IVF, Mass Production, and Coercion

David C. Reardon

Multifetal pregnancy reduction (MFPR) is recommended by the practitioners of artificial reproduction methods on the grounds that it is necessary to safeguard the health of the mother and surviving children. As with other abortion procedures, however, there is little, if any, evidence that this procedure actually attains the desired outcome.

In regard to the other children, MFPR introduces the additional risk of miscarrying all the children. The emotional trauma and self-blame that couples must experience after consenting to MFPR and then miscarrying all of their children, after years of longing, prayer, and payment of huge medical bills to become pregnant, is unimaginable. It has yet to be studied. And how can the pain of this devastated couple be weighed against the joy (tinged with grief) of couples for whom MFPR may have helped to avoid a natural miscarriage?

These points are hinted at by Ring-Cassidy and Gentles in the accompanying article. What they do not discuss, however, is the financial motivation of IVF clinics to risk high rates of multiple pregnancies and subsequent MFPR procedures.

My reflection on this problem was prompted by a call I received last year from a woman who was experiencing severe post-abortion reactions following an MFPR procedure. Prior to undergoing an in vitro fertilization procedure, she had told the doctor she would not agree to abortion under any circumstance and he had expressed respect for her beliefs. Despite this, he implanted several embryos with the expectation that most would not "take." When several of the implanted embryos did implant, he quickly began to pressure her to abort the "extras" to avoid losing them all.

Eventually, the mother, who desperately wanted children and abhorred abortion, gave in. Like the Polish woman in Sophie's Choice who was forced by Nazis to pick which of her children would live and which would die, this woman submitted to the pressure to respond to a question that is immoral to ask.

Even though this doctor knew this woman was morally opposed to MFPR, why did he put himself in the position of "needing" to recommend MFPR by creating and implanting more than the one or two embryos which he believed it was safe for her to carry to term?

The answer, I believe, lies in the fact that IVF clinics are run like competitive businesses. IVF is an expensive procedure with high failure rates. Clinics want to be able to report success rates as high as 20 percent to prospective new clients. The best way to boost "success" rates is to implant many embryos and abort the "extras." If clinics limited themselves to implanting only the maximum number of embryos that would be welcome, their success rates would be cut by half or more.

Respecting the anti-abortion attitudes of women like my caller threatens a clinic's success rate. If the physician were to tell couples up-front that they must agree to a selective abortion if he tells them it is necessary, he runs the risk that they will walk out the door. In that case, he may lose the income to be had from up to nine cycles of treatment.

But if he simply nods his head reassuringly when they express their anti-abortion views, then proceeds to implant the normal quota of extra embryos, the odds are good that they won't become pregnant with triplets or more. If they do, he knows from experience that he can still get his way. It is far more likely than not that they will eventually consent to MFPR if he just keeps insisting that is "medically necessary" in order to save at least one or two of their desperately wanted children.

The fundamental problem is that doctors working in IVF are accustomed to treating human embryos as commodities rather than as human beings. To cut costs, they use mass production techniques to create a large number of embryos for immediate and future implantation. They examine the embryos, discard those that are the least symmetrically formed, and keep the rest. Rather than freeze eggs and sperm so they can go through this process with each attempt, they can save time and trouble by doing the whole batch at once and freeze the "extra" embryos. Then when these "extras" are no longer needed by their parents, they can be used for such things as embryonic stem cell research.

The only justification offered for the mass production of "spare" embryos is efficiency--it saves money. But what if morality was more important than efficiency? Setting aside other moral problems inherent with IVF, what if IVF clinics were required to create only those embryos which they are prepared to immediately implant and nurture to term?

If this was the case, there would be no "spare" embryos, no court battles over who owns these frozen human beings, no worries about what to do with those no one wants anymore, no temptation to exploit them in experiments or to dismember them for stem cells. Moreover, if IVF clinics were limited to creating and inserting only the number of embryos that would be welcome to implant, normally two or three, the "need" for MFPR would not exist.

In essence, the true success rate of IVF should be measured by the percentage of human embryos which are created that survive to birth. The "need" for spare embryos represents the failings, not the success, of IVF techniques. The "need" for MFPR represents a failure, not a success.

These proposals would be unacceptable to IVF clinics, however, because they would cut profits and expose their inflated "success rates." Moreover, these proposals would have the inconvenient effect of better educating couples about the true failure rate of IVF--dozens of their children created, discarded, and lost so that one might be born.

In short, by imposing at least a minimal respect for the human lives created by IVF, these proposals would help couples to better confront the moral issues involved in IVF. Such steps may not be welcomed by the IVF industry, but they are certainly necessary on the path to restoring respect for human life.