article

07.26.10

A New Debate Over In Vitro

A report about women aborting fetuses conceived by IVF has even pro-choicers asking: Must women who get fertility treatments carry their pregnancy to term?

Despite early ambivalence about motherhood, when she reached her forties, Sarah decided she wanted a baby. She embarked on the often long, arduous process of in vitro fertilization—and conceived, using a donor egg. But as the pregnancy progressed, she felt less sure of her decision, her reservations growing with the embryo inside her. She realized that she didn’t want to be a parent, after all. So she got an abortion.

While several years have passed since Sarah (not her real name) solicited the New York University Fertility Center, her case stands out to Dr. James Grifo, director of the clinic, as the only instance of abortion after IVF he’s seen in his 22-year career. “You can’t always know how you’ll feel, until you’re there,” he told The Daily Beast.

Other fertility specialists across the U.S. recall similar stories, those rare exceptions to their usually extraordinarily grateful-to-be-pregnant patients. There was the woman who became pregnant with twins and felt unexpectedly overwhelmed, leading her to terminate. The anorexic woman who broke down when her stomach began to expand. The even rarer cases of parents who weren’t satisfied with their baby’s sex.

Until recently, these tales remained enshrouded in the walls of fertility clinics and obstetricians’ offices. Over the past month, however, they’ve been thrust into an international spotlight, sparking outrage and raising new questions about reproductive rights.

The debate began last month, when a front-page article in The Times of London revealed that, every year, an average of 80 women in England make the decision to terminate after IVF. The paper gleaned the figure from the country’s Human Fertilisation and Embryology Authority, under freedom of information rules. With the headline “IVF babies aborted as mothers lose in love,” the story suggested that these dozens of women ended their pregnancies after their relationships crumbled, or that they’d simply had a change of heart. Pro-lifers condemned the selfishness of the women, taking to blogs and comment sections. Pro-choicers and members of the fertility community called the story misleading.

“These abortions aren’t a trend,” says Lisa Marsh, a fertility counselor and London-based blogger for the American Fertility Association. “Nobody within the community is speaking out about it. [The paper is] calling it a scandal, with nothing backing it up.”

And in fact, a week and a half after the Times published its controversial piece, the British regulatory agency released a breakdown of the data, revealing a far more nuanced explanation than mere fickle fertility patients. The figure included abortions performed after mothers learned their fetuses had conditions that would mean death outside the womb. Other fetuses had Down syndrome or severe chromosomal defects. The figure even included some situations suggestive of miscarriage, which shouldn't have been classified as abortions in the first place. And notably, for about two-thirds of the cases, no data was provided at all.

Directors of fertility clinics, bioethicists, and counselors confirmed to The Daily Beast that the alarm bells were perhaps rung prematurely. Clinicians stress that abortions after IVF are something they’ve encountered once, twice, or at most a handful of times during decades-long careers. Dr. Mark Evans, president of the Fetal Medicine Foundation of America and the director of Comprehensive Genetics in New York, remembers one case of abortion after IVF in 20 years, in which a patient learned that her husband was having several affairs, and she couldn’t go through with the pregnancy. “Anybody can think of something that’s happened to somebody, sometime, someplace,” he says.

But the misleading Times article, and the outrage it sparked, inadvertently revealed an interesting new angle to the IVF debate—namely, that some people believe that mothers who conceive through in vitro fertilization give up a degree of bodily autonomy. It raises a provocative question: Do women who become pregnant through IVF relinquish their pro-choice prerogative to some degree?

Most pro-choicers say choice is choice, and no mother should be forced to have a baby. But some see shades of grey. “There’s a strong argument that they are [more responsible for carrying the baby to term],” says Dr. Josephine Johnston, a bioethics research scholar at the Hastings Center. “Women who go through fertility treatment have brought into the process physicians and nurses. They’ve really asked for a lot of help from other people.” At the very least, she said, these mothers owe it to their team to give the decision to have a baby serious thought beforehand.

It’s not so much that patients owe them, says Dr. William Gibbons, president of the American Society for Reproductive Medicine and director of the Baylor Family Fertility Program in Houston. He points out that some clinicians may feel conflicted about these cases because they indirectly helped to facilitate an abortion by creating a baby in the first place.

“Clearly, I come to work every day thinking that I am helping people build families, often through very sophisticated means,” he said. “Once someone’s pregnant, if she decides to terminate, it’s not our first choice. But neither is it our job to condemn someone for that.”

In England, because the country’s National Health Service pays for IVF in many cases—and also pays for abortions—some say that women who get pregnant with taxpayer money are obligated to at least take that into account when considering an abortion.

And pro-life supporters see little room for ethical debate. “It would be ironic if not so heartbreaking that women who go through the discomfort and expense of IVF would then turn around and abort the very baby they went to such an extreme to create,” says Carrie Gordon Earll, a spokesperson for Focus on the Family. “Carrying the baby to term is the right response in these cases, not abortion.”

Yet in the wake of the Times article, many bloggers and activists took the stance that the means by which a woman becomes pregnant shouldn’t impact her right to have an abortion, and Planned Parenthood Federation of America agrees. “A woman who has become pregnant using in vitro fertilization (IVF) is no different from a woman who becomes pregnant any other way,” Dr. Vanessa Cullins, the organization’s vice president for medical affairs, wrote to The Daily Beast. “Every woman must be trusted to make the best decision for herself and her family, regardless of how she became pregnant.”

While no data appears to exist on women who plan ahead to get pregnant naturally, then decide to terminate, it’s worth noting that a 2005 study by the Guttmacher Institute found that 48 percent of women surveyed, all of whom had sought abortions, said they’d done so because they didn’t want to be a single mother or were having relationship problems, among other explanations.

While women seeking post-IVF abortions for emotional reasons may not be a widespread problem, some clinicians say these cases underscore just how stressful fertility treatment can be—and the importance of seeking counseling. Marriages do occasionally fall apart during the process, or couples halt it halfway through. “Going through IVF can affect patients on so many levels,” says Dr. Lynn Westphal, director of the Stanford Fertility and Reproductive Medicine Center. “It’s their future. It can have financial implications. And for a lot of people, the emotional aspect is much harder than the physical aspects.”

For this reason, Dr. Alice Domar, director of the Domar Center for Mind/Body Health, affiliated with Boston IVF fertility center, recommends that all couples considering fertility treatment see a counselor at least once at the beginning of the process. Only some clinics in the U.S. require this. “Before anybody embarks on a behavior that gets them pregnant,” she says, “they have to really think: Is this the right time for you, are the circumstances adequate to support you?”

Because in the end, terminating fertility treatment or terminating a relationship may prove less traumatic than terminating a pregnancy.

Danielle Friedman has worked as a nonfiction book editor for Hudson Street Press and Plume, two imprints of Penguin Group. Her writing has been published in the Miami Herald, and on Slate's DoubleX and CNN.com. She is a graduate of the Columbia University Graduate School of Journalism.