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12 - Ripped from the headlines: assisted reproductive technology and multiple births

from Section 2 - Ethical issues at the beginning of life: perinatology and neonatology

Published online by Cambridge University Press:  07 October 2011

Douglas S. Diekema
Affiliation:
Seattle Children's Research Institute
Mark R. Mercurio
Affiliation:
Yale University School of Medicine
Mary B. Adam
Affiliation:
Department of Pediatrics, University of Arizona School of Medicine, Tucson
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Summary

Case narrative: a case of in vitro fertilization

OM is a 34-year-old woman with two previous children born with the assistance of in vitro fertilization (IVF). In the course of IVF treatment six additional embryos were created and frozen. Now, 6 years after the birth of her second child, she plans another pregnancy using the frozen embryos. She requests that all six embryos be returned (transferred to the uterus using a transcervical catheter: a simple outpatient procedure) for potential implantation. She asks for this number in spite of guidelines suggesting that, for a woman of her age and health, no more than two or three be transferred. All six are transferred and she becomes pregnant with what proves to be octuplets (the pregnancy contains two sets of identical twins). After a prolonged period of maternal bed rest and hospitalization, the babies are delivered via cesarean section at 30 weeks of gestation.

Introduction

This “case” mirrors some circumstances of the 2009 California pregnancy of a woman named Nadya Suleman, quickly nicknamed “Octomom.” The birth of her octuplets engendered a media storm, which included the revelation that she was a single mother who had six other children, all conceived through IVF. Many of those expressing outrage about the Suleman case questioned whether she was fit to be a parent. We have argued elsewhere that matters of fitness to parent are difficult for physicians to evaluate, and only in the most extreme and exceptional circumstances, none of which were present in the California case, should providers use such concerns to limit access to assisted reproductive technologies (Minkoff & Ecker, 2009). This chapter will focus on a question we feel more appropriately evaluated by medical professionals: what is the right number of embryos to transfer? This discussion touches on important principles of patient autonomy and respect for autonomy, two principles we believe are related but not equivalent. We will argue that the principle of respect for patient autonomy does not require physicians to accede to any request by a patient, to consider whether the number of embryos transferred in assisted reproductive technologies should be regulated, and, if so, to reflect on the appropriate nexus for such regulation.

Type
Chapter
Information
Clinical Ethics in Pediatrics
A Case-Based Textbook
, pp. 63 - 67
Publisher: Cambridge University Press
Print publication year: 2011

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References

ACOG (American College of Obstetricians and Gynecologists), Obstetric Practice Bulletins Committee 2004
ACOG (American College of Obstetricians and Gynecologists), Ethics Committee 2007
Adamson, D.Ginsburg, E. 2009 The octuplets tragedyObstetrics and Gynecology 113 970Google Scholar
ASRM 2008 Guidelines on the number of embryos transferredFertility and Sterility 90 S163Google Scholar
Centers for Disease Control and Prevention, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology 2007 Assisted Reproductive Technology Success Rates: National Summary and Fertility Clinic ReportsAtlantaUS Department of Health and Human Services, Centers for Disease Control and Prevention
Ecker, J.L. 2010 http://roomfordebate.blogs.nytimes.com/2009/01/27/eight-is-enough/
HFEA (Human Fertilisation and Embryo Authority) 2010 www.hfea.gov.uk/docs/2010_FEB_multiple_births_FIN.pdf
Jain, T.Harlow, B.L.Hornstein, M.D. 2002 Insurance coverage and outcomes of in vitro fertilizationNew England Journal of Medicine 347 661Google Scholar
Minkoff, H.Ecker, J. 2009 The California octuplets and the duties of reproductive endocrinologistsAmerican Journal of Obstetrics and Gynecology 201 15.e1Google Scholar
Minkoff, H.Marshall, M. 2009 Scripted consents: when ethics and law collideHastings Center Report 39 21Google Scholar
Schieve, L.A.Peterson, H.B.Meikle, S.F. 1999 Live-birth rates and multiple-birth risk using in vitro fertilizationJAMA 282 1832Google Scholar
Thurin, A.Hausken, J.Hillensjo, T. 2004 Elective single-embryo transfer versus double-embryo transfer in in vitro fertilizationNew England Journal of Medicine 346 731Google Scholar

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