Academic

Why We Should Ignore The ?Octomom? . . . Except Maybe Tomorrow

By Kim Krawiec

Via The New York Times, Fox Broadcasting will present a two-hour television special on Nadya Suleman on August 19:

The special could reignite debate over the well-being of the children and the media frenzy that surrounded their birth. Ms. Suleman has signed at least two television deals related to coverage of the birth and raising of the octuplets.

I urge here that we ignore Suleman as a regulatory matter, but leave it to you to decide whether to tune in on August 19.  Although the Times may be correct that the special is likely to reignite debate over the well-being of the children, the media attention, and the television contracts (issues also raised by Jon & Kate, see here), hopefully it will not reignite the type of embryo-transfer limit proposals that appeared in some states shortly after the Suleman controversy erupted.

Many feel understandable outrage at the ?Octomom.?  Fourteen children (or even one) are a daunting number even under the best of conditions, and the conditions surrounding the birth of the Suleman octuplets are far from ideal.  Critics have heaped both fascination and scorn on Suleman, and legislators, policymakers, and others have called for a variety of new restrictions on the use of assisted reproductive technology (ART) in response to the Octomom incident.

Yet the reform proposals leveled in the wake of the Suleman controversy represent a hasty response to a sad and disturbing ? but aberrant -- case.  Particularly worrisome to me are embryo-transfer limit proposals, which I argue would produce fewer benefits and higher costs than proponents assume.  

Looking first at the benefits, although ARTs are a contributor to multiple births in the United States (especially higher-order multiples), much of the increase in multiple births in the U.S. is due to natural factors and fertility therapies not involving ARTs.  (As an example, see today?s news reports, here and here, of a Tunisian woman pregnant with twelve babies, reportedly through OI therapy.)

By definition, this limits the capacity of embryo transfer regulation to control the health risks associated with multiple births. This alone is not a reasonable objection to embryo-transfer limits that otherwise promise substantial public health benefits, but it is a useful reminder that embryo-transfer limits will not alone fully address rising rates of multiple births in the United States.

Moreover, the currently low (and decreasing) incidence of higher-order multiple births as a percentage of live ART births leaves little room for improvement through government oversight.  Although there is more opportunity for improvement in twin numbers, it is unlikely that the U.S. has the political will for government-mandated single-embryo transfer limits. Although there are good reasons for this reticence, particularly in a system of private provision of fertility and other health-care services, such as in the United States, it also means that the proposed embryo-transfer limits are unlikely to significantly impact ART twin rates. 

Looking next at costs, aside from the direct costs associated with enacting, interpreting, and enforcing the proposed regulations, government intervention frequently is accompanied by delays, uncertainty, increased operating and/or production costs, and higher prices.  In many cases, these costs are outweighed by regulation?s benefits.  But embryo transfer limits are unlikely to produce substantial benefits in the United States and are likely to impose high costs, some of which are illustrated by current U.K. HFEA regulations, which I blogged about here a few weeks ago.  

Moreover, state medical boards already have the ability to police doctors and clinics that disregard professional guidelines and the public interest. This fact itself suggests the most logical mechanism currently available for regulating multiple births from ARTs: ex post liability and state and professional sanctions for doctors and clinics engaged in clearly irresponsible conduct.  If state authorities and professional medical bodies have so far been insufficiently attentive in these tasks, hopefully the Suleman case and the resulting social and political backlash will spur them to action.

Finally, advocates of embryo-transfer limits must recognize that -- because the solutions to multiple pregnancies from IVF that are most likely to preserve pregnancy success rates include selective fetal reduction, the creation of many embryos from which only the highest quality are transferred, and cryopreservation of excess embryos for possible future cycles -- embryo-protection goals are not only distinct from, but are often incompatible with, multiple-birth reduction goals.  This tension is demonstrated by the experience of Georgia; by that of other countries, such as Germany and Italy; and by Suleman herself, who reportedly transferred all of her remaining embryos because she was unwilling to destroy any.   The political minefields of abortion and embryo rights thus render it highly unlikely that the United States will implement comprehensive embryo-transfer regulation effectively designed to reduce multiple births anytime soon.

Read the whole thing, Why We Should Ignore the ?Octomom,? with data supporting these claims, here.

Related Posts:
Michael Jackson Wanted to Buy Octomom?s Babies
U.K. To Reconsider Payments to Egg and Sperm Donors

Image Source: motivatedphotos.com 

Full post as published by The Faculty Lounge on August 18, 2009 (boomark / email).