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Essays - Fertility Drugs and Their Consequences

Excerpt from Christopher Bates Doob's Sociology an Introduction, 6e.

If reproductive scientists had tried to devise an advertising campaign to sell their products and procedures, they couldn't have done better than the birth of the McCaughey septuplets in November 1997—what a highly supportive press called "the miracle in Iowa."

When an ultrasound test early in the pregnancy showed seven babies, the doctor told Bobbi and Kenny McCaughey that the odds against their survival was astronomical. But Bobbi McCaughey decided against aborting some or all of the seven fetuses, choosing instead to believe that a higher power would take over. Once they were born, she declared, "God gave us these kids. He wants us to raise them" (Driedger 1997, 26). But many experts on human reproduction are disturbed, feeling that the recent publicity has provided a simplified, even distorted picture of what is often a difficult, even dangerous process.

Women use fertility drugs because they have been unable to become pregnant. When stimulated by a drug like Metrodin, which Bobbi McCaughey received, women's ovaries can produce multiple eggs, with the result that about 20 percent of births achieved with fertility drugs involve two or more babies (Cowley and Springen 1997).

The Dangers of Using Fertility Drugs

The fertility business is just that—a business—one which is rapidly expanding, largely unregulated, and highly profitable, making about $4 billion a year. One journalist concluded that many experts are skeptical that those doing the selling really encourage the customers to think things through. Like all industries, the fertility business inevitably feels pressure to skip all the fuss about ethics and just give the customer what she wants.

Strong supporters of fertility drugs point out that those women or couples seeking to become pregnant have often tried for a long time, even many years, to have a child, and they're anxious, even desperate to produce the desired outcome. A doctor should mention the risk, but if the patient is still willing to proceed, can't the doctor just move ahead?

The problem is that the risks are very real. Multiple births are a tremendous strain on a woman's body. "We are not built to have such a high order of pregnancy," said Dr. Patricia Baird, who headed Canada's Royal Commission on New Reproductive Technologies (Driedger 1997, 27). Women carrying multiple fetuses are at increased risk for anemia, hypertension, and labor complications.

Because the human uterus simply isn't large enough to hold many fetuses, the crowding almost inevitably produces early delivery, greatly increasing the possibility of respiratory and digestive problems, neurological disorders, including blindness, cerebral palsy, and mental retardation (Cowley and Springen 1997, 68), with blindness, chronic lung problems, and learning disabilities sometimes not appearing for years (Driedger 1997, 27).

Steps toward Reform of the Industry

Even the most ardent critics of the fertility industry realize that even if they wanted to, they couldn't abolish the existing clinics By 1995, 9.3 million American women had sought help for infertility problems, and in that year alone, 1.2 million consulted a fertility specialist (Ackerman 1997). Regulation of the industry and oversight of fertility treatment seem to be the most prudent steps.

The fertility industry is so unregulated that one expert has referred to it as "the Wild West of medicine." Arthur Caplan, a well-known professor of bioethics at the University of Pennsylvania, said, "The field is screaming for regulation, oversight, and control. What keeps us from doing so is the notion that individuals should have procreative freedom" (Winters 1998, 80). In other words, in a country that prizes individual freedom, most Americans consider it inappropriate to interfere with private decisions about having children. As we have seen, however, a world without regulation of fertility procedures and drugs introduces various dangers for mothers and children.

The scientific knowledge behind many fertility procedures is limited, and paying patients often unknowingly become guinea pigs as doctors experiment with the techniques. Dodie Hoffmann, a 37-year-old Los Angeles nurse, became pregnant with a rarely used technique, but the child was born with Down's syndrome and died immediately. Brokenhearted she requested her medical records and learned that the incident had been classified as a miscarriage.

This case illustrates two common problems with the currently unregulated status of fertility clinics. First, the procedure used with Hoffmann turns out to be very dangerous, producing a high proportion of chromosomal abnormalities and encouraging the more cautious doctors to refrain from its use while others continue to experiment with it. Second, the fraudulent reporting of the case is not surprising in a medical world where until 1997 doctors were not required to provide statistical information on their fertility cases.

Clearly there needs to be a wide range of published studies indicating the success rates and the risks involved with different drugs and procedures. Then, of course, doctors practicing in this field must keep themselves abreast of those findings and act on them, either deciding on their own that certain procedures or drugs are too risky or, at the very least, carefully discussing the risks with their patients. In some areas the law probably needs to intervene declaring that some drugs or procedures are simply too risky or are immoral and thus need to be declared illegal. Consider one area many observers find troubling. Fertility clinics can buy women's unfertilized eggs, in one instance paying $5,000 for their donation. While it is illegal to sell organs, the American Society for Reproductive Medicine supports selling eggs, labeling them "body products" and not "parts" (Wright 1998, 81).

Another portion of the regulation process focuses on the interaction of the fertility specialists and their patients. As we noted, patients often have a tendency to rush in and make a quick decision. They need to be aware that usually there are many options and that options carry with them certain likelihoods of success and also certain risks. It's complicated, often overwhelming. As one writer noted:

Ideally prospective parents should grasp the relevant information: They should be relatively comfortable with the possible dangers and be ready to make difficult decisions if they do materialize (Leo 1997; Wright 1998). For instance, are users of fertility drugs willing to engage in fetal reduction, selectively aborting one or more fetuses in order to maximize the survival of the mother and the remaining fetus or fetuses? And using genetic screening, how does one decide which fetus should remain and which should be removed?

In addition, women need to be aware how time consuming and taxing the fertilization process can be. Fertility drugs are notorious for causing moodiness, cramping, weight gain, and bloating. Furthermore the testing procedures often require frequent office visits for blood tests, ultrasound scans, and injections. One patient declared, "Monitoring your body becomes a full-time job" (Wright 1998, 78).

Then, if the children are born and survive, are the parents prepared to deal with them? If there are multiple births, the chances are greater than normal that the children will have serious problems, and so the parents are forced to deal with that. Furthermore, even without problems, the work load can be terrific. For instance, newborn babies take a great deal of feeding time—about four hours a day. That means the McCaughey septuplets have required about 28 hours of woman/man time just to feed them. Before their seven children are toilet-trained, the McCaugheys will have used about 35,000 diapers. Professor Louis Keith, a professor of obstetrics and gynecology at Northwestern University, said that until the children could dress themselves, the parents would need "anywhere from 35 to 49 volunteers to provide one-on-one availability" (Goldberg 1997, A32).

I'd like to know how it has worked out for the McCaugheys. In fact, it would be interesting to see the results of studies about all of the issues just cited: the regulation of fertility clinics; the process by which patients seeking reproductive assistance learn about the possibilities, difficulties, and dangers of the various options; and the experiences of families with multiple birth resulting from fertility drugs. This is a new field, and thus research in it is just under way. The results of the studies should both be interesting and helpful for making judgments about the safest and healthiest ways for people to overcome barriers to producing children.

Discussion

In class you might examine the following issues:

1. Do you know families with multiple births, and how do the pro's and con's of fertility drugs and procedures relate to those cases?

2. Analyze the pressures motivating people to seek out fertility treatments.

3. If you found it difficult to produce a child, would you be willing or would you be unwilling to go to a fertility clinic?

4. If you found it difficult to produce your own child, would you consider adopting a child?

Sources: Elise Ackerman. "Newfangled Babies, Newfangled Risks," U.S. News and World Report. 123 (December 22, 1997), pp. 63–64; Geoffrey Cowley and Karen Springen. "Multiplying the Risks," Newsweek. 130 (December 1, 1997), p. 66; Sharon Doyle Driedger. "Baby Boom in Iowa," Maclean's. 110 (December 1, 1997), pp. 26–28; Carey Goldberg. "Living with the Septuplets, from Some Who Can Guess," New York Times. (November 21, 1997), pp. A1+; John Leo. "A New Medical Skill: Counting," U.S. News and World Report. 123 (December 8, 1997), p. 20; Karen Wright. "Human in the Age of Mechanical Reproduction," Discover. 19 (May 1998), pp. 75–81.