Should There Be Limits On IVF?
In a survey conducted by the British Fertility Society, in honor of the 30th birthday of the first IVF baby, doctors in the U.K. were asked a variety of questions on IVF ethics. You can read the results of the IVF survey here. What I found interesting and thought provoking was the response regarding lifestyle and IVF.
According to the news article, more than half of the doctors surveyed said that lifestyle factors, like smoking, should be taken into account before offering IVF to a couple. Smoking has been shown to lower the chances of IVF success, not to mention the potential harm to an unborn child during pregnancy (and after birth, for that matter.)
But should a couple be told they can’t have IVF, only because one or both partner’s smoke? (By the way, 29% of those surveyed felt that IVF should be offered to all, regardless of lifestyle.) In the U.K., there are already limits on IVF based on a patients weight, or BMI. (I’ve discussed the debate on BMI and IVF in a previous blog post.)
In a similar, but unrelated story, in early July, a 70 year old mother gave birth to twins via C-section, in India. The twins, a boy and a girl, were conceived using IVF technology. The media reported that she choose to have IVF babies because she “only” had girls, and they wanted a boy. In India, having a boy is a status symbol.
I’m not going to get into the debate on whether it’s right to use IVF to order to guarantee the “brand” of child you want. I won’t be shy in saying that it bothers me deeply that a family would insist on IVF treatment just because they never had a male child.
But, looking past this detail, what about her age? Should a woman in her 70s be granted IVF treatment? Obviously, she put her health, and the babies’ health, at risk by getting pregnant at that age. But now that they’ve made it past the birth, the question on my mind is, what kind of parents will she and her husband be?
I’m honestly not sure how I feel about the ethics of either of these issues. Part of me feels that there should be age limits on IVF. Part of me strongly feels that for a woman over 60, IVF should not be used. It’s just... weird. It feels unfair to the child.
Part of me also feels that smokers shouldn’t get IVF treatment. Let them quit smoking first. Why should that child be put at a health risk?
But then, I start to ache in my heart, and wonder if things are truly as black and white as they seem. Perhaps that smoking couple will be excellent parents. Maybe a 65 year old grandma-turned-new-mother will live to the ripe old age of 100, and chase that child at the park with more energy than my 30-something self could.
Where does the “lifestyle” factor stop? What if suddenly, couples who take anti-depressants aren’t allowed to have kids? (Maybe because a “depressed parent” is less than ideal?) What if someone decides that 45 is “too old” for kids? Should the government, or doctors, be making these choices for us?
I’m not sure.
What do you think? Take the poll (you can choose more than one choice), and please do leave a comment in the forums, or below in the comments section. I’d like to hear what your thoughts are. Should there be limits? If yes, what? And who decides? Or should IVF treatment be available to whoever wants?
Comments
This is such a tough question – and I’m guessing it’s very controversial indeed. I can sympathize with the idea that anyone could make a terrific or terrible parent, and that there’s no license required for typical parenting.
But IVF is a medical procedure. And doctors do choose transplant patients and gastric bypass patients on the basis of health and lifestyle factors, and potential parents go through all sorts of scrutiny prior to adoption.
Given that IVF is often paid for by insurance, it seems reasonable to me that there should be some minimum “health and lifestyle” requirements… and I think that potential parents who are in one way or another intentionally placing a baby-to-be at known risk are likely to continue to do so after the baby is born.
Lisa
Thanks for your comment, Lisa.
I just wanted to clarify one point. IVF is actually rarely covered by insurance, at least in the USA.
In the US, the marketplace really decides. I have heard that clinics in the US often limit who they accept because they want to keep their success rates high. Those with poor success factors have to shop around more.
BMI, age, smoking, drinking, etc. are probably factors they assess before accepting clients. But it’s economics, not social values! If they take all comers, they can’t advertise as high of a success rate.
I think anybody convicted of a sex crime or child abuse shouldn’t be a candidate. Felons lose their rights to many things.
A family in India isn’t the same as in the US. The 70-year old parents would have many relatives who would ensure the upbringing of their child. It’s far more risky in Britain or the US where we don’t have extended families and/or they don’t feel the same duty to their siblings or cousins.
Great question! I find it to be a difficult one also. On one hand, I think several of those limitations make sense technically (except restriction based on marital status, which I would not support) but I’m not sure how I feel about anything being across the board.
For example, I personally think it’s a bad idea for 70-year-old couples to have babies, but do I or anyone else have the right to make that decision for someone else on a general basis? I tend to think that the decision ought to be between the physician and the patient. If a 70-year-old is in excellent health and seems likely to live to 100, has a terrific family/social support structure to support the child if the parent died, etc. I don’t know that it’s the worst thing in the world for them to have IVF if they want it. But on the same note, I would think a responsible physician would not perform IVF on a 70-year-old who has multiple health problems and a high risk of dying within 10 years. The same deal is true with weight. A person who is overweight and has associated health problems is in a different situation from a person who is overweight but otherwise in excellent health, and I don’t believe they really understand the particulars of exactly how weight affects fertility yet.
I can see the strongest case for restricting IVF in couples who smoke or drink, because those are modifiable lifestyle choices that pose a risk to the baby and also decrease the odds that the procedure would even work. It might make sense to have a limitation for publicly funded or insurance funded IVF in these cases, especially because of the latter point. But as an across the board thing applying to all cases, it feels like a slippery slope. Do you then restrict IVF for women who drink coffee, who are over 35, who work around pesticides, or other risk factors also? It just seems like these should be personal medical decisions between a woman and her doctor and not subject to group regulations.
I agree with the above comment that couples where one parent has been convicted of a sex crime or child abuse, etc. should not be allowed to have IVF though. That’s one restriction that definitely makes sense.
Actually, IVF is covered by insurance in all but 15 states, and many plans do offer it up to a certain amount.