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Popular Fertility Treatments Still a Vast Experiment

Sunday, September 1, 2013

While IVF and ART are becoming increasingly common, there's still a lack of evidence-based medicine, and laws in place, behind these reproductive technologies, say the guest editors in this excerpt from Miriam Zoll's "Cracked Open."

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While IVF and ART are becoming increasingly common, there's still a lack of evidence-based medicine, and laws in place, behind these reproductive technologies, say the guest editors in this excerpt from Miriam Zoll's "Cracked Open."




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Mayo Clinic on Flickr, under Creative Commons (CC BY-NC-ND 2.0)

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(WOMENSENEWS)-- On Sept. 5, 2012, a 53-year-old grandmother from Chicago, Cindy Reutzel, birthed her daughter's baby, and said she would do it again. That same month reality television star Kim Kardashian announced that she was freezing her eggs for hopeful future use through a new technique unsupported by long-term women's and fetal health safety studies.

A few days later, news circulated around the globe that the first mother-to-daughter womb transplants had been carried out in a hospital in Sweden. Some headlines touted the "miracle" that a woman might now have the ability to birth her own child from inside the same womb she herself was carried. The success of the procedure, doctors said, will not truly be "celebrated" unless the daughters actually birth babies from frozen embryo transplants at some point in the future.

ABC News called the womb transplant the "latest fertility feat" and raised questions about the ethics driving an industry that has grown into an ever-expanding multi-billion-dollar global business. Dr. James Goldfarb, director of University Hospital's Fertility Center in Cleveland and past president of the Society for Assisted Reproductive Technologies, was quoted as saying: "I've been around long enough to see some stuff we never imagined become sort of standard."

Roll back to four years ago and news footage of "Octomom," an unemployed California mother of six who gave birth to octuplets. All 14 of her children were born as a result of assisted reproductive technologies (ART) or in-vitro fertilization (IVF). As in prior cases of higher-order multiple births involving quintuplets and sextuplets, the nation rallied for this mysterious woman, who early on was anonymous. Soon after, the world came to know her: Nadya Suleman posed for the cameras and described how her fertility doctor had implanted not the "standard" one or two embryos into her womb (to reduce health risks) but six.

Lack of Laws

As news about Suleman and her doctor's decision spread, unprecedented public debate erupted about the multiple ethical dilemmas surrounding the births. Kaiser Permanente's Bellflower Hospital, where the babies were born, deliberated about whether it should release the octuplets into the custody of a mother whose financial and psychological state was deemed perilous. The California Medical Board investigated the doctor, Michael Kamrava, and his Beverly Hills fertility clinic, and eventually discovered that he had implanted not six but 12 embryos. Biomedical ethicists debated that, while Kamrava--whose license was revoked by the board in July 2011--had acted with "gross negligence," he had not broken any laws.

The truth is, there are hardly any laws now in place to break. The federal government requires only that clinics inform the Centers for Disease Control and Prevention (CDC) of their success rates. In many respects it is ironic that while there have been so many recent attempts by policymakers to restrict women's access to legally protected contraception and abortion--two well-studied areas of reproductive health care--by comparison there are so few efforts underway to reign in misleading advertisements, conflicting fiduciary interests and other conditions that surround the growing use of ARTs.

Studies that have been conducted on higher-order multiple births have demonstrated increased risks for cerebral palsy, hearing and visual impairments, cognitive delays and other traumas associated with crowded gestation. Some studies have even purported links to cancer for women who undergo aggressive "ovary blasting."

"Cracked Open" describes the ways in which the hyper-marketed, unregulated U.S. fertility industry has become popularly embedded in our lives and culture. Suleman's story--though bizarre and exaggerated--reveals a landscape of unmonitored medical practices and the absence of meaningful public dialogue as complex new technologies are introduced. This much-needed discourse would benefit the many Americans of reproductive age facing difficult challenges and profound decisions for themselves and their offspring.

Increasingly Popular

Walk into a room full of mostly urban professionals in their 30s and 40s today and you're bound to find at least one couple--if not half a dozen--who have undergone fertility treatments or know someone who has. According to the U.S. National Survey of Family Growth, an estimated 7.3 million people experience infertility, or one out of every eight couples. Data from the CDC suggest that 1.2 million women of reproductive age have had infertility-related medical appointments within the previous year, and an additional 10 percent had received infertility services at some time in their lives. Almost 12 percent of U.S. women aged 15 to 44 have reported using some type of infertility service. The CDC's preliminary 2010 data show that nearly 150,000 ART cycles were reported at 443 clinics, about 91 percent of the total number of clinics in the United States. This resulted in an estimated 47,090 live births (delivery of one or more living infants) during that year.

Thus, increasingly, Americans turn to ART usage, and for a variety of reasons. Many people desire to use the technologies responsibly and as a last resort at building a biologically linked family. Many more are simply desperate, while others are interested in convenience. Some couples who could otherwise produce offspring seek surrogates to avoid the morning sickness and physical changes brought on by pregnancies. Regardless of the reasons, more and more Americans are swarming to the doorsteps of fertility clinics with their hopes high and their pockets bulging with cash.

Many do not realize the extent to which they are participating in a vast experiment, where evidence-based medicine has yet to establish a reasonable foothold. They surrender their bodies, sexualities and emotional lives to the doctors, syringes and drugs that might lead them into parenthood. They sign up willingly because they believe--and the U.S. media reinforces their beliefs--that science and technology have finally outsmarted Mother Nature, and that concern for women's biological clocks is no longer relevant.

Excerpted from "Cracked Open: Liberty, Fertility and the Pursuit of High-Tech Babies." By , Foreword by Judy Norsigian and Michele Goodwin. Published by Interlink Books; an imprint of Interlink Publishing Group, Northampton, Mass.

. . Judy Norsigian is one of the founders and current executive director of Our Bodies Ourselves, also known as the Boston Women's Health Book Collective. An internationally renowned speaker and author, she addresses a range of women's health concerns.

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