Multiple Births: When 'Supply' Exceeds 'Demand'

What's to Come of Treating Children as Commodities?

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By Dr. Rebecca Oas

WASHINGTON, D.C., FEB. 29, 2012 (Zenit.org).- In 1934, a French Canadian mother gave birth to five daughters who would become internationally famous as the first recorded set of quintuplets to survive infancy. During their childhood, the Dionne sisters became a popular tourist attraction and went on to appear in several Hollywood movies.

Seventy-five years later, Nadya Suleman, a single mother of six in California, gave birth to octuplets and became infamously known as the "Octomom," following in vitro fertilization (IVF) conducted by a doctor whose license was subsequently revoked. Throughout human history, multiple births have been regarded with interest, sometimes bordering on morbid fascination as we approach and surpass the known limits of human reproductive capability, now with the assistance of novel scientific interventions.

Part of what makes multiple births interesting is their relative rarity. Within the United States, the rate of multiple births compared to total births remained relatively steady at close to 2% from the early 20thcentury to the early 1980s. However, in January, the Centers for Disease Control and Prevention issued a report in which they documented a dramatic increase in twins, triplets, and higher order multiple births in the United States between 1980 and 2009 (1). This reflects an international trend, as studies from other countries such as Canada and Japan reported similar findings (2,3). From a public health standpoint, as multiple births have been associated with a greater risk of prematurity and other resulting complications than single births (4), such a significant increase in twins and other multiples has important implications for health care standards. 

Advancing medical technologies in the latter half of the 20th century have greatly reduced the level of infant mortality in general, and notably among multiple births as well. Between 1960 and the early 1980s, mortality rates among triplets and higher order multiples decreased by approximately 50% (5), which signaled that while such children were likely to require special care to survive, their survival was increasingly likely. Nevertheless, given the inherent hazards of being a twin or triplet as opposed to being a singleton, it follows that care must be taken wherever possible to not artificially increase the likelihood of multiple births, given the medical risks to the unborn children, as well as their mothers. To put this in terms of Catholic teaching, as the 1987 instruction Donum Vitae reminds us, the life and integrity of unborn children must be respected and not subjected to disproportionate risks, whether diagnostic or therapeutic (6).

A further matter of concern involves the underlying causes of the reported increase in multiple births in the last three decades. The studies from the United States, Canada, and Japan all cited two hypothesized reasons for the increase: greater maternal age (particularly the increased delay in having one's first child), and the expansion of fertility treatments, both in terms of variety and frequency of use. It is demonstrably clear that women are increasingly postponing childbirth into their 30s, and that the difference in maternal age within the population is causally linked to an increase in the incidence of twins or other multiple births, for reasons independent of medical treatments to increase fertility. However, as an increasing number of international studies show, this factor alone cannot account for the entire rise in multiple births, and there is a strong consensus among the authors of these studies that fertility treatments are a major influence as well. According to the study from Japan, as many as 50% of multiple births in 2004 and 2005 were iatrogenic, or directly resulting from medical intervention (3). The CDC report from the United States estimates that two-thirds of the increase in multiple births can be attributed to assisted reproductive technology (2). Clearly, even as medical advances are improving the outcomes for multifetal pregnancies, the reproductive industry is making this increasingly necessary.

There is no doubt that reproduction is an industry, and a very lucrative one, at that. The costs of IVF run in the tens of thousands of American dollars for a single attempt, and the woman must receive regular hormone injections and undergo invasive procedures to both retrieve eggs and transfer embryos into her uterus. Given the physical and financial toll exerted by IVF, prospective parents and medical professionals place a great deal of emphasis on achieving a successful birth with as few attempts as possible. Therefore, it is common to transfer more than one embryo at a time, in the hopes that at least one will survive. In the event of the survival of multiple embryos, or if the embryos further divide in a case of identical twinning, the parents are offered the option of a "selective reduction," in which one or more of the fetuses is aborted. 

The argument used to support this practice is that the fewer the number of babies, the better the projected outcome for the survivor(s). In other words, even if a mother would be happy to accept twins or triplets, she may be counseled to "reduce" the number of her children for fear that she might be more likely to miscarry and lose the entire pregnancy. Sadly, this barbaric practice is being increasingly recommended not only for higher-order multiples, but also for twins, including those which occur naturally (7). In an opinion piece in Newsweek, a doctor justified his practice of performing reductions by asserting that "lots of lives are at risk" -- yet further admitted that he takes parents' gender preferences into consideration when deciding who lives and who dies (8).

Just as medical advances are being abused to produce children as commodities, they are likewise being abused to destroy those children when the "supply" is perceived as being greater than the "demand." Researchers, medical professionals, and ethicists alike are working to establish standards regarding the number of embryos transferred in IVF, and there is broad condemnation of those who ignore all standards and recklessly endanger patients and their children, such as the doctor responsible for Ms. Suleman's shocking case. 

A recent article in the journal Fertility and Sterility reports a novel way to screen unfertilized oocytes (eggs) to determine which would be more likely to produce viable embryos once fertilized (9). This method, if successful, might be used to strengthen the argument for single-embryo transfer in IVF, and since the test is performed prior to fertilization, it might potentially reduce the number of embryos being generated in vitro and subsequently frozen. However, this discovery, as well as all other efforts to "perfect" IVF, are insufficient inasmuch as they fail to address the core problem with the fertility industry: the removal of the procreation of human life from the context of the marital embrace is an affront to the dignity of the couple, and to produce children on-demand as commodities is an affront to their dignity as human beings.

While every child born is cause for celebration, the sharp increase in multiple births is cause for sober reflection since we have identified assisted reproductive technology as a major contributing cause for this increase. On the one hand, medical advances have made it possible for more sets of multiples to be born and survive infancy than ever before in human history. On the other hand, the booming fertility industry and the resulting commodification of children have certainly made its mark on international demographics, as evidenced by these recent reports. As faithful Catholics, we must continue to educate our culture about the arguments against IVF, even as we welcome the children conceived both naturally and through the use of assisted reproductive technology -- whether they come alone or in groups of two or more.

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Rebecca Oas, Ph.D., is a Fellow of HLI America, an educational initiative of Human Life International. Dr. Oas is a postdoctoral fellow in genetics and molecular biology at Emory University. She writes for HLI America's Truth and Charity Forum.

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1) Martin, JA; Hamilton, BE; and Osterman, MJK. Three Decades of Twin Births in the United States, 1980–2009 http://www.cdc.gov/nchs/data/databriefs/db80.htm

2) Cook, JL; Collins, J; Buckett, W; Racowsky, C; Hughes, E; Jarvi, K. Assisted Reproductive Technology-Related Multiple Births: Canada in an International Context. www.jogc.com/abstracts/full/201102_HealthPolicy_1.pdf

3) Ooki, S. Effect of Maternal Age and Fertility Treatment on the Increase in Multiple Births in Japan: Vital Statistics, 1974–2009. Journal of Epidemiology. http://www.jstage.jst.go.jp/article/jea/21/6/21_507/_article

4) Alexander, GR; Kogan, M; Martin, J; Papiernik, E. What Are the Fetal Growth Patterns of Singletons, Twins, and Triplets in the United States? Clinical Obstetrics and Gynecology. Issue: Volume 41(1), March 1998, pp 115-125

5) Kiely, JL; Kleinman, JC; Kiely, M. Triplets and higher-order multiple births. Time trends and infant mortality. American Journal of Diseases of Children. 1992 Jul;146(7):862-8.

6) Sacred Congregation for the Doctrine of the Faith. Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation (Donum Vitae), 1987.

7) Antsaklis, A and Anastasakis, E. Selective reduction in twins and multiple pregnancies. Journal of Perinatal Medicine, Vol. 39, 2011.

8) Evans, MI. The Truth About Multiple Births. Newsweek; 3/2/2009, Vol. 153 Issue 9.

9) Swann K, Windsor S, Campbell K, Elgmati K, Nomikos M, Zernicka-Goetz M, Amso N, Lai FA, Thomas A, Graham C. Phospholipase C-ζ-induced Ca(2+) oscillations cause coincident cytoplasmic movements in human oocytes that failed to fertilize after intracytoplasmic sperm injection. Fertility and Sterility. 2012 Jan 2.