IVF: Is the In Vitro Industry Out of Control?

In vitro is worthy of a Nobel Prize, but that shouldn’t blind us to the havoc it’s caused. Debora Spar on how a lawless industry is spawning Octomoms, birth defects, and maternal deaths.

Yesterday, the 2010 Nobel Prize in Medicine was awarded to Robert G. Edwards of Great Britain, the scientist who developed in vitro fertilization. His work, which began in the 1950s, has resulted in the births of 4 million babies since 1978, when Louise Brown, now a mother herself, became the first life born of this groundbreaking therapy. IVF has fulfilled the dreams of countless hopeful parents stricken by infertility—couples, singles, gays, older women, cancer survivors—and extended nature’s narrow window of opportunity for women to enjoy both career and family. Dr. Edwards’ work has clearly led to massive joys for millions of individuals but, more quietly, it has also raised a host of issues that the U.S. refuses to grapple with, much less resolve.

Take, for instance, the strange story of Nadya Suleman, the now-infamous “Octomom,” whose saga reads like a bad MasterCard commercial. One round of in vitro fertilization: somewhere between $8,000 and $15,000. One Caesarean section: roughly $23,000, plus the additional cost of having 46 doctors and nurses in the room. Eight premature babies: about $165,000 for the cost of a stay in the neonatal intensive care unit, times eight. Food stamps: $132 per child per month. Having 14 kids to fill an inner void: priceless.

Big Fat Story: The Tricky Debates Over IVFOr consider Rajo Devi Lohan, now 72, who is believed to have become the world’s oldest mother when she gave birth at the age of 70. As of this summer, she was reported to be dying as a result of complications from her IVF pregnancy. This follows news of the death last year of the former world's oldest mom, Maria del Carmen Bousada of Spain, who left behind 2-year-old twins. While Lohan and Bousada are clearly extreme cases, their stories beg the question—how old is too old? There are no limits on the age at which a doctor can legally help a woman to conceive in the United States, and most fertility experts, who charge around $13,000 a cycle, are unwilling to set any. As one Manhattan expert expressed it, “Women have many reasons to want children, at any age. Who am I to stop them?”

As one Manhattan expert expressed it, “Women have many reasons to want children, at any age. Who am I to stop them?”

And then there is the conspicuous dearth of studies examining the risks to mothers, egg donors, and children. Part of the reason for this gap may simply be time: Assisted reproduction has only been around, after all, for 30 years. Yet one study from 2002 found that children conceived with IVF and ICSI (intra-cytoplasmic sperm injection, a technique that allows once-sterile men to father children) were twice as likely than normally conceived children to have a major birth defect. Another found them twice as likely to be born below normal weights—itself a predictor of problems later in life.

In most of the world, including in the United Kingdom, the home of Dr. Edwards and Louise Brown, the baby business is regulated far more heavily than it is in the United States. Clinics operate under state guidelines, in addition to professional ones, and are proscribed from offering certain kinds of treatment. Surrogacy is illegal in most of Europe, for example, as is the common practice (in the United States) of paying for another woman’s eggs. In Denmark, the state pays for three rounds of fertility treatment for any woman needing them—but only three rounds, and only if the woman is under the age of 40. In the United Kingdom, doctors are allowed to transfer no more than two embryos to a woman younger than 40; in Sweden, the law dictates that only one embryo be transferred. Had the 33-year-old Suleman gone to a fertility center in London or Stockholm, then, she almost certainly would have been permitted to transfer only one embryo and to have given birth to only two babies (had the single embryo developed into twins).

In the United States, by contrast, it can be said that “anything goes.” No regulation, no (or little) insurance coverage, and a correspondingly greater chance for bad things to happen in what has become a multibillion-dollar industry. In the United States, not surprisingly perhaps, we remain stubbornly resistant to the notion of regulation, particularly in an area as intimate as procreation. We don’t want our Internet regulated, after all, or our banks. We have fought hard, as women, to “keep the government off our bodies” and to preserve the right of reproductive choice. But as reproductive technologies continue to expand, they are bringing us options that push the notion of personal choice to terrifying limits. Do we really want single, unemployed mothers of six (or anyone, really) to produce eight more babies? Do we want parents to have the option of choosing the gender of their child? How about height or hair color or athletic prowess?

Dr. Edwards deserves the Nobel Prize. His work revolutionized the field of fertility medicine, and gave hope—and eventually babies—to millions of would-be parents. Because of his pioneering efforts, the genie of assisted reproduction is forever out of the bottle and sex has been joined by a whole range of high-tech means to produce children. As these new-fangled means proliferate, however, and as we continue to procreate with the assistance of science as well as nature, we need to continue to ask the critical ethical questions that surround assisted reproduction; questions that prod us to ensure that advances in assisted reproduction continue to do more good than harm.

Debora L. Spar is president of Barnard College. A political scientist by training, Spar is the author of numerous books, including Ruling the Waves: Cycles of Invention, Chaos, and Wealth from the Compass to the Internet and The Baby Business: How Money, Science, and Politics Drive the Commerce of Conception. Prior to coming to Barnard, Spar was the Spangler Family Professor at Harvard Business School and Senior Associate Dean, Director of Research.