New York Times Magazine Examines Continuing Debate On IVF

Main Category: Fertility
Also Included In: Women's Health / Gynecology
Article Date: 23 Jul 2008 - 6:00 PST

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Although in vitro fertilization developments over the 30 years since the first infant was born using the fertility treatment have been "miraculous," it has become "easy to forget the disturbing questions about IVF -- its practices, ethics and impact on public health -- that do remain and are left largely subject to a physician's conscience and a patient's desires," Peggy Orenstein, author of "Waiting for Daisy," writes in the New York Times Magazine.

According to Orenstein, in the U.S., early "fears" disseminated by conservative ethicists that IVF would create "freakishly malformed" infants or "designer children" contributed to a ban on federal funding for IVF driving its development into the private sector. "And for the most part, that's been swell," Orenstein says. About three million infants have been born worldwide using IVF or other reproductive technologies, and almost "every American now knows a family that might not exist were it not for IVF or one of its variants," according to Orenstein. The "trouble" is that "doctors who do IVF are selling a product and their patients are so vulnerable, their experience with infertility so fraught, that they're not always willing or even able to act in what seems like their own best interest," Orenstein writes.

Without independent safeguards, Orenstein writes, there is "little to temper patients' aching hearts." The American Society for Reproductive Medicine has issued voluntary guidelines on the number of embryos physicians should transfer to help reduce the likelihood of multiples with complications such as prematurity, lung impairments, cerebral palsy and death, Orenstein writes. Most reputable clinics observe the guidelines, but there is "always temptation to fudge," she writes, adding that a need to stay competitive and related pressures might contribute to the high rate of IVF multiples produced in the U.S.

Although Orenstein writes that government involvement in matters of reproductive choice makes her "uneasy," some "mandatory reining in might not be a bad thing." Naomi Cahn -- a law professor and author of the upcoming book "Test Tube Babies" -- said that distinction can be made between reproductive privacy and public health concerns. Cahn suggested that the federal government could create a national registry to track the long-term health of children conceived through IVF or formalize the guidelines on embryo transfer and lift the ban on federal financing for research. Cahn also said that requiring insurance companies to cover infertility treatment could reduce a patient's motivation to ask for multiple transfers of embryos (Orenstein, New York Times Magazine, 7/20).

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