants at the same time. Why should IVF be any different. There are also age and health restrictions on adoption as well.

I think some good basic guidelines are what would or could happen naturally. In the case of # of implanted embroyos, I think the health of the children and the mother needs to be the most pressing issue. Then the ability to raise these kids. Again there are financial guidelines to adoption as well. I think the current suggested guidelines work well. No more then 2 in women under the age of 35 and no more then 3 in a women past 35.

I personally think the top age should be 50. A women is generally considered medically infertile at around age 45. Doesn't mean that a women could not get pregnant naturally older then 45, it means it is highly unlikely (less then 1% chance). So given even a little extra time, 50 sounds like a good age to stop IVF.

Why anyone would want a newborn at age 70 is beyond me. But given they wanted children, I don't know how they can logically think they will be alive and healthy to raise them even in 10 years.

Of course even young people can die but the probability is lower then a 70 year old. And yes, it is unfair that IVF should be regulated why any fertile Myrtle can get pregnant. But life isn't fair. But we need to think of these children and women.

I think Suleman's doctor was crazy to implant her with 6 embroys (she claimed two sets of identical twins) after she had 6 kids under the age of 8 at home, no husband, no support system (like a marriage), and no job.

Posted by: foamgnome | February 9, 2009 8:59 AM | Report abuse

I have not really followed the gory details in the news. I understand that the mom currently has no husband and is not employed. Does anyone know how she paid for the IVF? Isn't IVF very, very expensive? Is she independently wealthy, or what?

Posted by: VaLGaL | February 9, 2009 10:21 AM | Report abuse

Problem is the demands we face in chasing our dreams can hit a roadblock when it comes to biology. For every octuplet mom we hear about, there are hundreds of others who would be happy with a baby at 40 or so and willing to consider other options to conceive, if needed. I am 41 and my wife is 38 and expecting our second child. We did not use IVF but we would not have hesitated if we were unable to conceive. And I think I am at a great time in my life to be a Dad - I am more resilient and more patient. Plus I am a lot less selfish than I used to be.

Posted by: Dadat39 | February 9, 2009 10:28 AM | Report abuse

Valgal: It's a little sketchy. The mom of the mom has said that her daughter was paid to do it - but that begs the question...why? It's so strange.
Yet Canada is denying health care to people every day - and some of those decisions are based on age (and sometimes people as young as 57 being told they are too old for certain procedures).
I don't know what the answer is. I certainly think if a women is past menopause, then she shouldn't get IVF. I just don't want laws to that effect on the books.
Again, if the person pays for it themselves, well, then, I don't know. But there are plenty of things that people pay for that I don't agree with. The question is - should it be illegal? yes, it is most definitely ethically suspect (Who carries that many babies and thinks it's okay? The woman needs a psychological evaluation, actually, not IVF). How could one person possibly take care of 14 kids? We have two (with two parents) and I find it exhausting.

Posted by: atlmom1234 | February 9, 2009 10:31 AM | Report abuse

Count me in the minority of those who think that IVF and other related technologies are solutions in search of a problem. I agree that it can be a blessing for those who are unable to have children otherwise. But as a society, clearly we're not ready to yield the technology in a responsible manner. Sometimes, life just isn't fair. That said, the genie is out of the bottle, so any attempts to restrict the use of IVF and related technology would be a Sisyphean task.

Posted by: NoVAHockey | February 9, 2009 10:54 AM | Report abuse

"Why anyone would want a newborn at age 70 is beyond me. But given they wanted children, I don't know how they can logically think they will be alive and healthy to raise them even in 10 years."

Because we do a really poor job of discussing and preparing, let alone accepting the inevitablitiy of, death. This is just an extreme manifestation of that. 50 is the new 30 and all that nonsense.

Posted by: NoVAHockey | February 9, 2009 11:08 AM | Report abuse

Boy, you start restricting a woman's right to have children, regardless of how ethically sticky it may be, and you get into dangerous territory. However, I do think a line should be drawn for the benefit of the children. It's pretty clear that anything beyond triplets, and even triplets, is incredibly dangerous to the children. Our bodies are just not meant to nourish the nervous systems of that many fetuses.

I think it's safe to say you shouldn't implant more than 3 embryos. If you're doing clomid, etc and more than 3 eggs are developing, you should wait another month and reduce the dose. As far as age, I would think post-menopausal is too old. Now, this is just based on trusting biology. Of course people want to push the boundaries of biology. Is that best for a child? I doubt it.

I just hate to see the countless families who are using the technology to have a single child born into a stable, loving household smeared because they are lumped in with the insanity of this particular case.

Posted by: atb2 | February 9, 2009 11:11 AM | Report abuse

Just because you can do something doesn't mean you should.

Posted by: falltillfly | February 9, 2009 11:21 AM | Report abuse

NoVa: I definitely agree with you.
atb: No one is smearing anyone. We are discussing these 'out there' cases. And what we can learn from them.
I personally have incredibly mixed feelings having my own biological children. There are so many adoptable children out there - and I selfishly had my own? I rationalize it a little bit (it happened naturally, easily, so, well, then it was meant to be).
So I am pretty sure (no one can no anything for sure til they're in that space) that I could not have gone through any of those treatments, or whatever, to have children biologically. I would have thought - well, then it's not meant to be, there's some reason I can't have children biologically - so I'll go and adopt.
So it's definitely tough for me to look at others and wonder how they think that their biology is so important that when a power higher than them has said, basically, no, and yet they want to do it anyway. We are a society of 'want to do it anyway' for SO many things, and this is just another one.
Then what ends up happening, is what we see today - the child is the be all and end all of everything. There are so many parents who have gone through so much that they spoil their kid(s), or let them do whatever, because they are so grateful to have had any children at all - they would bubble wrap them if they could, too. So we're creating the society we have (and we've certainly discussed this before on here) regarding children who think the world should be handed to them, of parents who do everything (including calling up university professors when their kid gets a bad grade, etc).
Having said all that - I DO NOT believe that there is much to do to regulate it. As I mentioned - not having women get IVF after menopause would be a start. Implanting up to only 3 embryos would not be a hardship. But I don't know how I feel about it being regulated by the government passing laws - it SHOULD be regulated by a medical body. HOWEVER, it doesn't matter what you do - there will always be somewhere a person can go to get any procedure they would like somewhere in the world. People should have their own ethical barometer and live by that.

Posted by: atlmom1234 | February 9, 2009 11:26 AM | Report abuse

I saw the segment on the Today show this morning. All I can say is, the fertility specialist should have requried psychological counseling first. He may have made the same decision in the end, but I'm not so sure. The mother admitted that she wanted a lot of children because she didn't feel she got enough love as a child, and admitted she isn't sure she gives her 6 children at home enough, if she didn't get enough as an "only". She admitted that the older kids didn't seem too keen on the idea of another sibling. She admitted that she hasn't worked for years. And while she says she hasn't, and won't, take government assistance, she is counting on her church, family, and friends to help provide supplies and care for her children.

And this is where I have a problem. I"m fine with the idea of choosing single motherhood - I made the same choice, and look forward to welcoming my 1st child in about 2 months. I'm fine with IVF, and even implanting more embryos than normal in a patient who has proved to have a low response to the treatment (I think she said each of the previous pregnancies she had 6 embryos implanted, and had 4 singletons, and 1 set of twins, before the 8). I'm not fine with people actively choosing to go to extreme efforts to have children when they are not supporting the children themselves. I know it happens all the time in low-income homes, but these people aren't going through IVF. Most people think long and hard about the financial cost of children, and the physical/emotional reality of raising them, in deciding how many they really want. People make sacrifices to pay for daycare, or sports, etc. This mother had a fresh manicure, and her own mother providing food, shelter, and care for her 6 children. What sacrifice has she made? What is her contribution to her children's upbringing?

Posted by: JHBVA | February 9, 2009 12:02 PM | Report abuse

I heard her on the nightly news. She said she got some financial pay out for a job related incident years ago. I think it was around 165,000K.

While that is plenty of money to do multiple rounds of IVF, it is not much money to support 14 kids with no job.

She admitted that she had no real idea of how she was going to pay for these kids. All she says is she plans on going back to school to get a masters degree in eductaion (I think?) I don't know but I am guessing the average MA/MS degree does not pay enough to support 14 kids.

The women is a certifiable.

Posted by: foamgnome | February 9, 2009 12:45 PM | Report abuse

Correction: The women is certifiable.

Posted by: foamgnome | February 9, 2009 12:46 PM | Report abuse

Foamgnome: the average for any job (except, maybe CEO) won't support 14 kids.
But more than the support - how do you manage them anyway? Just logistically? When you have 14 kids in succession - i.e., maybe one every two years or so - you have older children to help out with the younger ones. Whereas with this - she has 14 kids under 8 (I think that's the age). So the older ones can hardly take care of themselves, let alone help out.

Posted by: atlmom1234 | February 9, 2009 12:48 PM | Report abuse

> I do not agree that people who can't have children shouldn't. However, I do not understand why these people won't adopt.


Actually, adoption was our first choice. But because I was married previously, we were told we have to wait at least two years before we could even begin the process -- and then we might not be placed with a child for another year or two, if ever. At ages 43 and 42, and childless, we decided we did not want to wait that long. So we did IVF and now have a beautiful baby girl. We chose to transfer only a single embryo (out of three fertilized) and everything worked beautifully. Although money was not a factor in our decision, I think it's worth mentioning IVF cost us less than half of the adoption fees.

So although adoption was our first choice, IVF was faster, cheaper and we were were in total control of our daughter's pre-natal care -- three possible reasons "why people don't adopt."

Posted by: layla2 | February 9, 2009 2:22 PM | Report abuse

I have to agree with lalya2. When I started on my journey to parenthood, I was convinced I would adopt. As I did more and more research, I realized that the restrictions on international adoptions have multiplied in recent years, and if you don't have $20,000+ sitting in a bank account, good luck. And then, if you're lucky, you'll take home a 10 month old "infant" - so not only do you have no so in prenatal care, you miss out on early infancy. And while there are several countries that place infants in foster care,many still place infants in group homes, so you have increased attachment disorder issues, among other things. Domestic adoption also has it's financial and time challenges, not to mention prenatal care. But assisted reproduction - parts of it might be covered by your insurance company, you have slightly more control, and of course, you do control the prenatal care and start raising your child as a newborn. Plus, it's WAY cheaper.

For those who choose to adopt older children out of the "system" - I commend you. It may be cheaper, and these children no doubt both need and deserve loving homes. But many of us are not equipped to handle their special needs, or can afford the time off work required to see that they get the aid available to them.

Posted by: JHBVA | February 9, 2009 2:48 PM | Report abuse

fr jhbva:

>...The mother admitted that she wanted a lot of children because she didn't feel she got enough love as a child, and admitted she isn't sure she gives her 6 children at home enough, if she didn't get enough as an "only". She admitted that the older kids didn't seem too keen on the idea of another sibling....

Gee, I wonder why they wouldn't want another baby in the house.....This reminds me of that family in Iowa, I think that had 7 kids w/IVF. The oldest child who was about 3 at the time actually put a sign on her bedroom door that said "No babies in here". I can certainly understand why; there is no WAY one parent can take care of 14 kids.

Posted by: Alex511 | February 10, 2009 12:05 PM | Report abuse

Men can reproduce at any age. Women should have the same capability.

Posted by: commenter5 | February 10, 2009 1:05 PM | Report abuse

many who object to abortion believe it's "God's will" that unwanted babies be born. Do any of them ever consider that it might be "God's will" that some women not become mothers?
I hope both Nadya and her doctor get the mental help they need.

Posted by: sophie138 | February 11, 2009 3:33 PM | Report abuse

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