Chukwu is not alone in her prayers. As women delay pregnancy until their 30s and 40s, fertility treatments have become increasingly common. But they carry risks other than failure. New drugs raise a woman's odds of having a multiple birth from roughly 1 in 100 to 1 in 5. The resulting costs are usually far beyond parents' means, begging the question of who really pays the bills. The Chukwus' insurance will cover some of the roughly $2 million it will take to see their babies through neonatal intensive care. But will insurers begin to pass along such expenses in the form of higher premiums for everyone?
An even more disturbing side effect of multiple births is the possible toll on the babies themselves. "When technology starts creating severely handicapped kids, something is wrong," says bioethicist George J. Annas, noting that severely premature babies are far more likely to suffer serious complications than ordinary infants. A graduate of both Harvard Law School and the Harvard School of Public Health, Annas, 53, teaches law and medicine at the Boston University School of Public Health. Married, a father of two and the author of 12 books in his fields, he spoke recently with special correspondent Michael Haederle about the ethical dilemmas posed by the latest fertility techniques.
How common is it for women to seek treatment for infertility?
Very, and becoming more so. Twenty years ago infertility was considered private, almost shameful. Now it's a $2 billion-a-year industry, with more than 350 fertility clinics around the country.
What techniques are used to treat infertility?
In vitro fertilization (IVF), which came to the U.S. in the 1980s after being pioneered in England, is the one most clinics specialize in. It's a procedure in which eggs—either a donor's or the woman's own—are fertilized outside the body, then implanted in the uterus. The cost of conceiving a baby using IVF is estimated at $60,000, which most health plans don't cover. Also, the average success rate is around 20-25 percent, which means most couples undergoing IVF will not get a baby. Because women in their 40s are more successful at conceiving if they use donor eggs, you now see ads in college newspapers seeking young women willing to sell their eggs for $2,000 to $5,000. The older treatment of chemically hyper-stimulating ovaries to release eggs, as the Chukwus did, is even more likely to result in multiple births because you can't control how many eggs are released.
What are the dangers of multiple births?
The main danger is prematurity and all the problems it can cause, especially if the child is delivered before 28 weeks: mental retardation, deafness or cerebral palsy.
Should there be a limit on the number of cultivated IVF embryos?
The American Society for Reproductive Medicine recommends three. Some doctors still implant more than three because it increases the odds that one pregnancy will take. And couples who are paying $10,000 per cycle, which is typical, may well go that route. Today there's no regulation in this area. Zero.
Who should decide how many embryos a woman can carry?
At present, the ethics of the fertility industry focus exclusively on the interests of the couple who want to conceive. But the baby has to be considered here too. What responsibility does the medical community have to children who are born?
What other ethical problems arise in fertility treatment?
Once you decide how many IVF embryos you implant, what about the embryos that are not used? Most doctors now freeze them in case the couple wants to try for another pregnancy later. It's been estimated that there are 100,000 frozen embryos in the U.S., and we don't know what to do with them.
What about fetal reduction, the process that eliminates the extra fetuses?
The last thing any prospective parents want to do is terminate some of their fetuses. But if their goal is to have healthy babies, sometimes you have to do it.
Is fetal reduction the same as abortion?
Abortion is done to terminate a pregnancy, fetal reduction to produce healthy children. That's what makes the two procedures different. But these issues have to be explored before treatment. IVF couples who balk at a three-embryo maximum and couples who want infertility drugs but are opposed to reduction should both be ineligible for treatment.
Should such decisions be left up to patients and their doctors?
Because of the commercial nature of the enterprise, I think there should be national regulation for the whole fertility industry. Society has an interest in children born through reproductive technology. England licenses fertility clinics. So does Canada. We're the only country that has a market in human eggs, permits payment to surrogate mothers and lets the private market dictate what's done.
But what about advances in the medical care of extremely premature babies?
At present, most doctors do everything they can to ensure a baby's survival, regardless of how handicapped it might be. Neonatal intensive care has gotten incredibly good, but that's not always a blessing. Very young babies may live, but be severely impaired.
How does being part of a multiple birth affect the quality of a child's life?
This is new territory. At the most basic level, it's impossible for a mother to breast-feed all her babies, which is important for their health and development. And what about something as simple as nurturing, holding and stimulating young babies? It's impossible for parents to take care of these kids by themselves. With the McCaugheys, they have dozens of people providing care.
Short of legislation, what more can doctors do to prevent high-risk multiple births?
The key is to put the interests of the children first. Physicians have to take every reasonable step to prevent bad outcomes of their own-making. The more we treat this area of medicine as a simple consumer good and children the product, the worse off the children become. What we should want to do is to give these kids a real shot at a healthy life.
Saved by the Bell Reunion
The hookups, the meltdowns, the memoires
The case reveals what was really going on what they think of each other now!
