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Assisted Reproduction

Beware The Wolf in Sheep’s Clothing

Octomom. Patron saint of the Clown Car. Image by davidvogler@flickr

Nadya Suleman and her doctor, Michael Kamrava, have become the poster children for the anti-reproductive choice crowd who are intent upon restricting access to medical technologies such as IVF which are essential for many of the 1 in 6 couples suffering from infertility in the United States. Ever since the Octo-Mom Circus began playing on a television near you, self-described bioethicists and compassionate conservatives have been quick to call for the regulation of the ART industry. Portraying the Octo-Debacle as the norm rather than the aberration, these ideologues have sought to roll back decades of hard-fought for victories in the advancement of reproductive choice. Today, an organization called The Center For Bioethics And Culture Network published a duplicitous opinion piece by their director, Jennifer Lahl:

This booming business is relatively new, having really taken off in 1978 with the in vitro fertilization (IVF) and birth of Louise Brown, the world’s first “test-tube” baby. Since then, reproductive medicine has been woefully unregulated and out-of-control. Can you say, “Octomom”? Nadya Suleman’s octuplets recently had their first birthday. Early last year, when news broke in the mainstream and celebrity-reality-media, the blame game and finger pointing was endless. The reproductive medical community pointed to Dr. Michael Kamrava, Suleman’s physician, as some rogue doctor-turned-cowboy in the “wild wild west” of California fertility medicine — he didn’t follow professional guidelines. And yet, Dr. James Grifo, a fertility specialist at NYU School of Medicine said, “I don’t think it’s our job to tell them how many babies they’re allowed to have. I am not a policeman for reproduction in the United States.” Dr. Grifo, you are right, you are not a policeman. You are a medical doctor and a member of a profession which has fiduciary duties and obligations to your patients — that means both mothers and children.

How are these positions inconsistent? First of all, the California Medical Board charged Kamrava with gross negligence and violation of professional guidelines which may very well result in the loss of his medical license. So the profession being attacked by Ms. Lahl has discharged their fiduciary obligations by disciplining their own. Secondly, Lahl distorts Dr. Grifo’s statement to advance her own disingenuous point. Clearly Dr. Grifo was speaking to a doctor making the arbitrary determination as to how many children a parent should have. Anyone want to take a bet that Ms. Lahl and her organization would be in a tizzy if President Obama sought to pass a law similar to China’s One Child policy which restricted the number of children an American family could have? Lets be clear here: Ms. Lahl is only concerned about the number of children a family can have through IVF and would bitterly oppose any federal restriction on how many children fertile Americans can have through traditional family building options.

Ms Lahl continues:

Of course, the fertility industry, and those who profit from this $6.5 billion a year business, would like nothing better than to keep it unregulated and unlegislated. And sadly, legislators shy away from passing laws that would bring some sanity and safety back to fertility medicine; they’re either operating for or being intimidated by reproductive “choice” and “rights” rhetoric. The American Society for Reproductive Medicine (ASRM) — led largely by fertility doctors — is already pushing against the existing regulatory legislation over egg donation in several states. Much has been lost in the modern medical profession, which consistently avoids roping in this industry and their colleagues who practice in and profit from the baby-making business. The resistance is powerful and predictable.

Really? Of course Ms. Lahl has nothing to substantiate this charge. If Ms. Lahl was being honest she would have to concede that every major organization, including ASRM, condemned Kamrava and the treatment he provided to Suleman. Other groups, such as the American Bar Association, are working on model Guidelines to assist states in navigating issues related to assisted reproduction. The FDA has passed significant restrictions on ART and the ASRM also has laid out its own guidelines. What Ms. Lahl is not telling her readers is that the only legislation being opposed by these physicians and groups are the ones that would effectively bring about the end of IVF as we know it or eliminate any compensation to men and women offering to be donors. Ms. Lahl would like nothing better than to make surrogacy and egg donation an altruistic-only endeavor which would effectively close the door to the majority of patients suffering from infertility and who need the assistance of a third party to begin their families. One need only look at most other countries around the world who prohibit compensated egg donation and whose citizens find themselves on waits lists as long as ten years before they can proceed with a donor. In fact, in some countries, by the time they reach the top of the wait list, age restrictions prohibit them from proceeding.

Chills still run up my back when I recall testifying to the Georgia State Senate in 2009. I walked into the packed, standing-room-only hearing, a whole bay of television cameras and reporters standing by. But what really caught me off guard were the throngs of women who held pictures of their IVF babies, accusing me of trying to steal their reproductive rights. Similar outpourings of hysterical resistance were just witnessed in Arizona, regarding legislation that would ban compensating women (apart from their out-of-pocket expenses) for their eggs.

The chills Ms. Lahl experienced was nothing in comparison to those felt by the people who would have been effected had the draconian legislation being proposed in Georgia been passed. Call me cynical, but I really doubt Ms. Lahl was genuinely surprised at the reaction from the very people who would be childless if she had her way. What Ms. Lahl did not inform her readers was the testimony she gave in Georgia was to support a bill that would have classified an embryo as a “child” and thus be entitled to personhood status. It also sought to legally mandate how many embryos a doctor can implant. The uncertainty of that law left in doubt what patients could even do with their own frozen embryos. As for prohibiting compensation to egg donors, Ms. Lahl knows very well that had Arizona passed that law, the supply of egg donors would entirely disappear (other than family members and friends). In the “ideal” world that Ms. Lahl aspires to live in, all states would prohibit donor compensation thus effectively ending egg donation as a viable option to family building.

The first IVF children are only now entering adulthood — most are still under 20. And sadly, no long-term studies have been conducted. This is just irresponsible in light of the many risks and aspects we don’t yet understand.Researchers have found a five percent to10 percent chromosomal difference between IVF children and naturally conceived children.IVF children are at increased risk of birth defects such as neural tube defects and low birth weight (later predisposing them to obesity, hypertension and Type 2 diabetes). A new study just out in Europe (where IVF is heavily regulated and monitored) looked at 20,000 singleton pregnancies and saw a four-fold increased risk of stillbirths in children created using IVF or Intracytoplasmic Sperm Injection (ICSI) technology when compared to children conceived naturally or through non-IVF fertility treatment.

And what about the high failure rate of IVF? Recent U.S. data reports that of 140,795 cycles, only 56,790 resulted in births — 40 percent success. Given the promises of the baby business, it’s clear that infertile couples are willing to ignore the financial and health risks — to themselves, to their future children, and to third parties (e.g., egg/sperm donors, gestational surrogates). Is 40-percent-happily-ever-after worth the risks, the disregard, and the debt?

I’m really confused now. On the one hand, Ms. Lahl is claiming no long-term studies have been conducted, then goes on and cites a number of long-term studies! Moroever, Ms. Lahl is trying to sell a pig in a poke as no one has ever claimed that IVF is risk free. Clearly Ms. Lahl has never seen the consent forms an infertility patient has to sign before proceeding with treatment. Had she bothered to take the time to review the typical consent forms, she would know that all of these risk are disclosed and discussed in great detail. Moreover, would Ms. Lahl deprive a cancer patient of treatment because it is new or there was no long-term studies addressing its efficacy? Or would Ms. Lahl be comfortable with the federal government preventing Americans from knowingly and volitionally assuming the risk of any medical treatment that does not have a 100% guarantee of success and without any possible complications? Simply stated, Ms. Lahl’s position is not grounded in any consistent or intellectually honest belief. To the contrary, it is result driven and designed solely to bring an end to reproductive choice using any specious argument available. Parenthetically, Ms. Lahl seems a bit math challenged as the “first IVF children” are now in their early 30s and well into adulthood.

Ms. Lahl concludes:

Given the reality that the fertility industry and fertility specialists seem uninterested in changing their practices, if they are successful in blocking good, sound, sensible legislation, soon enough the facts will catch up with them, and they will have to answer to the public. We have the obligation to speak and legislate to protect those who have no defense and no recourse.

Oh no, a boogeyman is out to get us! Ms. Lahl reaches deep into her bag of hyperbole with this passage. No one denies her right to speak as that is constitutionally protected. What is objectionable is her intent to limit others constitutional rights to procreative choice. Further, who are these defenseless people without recourse that she claims to be protecting? A child of IVF? Parents of twins born as a result of egg donation? This is nothing more than a shameless and baseless emotional appeal to justify the imposition of her organization’s pro-life, anti-choice ideology on the country. Children from IVF have been around since 1978 and I have yet to hear of a single incident in which the doctor responsible for their conception or their parents who brought them into the world, were sued for wrongful life. Further, in order to make the specious claim about the industry being disinterested in change, Ms. Lahl has to ignore the disciplinary action against Kamrava, the guidelines imposed by the ASRM and its affiliated societies, the rules promulgated by the FDA and groups like the ABA and AFA who are constantly working towards improving this field.

I would have had more respect for Ms. Lahl if she was honest about her true motivations which is to outlaw IVF, surrogacy, egg and sperm donation because she finds it immoral and violative of God’s law. Instead, she cowardly cloaks herself as an avenger for justice to protect the naive, voiceless and defenseless patients of evil doctors like Michael Kamrava. The bottom line is Ms. Lahl and those of her ilk want to legislate morality — and impose their morality on everyone else.

Discussion

6 comments for “Beware The Wolf in Sheep’s Clothing”

  • I have an issue with legislating morality. I have an issue with Uncle Sam entering my uterus. Ms. Lahl would like not only egg donors to donate without compensation I believe Ms. Lahl’s position) (I could be mistaken) is not to allow egg donors to donate at all because there have been no long term studies on egg donors.

    Also it needs to be stated I do believe Ms. Lahl works with a physician who tragically lost a child to cancer who was an egg donor. I need to research that piece more. But there is clearly an agenda.

    I agree that we aren’t doing a great job with self regulation and we need to create something that will work because if the government becomes involved to put it bluntly — “We’re all screwed”

    Needless to say, I don’t agree with all of what Ms Lahl has to say.

    Thank you for writing a great piece about this as always.

  • Karen Kitterman

    I am amazed by how poorly this article and the previous comment are reasoned. A personal attack on Ms. Lahl is the lowest form of persuasion — especially when her words were twisted and the authors attributed to her stances she has not taken. Shame on you both for dissing the truth.
    As an attorney and a woman, I know it is appalling how little legal regulation of egg “donation” is in place. Women — especially young women of college age — are exploited, resulting in the death of some, the reproductive destruction of others, and permanent disability of still others.
    If you want truth, just Google “Calla Papademas” to learn about the Stanford student who suffered a stroke and permanent disability, all due to the “egg donation.”
    The authors’ assertion (“What is objectionable is her intent to limit others[‘] constitutional rights to procreative choice.”) shows, sadly, his ignorance. There is no Constitution right to in-vitro fertilization. “Reproductive rights” is not even a legitimate legal term – it is a euphemism for abortion – the brutal ending of reproduction.
    Future generations will look with horror at how callously we have treated women, exploiting them for eggs to fulfill others’ wants (not needs), just as we now look with horror on how callously our nation once treated slaves.

    • Thank you for your reply Karen, even if we disagree. I should point out that I do not believe I attacked Ms. Lahl at all. Rather, I simply quoted her verbatim and attempted to refute her statements.

      Also, it bears mentioning that the only personal attacks in this blog post were made by you: both as to the writing skills and my ignorance of the law. While I will not attempt to defend the writing quality as that is a subjective determination, I would humbly suggest that in the future you not accuse anyone of ignorance of the law, lest you be hoisted by your own petard. As an attorney, you should be well aware that the United States Supreme Court has long recognized that the right to procreate is a fundamental right protected by the Constitution. In Skinner v. Oklahoma (1942), the Court invalidated a state statute that provided for mandatory sterilization of criminal inmates. The Supreme Court held that the right to procreate was a “basic right of man.” U.S. Court of Appeals cases, including Lifchez and Jane L. have also expressed a constitutional right to procreate using advanced medical technologies.

      I do not disagree that their are examples of women being exploited. I have written countless pieces on the need to legislate in this field. Where we differ, however, is the nature of the restrictions. It is apparent that you would favor the complete prohibition on any form of assisted reproduction which, in my opinion, would be a violation of an individual’s right to procreate. So lets be honest here — your opposition to egg donation is part of a larger agenda to outlaw all forms of assisted reproduction and a woman’s right to choose.

  • Kudos to you, Karen. Well said.

  • First a math comment – Louis Brown was born in 1978, which means that she is presently ~32 years old. The rest of those born through IVF in the 1980s are in their mid to late twenties. I think that’s what Jennifer Lahl meant.

    Secondly, I think that seeking to regulate IVF is not the same thing as regulating how many children women can have through natural conception and birth. IVF produces left-over embryos that are frozen, but this is not the case with natural births. The controversy over IVF comes from these half a million or so frozen embryos. Secondly IVF is far, far more expensive than IVF. In the case of Octomom, the only way she could pay for her IVF and subsequent is for the taxpayers to foot the bill for her. What’s so sinister in suggesting that IVF needs to be reeled in?

    Kamrava might have been disciplined, but how do we know this sort of thing isn’t going to happen again?

    • Michael,

      Children of IVF already have their own children — so there is plenty of anecdotal data out there for anyone interested in the safety and efficacy of IVF. Secondly, with Nadya Suleman, there is no information at all indicating that taxpayers paid for her IVF. Could you please cite to me any source indicating that California tax payers subsidized her IVF treatment?

      Also, if your concern is fiscally motivated, would you support mandatory sterilization of women whose income is below the poverty line? Or would you support a cap on the number of children a fertile couple could have so as to not burden taxpayers?

      If you are going to be intellectually consistent and believe that the government has the right to determine how many children an individual can have, then why are you discriminating against those who are infertile and need medical assistance from those that are capable of reproducing without help?

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