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.”

Everybody's favorite villain (again): the single mom

Events have shifted that octuplets story. I figured it would play out the way the story of the McCaughey septuplets in Iowa did—with oohs and ahs and a donated 16-room house, 15-passenger van, baby food from Gerber, and a lifetime supply of Pampers from Procter & Gamble —and I was all set to rain on that parade.

Never underestimate the power of race or sexism to flip a story. Now that it has emerged that the mother of the octuplets is unwed (and has six other kids), there isn’t much gushing. The headline in my local paper reads, “Winning Sympathy the Hardest Task.” In the article, a call-out headed “Cost of 14 Kids” reads “for a single mother, the cost of raising 14 children through age 17 ranges from $1.3 million to $2.7.”

Excuse me?

Last I checked, children cost the same to raise whether by a single mom, a single dad, two moms, two dads, or a mother and a father. Suggesting children cost more if raised by single mothers vilifies single mothers, implying they’re parasites on society. The birth of the octuplets already burdens society, in the form of the millions of dollars their birth cost our medical system, but that would be true even if Ozzie and Harriet were their parents.

This woman is surely crazy, but then so are the McCaugheys and the Gosselins (of the TLC reality show). It’s just that certain forms of insanity—such as having sextuplets in God’s name or putting your children on a reality show—are socially acceptable and others aren’t.

Lynn Paltrow of National Advocates for Pregnant Women (so glad to learn about them!), put it best (courtesy Salon’s Broadsheet):

"When the pregnant woman is not brown or black and the drugs/technologies are provided by big pharma, the discussion focuses on questions of ethics. But if the issue is childbearing by low-income women of color, and the drug is homegrown/ illegal then the debate is a question of punishment through the criminal justice or civil child welfare system." Paltrow also cited a study showing that, while we often talk about the effects illegal drugs can have on pregnancy, "women who take fertility drugs and choose to carry three or more embryos to term often experience pregnancy loss and risk severe, lifelong harm to the children who survive."

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.