We’ll take only one baby please…

In-vitro fertilization (IVF) is a procedure used to treat infertility when other methods of assisted reproductive technology have failed. A major risk of IVF is multiple births because a common practice of treatment is multiple embryo transfer to boost the pregnancy rate. Since IVF is sometimes a last resort for a woman to get pregnant, many couples welcome the idea of multiple births since they were having trouble having one baby, let alone several. However, others are not so keen on the idea.

Recently, a lesbian couple in Australia attempted to sue their obstetrician for failing to ensure that a single embryo was implanted in the birth mother. The couple, now the parents of 4-year-old twin daughters, were seeking medical negligence in the amount of $382,000. According to an article in USA Today, the claim was to cover the cost of raising one of the children, including private school fees.

The judge overseeing the case ruled against the couple, citing that the birth mother had actually acted negligently by failing to ensure the IVF clinic staff were aware that she no longer wanted to have multiple embryos implanted. The couple are considering an appeal but the case leaves many, including the state president of the Australian Medical Association, wondering why such a suit was ever brought before a court in the first place.

Yes, multiple births are accompanied with increased risk of pregnancy loss, complications, prematurity, neonatal morbidity, and the potential for long term damage. However, when IVF results in the birth of healthy babies, why mess with it? IVF is an investment that people can spend years thinking about before deciding on treatment. It is not cheap and most expenses are paid out of pocket by the couple. If a couple has devoted that much time and personal resources for IVF treatment, shouldn't they have enough sense to set aside adequate resources for the end result? Or in this case...results?

Too many twins? Says who?

Today's NYT ran a piece that describes calls to reduce the number of multiple births resulting from in vitro fertilization efforts. Since the introduction of IVF in 1980, multiple births in the United States have increased by a whopping 70 percent--in no small part due to the fact that many prospective parents choose to implant multiple embryos in the hopes of increasing the odds of a successful pregnancy and birth. Several of us have blogged on other issues re multiples before, too... here, here, here, and here.

The article quotes a few experts who basically say that as the technology has improved, the need to implant "extra" embryos has diminished; but this raises the question of just what a successful IVF result looks like. Is one baby? More than one baby? All the babies the woman wants? And what about the health status of the infant(s)? If carrying multiple fetuses increases the health risk to mom and babies, but the woman wants to "maximize her investment" in the painful and expensive IVF cycle by shooting for triplets, can/should physicians try to dissuade her? On what basis?

It will be interesting to see how this plays out, particularly since fertility medicine is largely a consumer-driven affair. Infertility treatment generally isn't considered medically necessary by insurers and therefore isn't a covered benefit. People who pursue it are paying thousands of dollars--per cycle--out of pocket. Given all that, I wonder whether "the customer is always right" will be the governing rule.

Removing the need for men?

From the Daily Mail, a scientific breakthrough with a technique will help lead to new treatments for infertility, but may render the male partner obsolete in reproduction: British scientists discover how to turn women's bone marrow into sperm.

The comments to the article range from humor (But without men, who would mow the lawn?) to outrage (What is it coming to, the world has gone totally mad...) But I can think of several reasons why this won't render males obsolete -- first, I'm really rather fond of the male I'm married to, and secondly, there is nothing that indicates that the 'new' way' is more fun than the 'old way'. Also, I guess I also to like think of my life partner as something far more than a mere tool for reproduction; that our union is something that has contributed to our personal and spiritual growth.

Surrogates from India, the WBP and the Huffington Post

Our founding director, Kathryn Hinsch is quoted on the Beth Kohl's Huffington Post blog, voicing her concern over the exploitation of women in India, ending up on the short end of the surrogacy stick. Kohl writes about "reproductive tourism" at the The Akanksha Infertility Clinic located in Anand, India in the Gujarat State: "To be clear, these are professional surrogates, local women who receive decent medical care and detailed contracts...Using a gestational surrogate in the U.S. can cost $50,000 and up. But an Akanksha surrogate costs only $5,000. The surrogates at Akanksha earn more than 100,000 rupees ($2,250 U.S.) per pregnancy, a massive amount compared to the average daily income of five dollars. Some people consider this a win-win situation..."

After speaking with Hinsch, Kohl writes: "Hinsch also voiced concern over the long term health implications of carrying another person's genetic matter, pointing to the fact that women who gestate even genetically-related multiple boys have increased risks for autoimmune problems, the genetic difference between the male and female of the species being enough to upset our natural physical make up. So what is the physical impact of carrying a non-related fetus? How is that risk compounded when carried out repeatedly which may happen at a place as well-managed as Akanksha in a developing region like Gujarat, India?"

Kohl has immense stores of sympathy for infertile couples and recognizes that there is a cost-effectiveness that is appealing to these couples -- I like the way she concludes, proceeding with caution, taking nothing for granted: "The act of bringing forth life, no matter whose constituent parts, no matter whose uterus or birth canal, is far too complicated to isolate it from history or the world as it is."