IVF And The Right To Life

In vitro fertilization has long been a controversial issue for our society, except for couples who want children and for whom IVF is either their best or only option. It violates the (in my judgment, debatable) teachings of more than one religious tradition. Its failure can leave crushing disappointment and hopelessness in its wake. Its high cost creates pressure for quick success, and tempts physicians to increase the odds for such by transferring a larger rather than smaller number of embryos to the uterus in a particular cycle. And it sometimes forces medically necessary but ethically disturbing considerations later in a pregnancy about aborting one or more fetuses for the sake of the others’ and/or the mother’s health.

Of all the most recent discussions of these issues, surely the most volatile is the one set off by thenow infamous clinic whose doctors transferred six embryos into a California woman who had already proved her fertility six times over and who subsequently gave birth to octuplets from the transfer. (Two of the six implanted embryos subsequently split into identical twins.) Hopefully, the needs of the innocent newborn in this fiasco will not soon be forgotten in the rush to judgment on their mother and on the physicians and clinic staff members who aided and abetted what surely is egregious medical malpractice.

In the meantime, the rest of us might make good use of our reflection time to weigh some of the complicated moral issues that surround, sometimes oppressively, the practice of IVF. The situation begins with a couple unable to conceive a child by what is supposedly God’s own preferred way of doing it, and suffering no small amount of anguish over the all too evident absence of divine intervention to make their love-making “fruitful.” Into the situation enters an angelic host with medical degrees, offering a technological solution to their spiritual problem. For some observers, the only relevant moral issue is whether the couple will muster the courage to say “No” to the proposed intervention. For others, it is whether the couple will have enough hope to say “Bring it on,” with the more embryos successfully transmitted the better. Those who take either position will probably be more comfortable logging off of this website now, for in fact we have only begun to approach what is at stake morally with respect to the recent Nadya Suleman controversy.

Given a typical picture of multiple miscarriages and limited financial resources, most couples who make use of IVF would not be content with the transfer of a single embryo. (Currently, less than 10% of IVF procedures involve such.) Prevailing guidelines in the medical profession seem more reasonable, permitting in “usual” circumstances the transfer of up to two embryos to a uterus in any cycle. Transferring more increases the risks of neonatal deaths and of developmental disabilities over the survivors’ ensuing lifetimes. The problems begin when these guidelines are overlooked, along with the fact that transferred embryos many times yield twins (in a third of cases or more), or even triplets or more (between 4 and 5%). From both a medical and an ethical standpoint, is further intervention in these latter instances necessary?

Responsible physicians answer in the affirmative, at least in the sense that having the option to intervene medically is a necessary condition of responsible medical practice. What kind of intervention in specific? Basically, “selective reduction” of the multiples: in essence, abortion, on the basis of genetic testing, of observations via sonograms up to three months into the pregnancy, and sometimes of the parents’ gender preference.

Responsible ethicists have to weigh in on answering this question with other considerations in mind, also. One is the distressing possibility of selective reduction’s serving the purpose of engineering “designer babies” rather than just healthy ones. Another is having to wait a relatively long time in the pregnancy to learn enough about the relative chances of survival and thriving of each of the “higher-order multiples.” At three months, a fetus encounters us as much more like an actual human being than an embryo does at three days. But the right to life extends to all the embryos, and it is the very existence of them all that may be at risk precisely because “all” encompasses such an unhealthily large number.

One thing that seems clear from the Suleman case is that too many physicians out there are playing fast and loose with their Hippocratic oath to do no harm. Transferring fewer embryos at the outset of an IVF procedure will go a long way toward allowing couples to be fruitful and multiply responsibly, and toward freeing the rest of us from moral dilemmas that might be avoided in the first place.