How Many Babies Is Too Many?

Like many of you, I have watched as the world has been captivated by the birth of the octuplets to Nadya Suleman. To say that this case has opened heated debates on the ethical and psychological issues related to in vitro fertilization (IVF) would be a gross understatement. What makes this case especially newsworthy is the fact that Ms. Suleman not only has a total of 14 children, all with the help of IVF, but is also single and unemployed.

This is not the first octuplet birth to rock the medical community worldwide. In London 12 years ago the The Lancet produced an editorial on the story of Mandy Allwood. That case was also interesting for its many ethical questions: Ms. Allwood was secretly taking fertility drugs without medical supervision or informing her significant other. In the early stages of the pregnancy, doctors also recommended that she reduce the number to twins in order to ensure safe delivery and development, advice which she refused. Accusations that decisions were made based on financial incentives were compounded by statements made by her public relations consultant Max Clifford. He implied that the more children who were born, the more money there was to be made. Tragically, all eight of the babies died within an hour of birth at 22 weeks.

Exactly how many children can a woman carry safely to term and are there any limits imposed on fertility doctors?

Recommendations have been made by the American Society for Reproduction Medicine that a maximum of two embryos should be placed in a female. However, there are those who would argue that fertilized embryos are already a life, that selective termination of some fetuses to increase survival of the others should not be done and that all embryos should be implanted and given the opportunity to become a full term pregnancy. Last year, Evans and Britt presented a review that showed fetal reduction in cases of multi-fetal pregnancies improved the overall outcome. Despite these results, it is understandably a difficult decision for many to make. IVF parents are especially reluctant and feel a special attachment part partly because of their previous difficulties conceiving.

One of the major issues that has arisen out of the Suleman octuplet story is that the fertility doctor should not have made the choice to implant this many embryos. Also, there is the question of what if any, psychological screening was conducted on Ms. Suleman before proceeding with the procedure.

What are your thoughts on this issue? Should restrictions be placed on the practices of IVF? How far away are we from so-called “designer” babies, selecting not only gender but other desirable characteristics as well? Should there be stricter psychological testing for women and couples undergoing IVF and why should the process be different for women who have children naturally?

References

M DEAN (1996). British octuplet pregnancy upsets the medical applecart The Lancet, 348 (9027), 605-605 DOI: 10.1016/S0140-6736(05)64810-6

American Society for Reproduction Medicine

MI Evans, DW Britt (2008). Fetal reduction 2008. Current Opinion in Obstetrics and Gynecology. 2008 Aug;20(4):386-93.