Having a child can be one of the greatest joys in life.  Unfortunately, many people are unable to have a child whether its due to hormonal imbalances, scarring in the reproductive tract, or from many other causes.  Doctors estimate that about 15% of Americans cannot have children from what we would call normal, sexual reproduction - that is, a man's sperm and a woman's egg join to produce a child through intercourse.  Fortunately, modern science has evolved to meet some of these needs through a variety of assisted reproductive technologies (ART).

One option is donation.  Donation is used when one partner's gametes (either the sperm or egg) are not of the highest quality.  This can be due to age, hormones, genetics, or even unknown reasons.  A donor male or female could give their sperm or egg to the infertile couple.  If sperm is donated, the woman can be artificially inseminated or have the sperm inserted into her uterus by a doctor.  However, if an egg needs to be donated, then in vitro fertilization needs to take place. 

In vitro fertilization (IVF) involves fertilizing the egg with sperm in a laboratory, allowing the embryo to grow for several days, and then transfering the embryo into the woman's uterus.  Please watch the multimedia presentation for further illustration.  Since IVF is not 100% effective, most doctors implant two to three embryos at a time and hope that at least one results in a child being born.  Doctors normally implant only a few embryos at a time because doing more could be dangerous for both the woman and the growing fetuses.

3. A Closer Look - Nadya Suleman's Story

Nadya Suleman is a 33-year-old single mother of six children, all under the age of 8.  She lives with her parents near Los Angeles, California as she has neither a job nor a house.  The children she had were produced through IVF since her reproductive tract had scarring.  Ms. Suleman stated her greatest joy was in being a mother, so she decided to have more children.  So she went back to the same doctor, who implanted six more embryos.  All her embryos were created through using one sperm donor.

Ms. Suleman's pregnancy was extremely high risk since two of the six embryos had split to form twins, so she now was carrying eight fetuses.  Her doctors asked her if she wanted to selective reduce the number of fetuses she was carrying, since such a high number is both dangerous to the woman and to the fetuses.  Ms. Suleman refused even though she would have to be on strict bedrest at the hospital for much of the pregnancy since there are many health risks to carrying extreme multiples.  These include problems with blood pressure, diabetes, preterm labor, the need to have a Caesarian section, and many others.  Such a pregnancy is also dangerous for the fetuses because they are often born very prematurely.  These small babies often have poor lung, brain, and gastrointestinal system development.

Ms. Suleman delivered her babies through a Caesarian section 30 weeks into the pregnancy (full-term is considered 40 weeks).  Remarkably, both mom and babies are doing well.  The babies were sent to the neonatal intensive care unit since they were born early, where they will stay for several weeks to be closely monitored.  She is only the second woman in America to give birth to octuplets.

4.  What Are Some Of The Ethical Issues Raised?

There is a wide variety of ethical issues that have been raised by assisted reproductive technologies.  Many of these are seen in the Nadya Suleman case.  Some of these are -

Regulation of ART

Currently, there are thousands of fertility clinics across America that serve women such as Nadya Suleman.  A voluntary professional organization, the American Society for Reproductive Medicine (ASRM), issues guidelines for these clinics to follow.  For example, ASRM's guidelines state that no more than two embryos should be implanted at a time in a woman Nadya's age.  However, the government currently does not regulate the medical decision-making or treatments provided in these clinics.  Many doctors argue that medicine is rarely regulated by the government, and so fertility clinics should have the same level of independence.  The counter argument is that the creation of new members of society is sufficiently important to the public that the government should get involved.  This is the case in other countries such as Italy and Germany.  What do you think?

Role of Reproductive Endocrinologists

Reproductive Endocrinologists are the subspecialists that perform IVF and other ARTs.  Some would say that since they are helping to bring children into the world, they have some role in screening parents.  That is, perhaps women like Nadya that are single and jobless should not be permitted to use ART to create children since they will be unable to provide for them well.  Others say that this is not the job of doctors.  All people should have access to ART regardless of their income, education, or social background.  Should the doctors be held responsible if they transfer too many embryos?  Should there need to be laws on the number of embryos that can be transferred or whether selective reduction needs to be a requirement if you opt to have IVF? What do you think?

Distributive Justice

A "big picture" question that is raised is that of distributive justice.  Distributive justice deals with how society allocates its scarce resources among its members.  Since it now appears Ms. Suleman does not have an income, society may have to pay the medical expenses to care for children.  These will likely be many hundreds of thousands of dollars because of her high-risk pregnancy and the extreme prematurity of the babies.  Society often pays for other people's medical bills in cases such as an organ transplant, heart attack, or trauma.  But should society pay for other people's medical bills when they are voluntary or not life-saving?  Also, ARTs are rarely fully covered by health insurance.  Since IVF can cost thousands of dollars, it is much easier for the rich to afford than the poor.  Is this fair?  Should only those that are rich and infertile have the joy of being a parent, or is society obligated to pay for those that cannot afford ART?

5.  Review Questions

1. Explain some of the assisted reproductive techniques available to help those that are infertile
2. Discuss some of the risks of extreme multiple pregnancy
3. Identify three ethical issues from the Nadya Suleman case and discuss your stance on each of these issues.
4. What is distributive justice? Give another example of a scare resource that society allocates.
5. Discuss some other scenarios in which doctors decide who can receive treatment and who cannot.

References

1.  American Society for Reproductive Medicine
2.  Society for Reproductive Endocrinology and Infertility
3.  CNN coverage, Octuplets' mom:  ‘All I ever wanted'
4.  Philadelphia Inquirer, Ethics and Octuplets:  Society is responsible
5.  Shivas, T. & Charles, S. "Behind Bars or Up on a Pedestal: Motherhood and Fetal Harm" in Meagher, S. & DiQuinzio, P. 2007. Women and Children First. Albany: Suny Press

Multimedia

What Is In Vitro Fertilization?