By David Gushee
In January, a California woman named Nadya Suleman gave birth to octuplets through in vitro fertilization. These eight babies were added to six others that Suleman had also conceived through in vitro procedures.
Nadya Suleman is an extreme example of a growing trend. The reproductive-technology industry is booming, with over 130,000 procedures and 50,000 births a year, up from around 65,000 procedures and just below 20,000 births a little over a decade ago. Almost 90 percent of in vitro procedures involve transferring more than one embryo; nearly a third of in vitro live births involve multiple children; 2 percent of them involve triplets or more. And these multiple births often come with health consequences such as the need for long-term care due to low birth weights and various disabilities. Sometimes these long-term expenses are paid by the taxpayer.
Demand for in vitro and other reproductive technologies is driven from a number of directions. Infertility rates among couples seeking children now stand at over 10%, due to social and environmental factors. Single and divorced women, and some men, also have turned to the industry in search of the children they cannot have any other way. The breakdown of marriage has produced more and more people in such situations.
The reproductive-technology industry is almost entirely unregulated. Professional standards for the industry are primarily framed as guidelines and not enforced by law. For example, the American Society for Reproductive Medicine established a guideline, not a rule, that doctors should transfer no more than two embryos for women under 35, and no more than five (!) for women over that age. But this is just a guideline, and even statistical reporting of what fertility clinics are doing is voluntary.
As a competitive industry, reproductive clinics must sell themselves based on their results. The bottom line is that people are desperate to make babies. Implanting multiple embryos, it has been believed, increases the likelihood that at least one will survive to birth. It is therefore in the business interest of fertility clinics to do whatever maximizes their live birth rate. Meanwhile, the expense of these procedures motivates patients to make the most of every round of in vitro fertilization.
The spate of well-publicized multiple births appears at least partially related to a striking paradox — conservative religious believers who do not believe in wasting, destroying, or “selectively reducing” the embryos from their in vitro processes. These are people whose religious beliefs do not prohibit them from intervening via technology in the procreative process, but do prohibit them from destroying embryos once they have been produced. It makes for an uneasy combination of tradition and innovation, of ancient beliefs partially adapted to contemporary medical practices.
Certainly reproductive technologies have brought into the world hundreds of thousands of children much loved by their families. No one can or should question that. In a society in which over a million babies are aborted each year, it is heartening that the desire to give birth to new life still runs so deep in so many.
But this industry needs better regulation. Federal law is required to establish basic professional standards for the industry in areas such as physician training, reporting and practices. I would like to see a healthy debate on a ban of the transfer of more than two embryos, as well as on “selective reduction.” Any reform of our health-care and health-insurance system requires consideration of the cost and value of these procedures.
Meanwhile, Christian ethics has work to do. While Roman Catholic ethics officially has rejected any technological intervention in the procreative process, Protestant ethics has tended to offer an uncritical blessing, to try to suggest a few caveats or limits, and mainly to say nothing. A handful of recent younger ethicists and social critics have begun exploring the deeper implications of this increasingly massive industry. But this analysis hasn’t really filtered to the grass roots. Most local-church pastors have little background or training to help couples and families think through the theological, financial, and moral issues raised by the reproductive-technology choices they are presented with when they face fertility problems.
Absent any serious reflection or guidance from their churches, many of our people gradually wander into the thicket of reproductive technology without a guide. The churches must do better. Our nation must do better.