Infertility Treatments and Ethics

Medicine always has an impact beyond the walls of the clinic, and this is doubly true of fertility medicine. Aspects of some fertility treatments remain controversial, and will probably always remain so: they touch on basic elements of human culture, and in a very real sense are too important to be left to the doctors. There are few right answers here, and not even any obvious ways to balance the interests of the parents, the child, and society as a whole. So we don’t attempt to give any answers, but simply to point you towards some of the big questions.

Multiple babies

The practice of implanting multiple embryos in IVF and related treatment means that a few cases treatment will be too successful, and several embryos will survive. This is a large part of the reason for a 50% increase in the number of twins born in the USA since the beginning of IVF treatment. Multiple births are some 20 times more likely after IVF treatment than in the population as a whole, with the difference being even higher for triplets and larger groups.

The issue of multiple births can cause ethical concern for several reasons. Firstly, multiple pregnancies are much more likely to end in miscarriage, stillbirth, or premature birth. Over half of multiple pregnancies end in premature birth some 7 times the level in non-multiple births. Partly because of this, the children of multiple births have much greater risk of dying in childhood. Secondly, multiple pregnancies can be very dangerous for the mother.

Multiple births also involve serious financial costs, including on the state. Britain’s National Health Service spends an average of £32,000 on a set of triplets, compared to just £3000 for a singe birth.

All these problems have resulted in a legal drive to reduce the number of multiple pregnancies coming about through fertility treatments. In the UK and Europe, it is now illegal to implant more than two embryos at a time, except in women over 40. The argument for this exclusion is that older women already have a much lower chance of success in IVF treatment, and so the likelihood of several embryo implants being successful is very low.

Increased disease in babies

Babies conceived as a result of fertility treatments are particularly susceptible to certain health problems. Some thinkers question the ethics of doing everything to conceive, at the cost of producing a child with a much higher likelihood of illness. Health problems linked to infertility treatment (or to giving birth at an older age, something facilitated by fertility treatment) include:

    Beckwith-Wiedemann Syndrome
    Angelman Syndrome
    Down Syndrome

Different forms of fertility treatment cause different diseases. Where artificial insemination is used, the baby seems to be at greater risk of a class of genetic disorders known as ‘imprinting defects’. These include Beckwith-Wiedemann Syndrome, a disorder involving overgrowth, which one report claims is six times more common among the children of assisted reproduction than in the population as a while.

Another genetic defect, Angelman Syndrome, which involves retardation and physical deformities, and is caused by the inactivation of genes from the maternal chromosome, may also be more common in children conceived through Intracytoplasmic sperm injection.

There is a major problem in interpreting these findings. The genetic conditions mentioned above are all very rare, and so a report of increased likelihood of them may refer only to a handful of extra cases. When the numbers of sufferers are so small, it is hard to determine whether the increased numbers are just chance.

As more evidence becomes available over the years, we could well see a ‘regression to the mean’, as the reports turn out to be just overemphasizing something that is the result of chance. In any case, it is not clear that the risks facing children born through assisted reproduction are any greater than those incurred through other non-ideal situations like conceiving at an old age or when drunk.

There’s another element to genetic problems with children born from fertility treatments. There is a clear and well-researched link between older mothers and more genetic defects in children. For example a child born to a mother aged 49 has a 1 in 11 chance of having Down Syndrome. If the child is born to a mother aged 25 the risk is massively lower, at just one in 1,250.
Ethical issues with frozen sperm

The use of sperm banks brings with it complications to the normal standards of sexual consent. The legal situation governing the use of frozen sperm varies from country to country but, at a minimum, the written consent of the donor will be needed before stored semen can be used. Some areas remain highly controversial for example the use of a man’s sperm after he has died. The legal, social, and political battles over this area are far from being settled, and will doubtless be a source of dispute for years to come.