Two (or three or eight) embryos no better than one, IVF study says

Timed perfectly in the still-buzzing hullabaloo over the octomom, a new study has cast doubt on the American practice of implanting multiple embryos when doing IVF, in the hopes of upping the odds of a successful pregnancy. The study found that implanting multiple embryos at a time didn’t increase the odds, and of course it does increase the costs and the dangers brought by multiple births.

Our Wild Western approach to fertility treatment contrasts with the more regulated European model, which it appears not only has safety and cost-containment to say for itself, but also effectiveness. The elephant in the room, of course is our insane employer-based healthcare system. Here’s hoping that studies like these encourage Obama and others, as they seek to reform our healthcare system and contain its out-of-control costs, to look at placing limits on the number of embryos that can legally be implanted at a single go.

So far, even as discussion of cost-containment is getting lots of play, I haven’t heard discussion of birth practices. Yet the American love of technology has spectacularly played itself out when it comes to birth, turning a basic human rite of passage into a miracle of science. Not, in fact, quite such a miracle, if you look at what we have to show for it: rates of maternal and infant mortality, premature birth, and complications that are nothing to brag about. Talk about win-win: changing our birth system to something less medicalized would contain costs and improve health. And regulating reproductive technologies by limiting embryo implantation would be one step in this effort. For starters, it would likely bring our out-of-control C-section rate down significantly.

I’m also fascinated by the sociological implications of our IVF practices. America has been engaging in a living social experiment: What does a dramatic rise in the incidence of twins (and triplets) do to a society? I hope some brave sociologist plans to study the phenom, even as it may be coming to an end. Historians may someday speak of this era’s children as “Generation Twin.”

The petri dish can't replace the female body

It’s not really surprising, but it is interesting that evidence of the long-term health risks to babies born from IVF is starting to emerge. For a while now there has been some evidence of higher rates of prematurity, low birth weight, and birth defects in IVF babies. What’s more interesting is what the New York Times is reporting today—that there are “unusual gene expression patterns”—bad ones—in IVF babies.

This dovetails precisely with what current biological science would predict. Turns out that the science I was taught in high school biology class about genes, that they are blueprints from which critters are mechanically churned out, is nearly all wrong. The blueprint, or computer code, metaphor doesn’t work. We can’t be said to simply be the sum of our genes. It’s more like we’re the sum of a process, namely what’s called by biologists “development”—the precise, complex choreography that results in the growth of a creature from (almost) nothing.

So it makes sense that doing part of that development in a Petri dish instead of the human body would have consequences, genetic ones at that. The age-old yearning to be free of the female body has once again been frustrated.

Strange choices bring octuplets

I’ve been spending a lot of time in the last few weeks talking to mothers who can’t get the most basic health care for their children—because they have no health insurance—so the story of the octuplets born this week stuck in my craw. Even as mothers can’t get their daughters the asthma medications they need, can’t get their children to the dentist, can’t get their son’s broken shoulder set properly, get taken to collections for the bill from treating a child’s ear infection, 46 doctors and untold millions of dollars have been devoted to this freak of un-nature.

And it is certainly not natural. The newspapers are being coy about the question how the mother came to bear so many babies at once. But they do note that there’s virtually no chance this happened naturally; it’s a near certainty the parents used fertility treatments, most likely IVF, and that the parents refused what’s delicately termed a “reduction.” Yet as AP notes, “Multiple births can be dangerous for babies and their mother, and in some cases, may result in lasting health problems.” That’s an understatement. One of the doctors in the case noted that the human uterus is designed to hold at most two babies. Putting more in there puts a mother’s life at risk and is likely to cause terrible health complications and suffering for the babies (including long-term physical and cognitive problems).

Make no mistake, therefore, octuplets are the result of choices, some very strange choices at that, most likely based on strange and incoherent ideas about God’s will. The parents and their caregivers chose to have multiple embryos implanted and they chose not to reduce the number of fetuses in the interests of the health of mother or babies.

This case is also the result of choices we as a society have made, to devote resources to enable these strange choices, at the expense of basic health care for all children. The AP article on the case quotes a doctor saying that doctors can’t force women to have reductions, but in most European countries there are limits on the number of embryos doctors are allowed to implant or the number of cycles of IVF covered by national insurance (and there is evidence that increasing the number of embryos doesn't increase the odds of success).

All of us bear the cost of extraordinary medicine like this, through our insurance premiums and our tax dollars, in the form of the state and federal funds that go to hospitals, doctors, and medical schools. As I have listened to Vicky worry about her daughter’s next asthma attack, Paula anguish over missed check-ups and dunning letters from collections, and Traci worry about the pain in her son’s teeth, I am disgusted by my society’s choices. The octuplets are no miracle.