walkitout (walkitout) wrote,
walkitout
walkitout

It's All Cultural, this time, IVF and risks

Many, many (say that about a dozen more times) people have commented on risks to the embryo and the fetus and how the same level of risk is treated differently depending on cultural factors. For example, just about the worst thing that can happen to a fetus or embryo is for mama to experience physical trauma, say, by domestic abuse or a car accident. Really, altho it's a little tricky depending on how you count it (over population, or a particular embryo/fetus -- but it's really bad). Yet while everyone gets all over women who smoke or are even around smoke while pregnant (never mind alcohol, which is even less bad, yet, altho again, depends on a number of factors). But not too many people want to talk about domestic abuse, and nobody talks about car accidents. (Hyperbole alert.) Funny, that.

Over at the NYT, Kolata talks about some recent research on the risks of IVF:

http://www.nytimes.com/2009/02/17/health/17ivf.html?8dpc

Unsurprisingly, we're starting to see some differences in the rates of some birth defects, and there's some suspicion being directed at the methylization process and therefore epigenetic changes. This is a new and rapidly developing area of research, so it is not going to be easy to nail down anything in particular. But it is telling that:

[start quote]Richard G. Rawlins, who directs the in vitro fertilization and assisted reproduction laboratories at the Rush Centers for Advanced Reproductive Care in Chicago, said that when he spoke to patients he never heard questions about growing embryos in the laboratory and the possible consequences.

“I have never had a patient ask me anything” about it, he said, adding, “For that matter, not many doctors have ever asked, either.”[end quote]

I get that by the time someone has reached IVF, there is usually a level of desperation because other methods have failed. And I'm not suggesting that anyone should decide NOT to have IVF because of an elevated birth defect risk, any more than I would suggest that anyone should abort a Down's baby or whatever. Their decision, their life and I'm okay with our tax dollars going to help out. Whatever.

I do, however, have a little concern about some failures in the bio-ethical discussion of IVF. People get whacked about gender selection using IVF, and hypothesize that some day people will be using IVF or similar to get a green-eyed girl or whatever they have set their heart on. Shouldn't _these_ people be incorporating at least hypothetical risk (if we haven't nailed it down because come on, if we tell women not to take unstudied drugs while pregnant, ya gotta figure sticking the baby in a petri dish might have some risk associated with it, right?) into their discussion? I understand that people who are willing to shell out in favor of gender parity in their family might or might not be swayed by discussions of risk, but they _might_ be swayed if they were brought to contemplate the cost and general hassle of, say, Beckwith-Wiedemann syndrome. It seems to me there's a major lapse of rhetoric here, but possibly it just got edited out before it reached the information sources I've run across.

ETA:

http://www.sharedjourney.com/ivf/sex_selection.html

Does not mention risks; some of the methods described involve IVF. Includes a legal/ethical section.

http://www.ivf-infertility.com/infertility/sex_selection.php

Does not mention risks. Does describe IVF as costly and invasive. Includes comment about legality of gender selection for purposes other than to avoid a sex-linked genetic disease.

ETAYA:

This is actually starting to bother me (yeah, I know. Just starting? You blogged, you added, and _now_ it's starting to bother you? Why were you posting initially? For the same reason I post about almost anything -- a compulsive need to opine. And at least here, there's reason to believe someone is interested in my opinion.).

http://www.fertilityneighborhood.com/content/in_the_news/archive_1302.aspx

So _that's_ from about 3 years ago, showing elevated birth defect risks for IVF and IUI. And they're still trying to downplay it, mostly by saying, hey, if the IUI had been higher than IVF, we'd have known it was something about infertility that was the problem (that doesn't follow at all, to my mind -- it would just indicate that something about the IUI procedure per se had more of a problem than the IVF procedure per se; the transfer associated with IVF looks a little different than IUI but I'm no fertility expert). Because natural is lowest, IUI next and then IVF, they're still hedging. The article also _assumes_ that people undergoing IVF are doing so because of infertility, which is not the assumption when people start talking about making a Perfect Baby.

Finally, and I think this is what really startled me, was this claim:

[start quote]While the findings do not necessarily suggest that there's a relationship between ART and birth defects, it's important to address because nearly 1 percent of all children born in the United States are conceived using in vitro fertilization, explained Brad Van Voorhis, MD, a professor of Reproductive Endocrinology at the university, and the study's lead researcher.[end quote]

I was surprised. Were you?

ETAOMT:

http://bioethicsdiscussion.blogspot.com/2008/10/art-of-getting-pregnant-benefits-vs.html

Here's a link to an article about women waiting due to career and then having trouble getting pregnant and, in the US and some other places, having multiple embryos transferred (oh, yeah, _that's_ been in the news lately) to get pregnant with at least one as quickly as possible. The language in the blog strongly suggests that the multiples issue is the primary risk. What I'm picking at, however, does not appear to have anything to do with multiples, per se, but with something else in the IVF process -- and possibly in IUI as well. And I'm sticking to my initial assertion here. Someone should be highlighting this risk when they're talking about the bioethics of ART.
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