The More the MerrierIn Vitro Fertilisation

As previously noted, the HFEA have specified in the most recent HFE Act that clinics are to create standard operating procedures to outline how they are going to reduce the number of embryos implanted in to recipient women; with the goal of achieving single embryo transfers (SETs) wherever possible.

So what is the problem with transferring multiple embryos? With the success rate of IVF being anything from 10-40% depending on the clinic used, surely the possibility of multiple births is a price worth paying for an increased chance of success?

As Professor Robert Winston points out: “In most clinics, the chance of a twin pregnancy is about 25 per cent. Many infertile women after years of unsuccessful treatment are only too ready to accept such a risk.”

However, as Winston goes on to highlight, whilst twins may not present too much of a problem in terms of risks of premature delivery, congenital abnormality or even, on a more practical level, the very feasibility of raising more than one child at the same time “ triplets are difficult to deal with and quadruplets can be disastrous.”

It should also be noted however, that recent research suggests that IVF in itself results in even singular pregnancies having an increased relative risk of up to 30% of certain abnormalities. Whilst these abnormalities are in themselves rare (cleft lip and palate, for example, occurs 1 in 700 pregnancies), the HFE Act 2008 has specified that parents must be informed of this increased risk and informed that the risk is further increased in multiple pregnancies.

The case of Mandy Alwood emphasises these risks only too clearly.

Case Study: Mandy Alwood

Following fertility treatment, Many Alwood conceived octuplets. Despite her doctors’ advice that she selectively abort at least some of her foetuses in order to increase the chance of birth of at least some of them, Mandy remained adamant that she would continue her pregnancy as she was. Sadly, this decision ultimately resulted in the loss of all 8 of her children.

(Winston 1999)

The fall out from Mandy’s case was dramatic. Some criticised the extent to which Mandy’s autonomy was allowed to be the presiding factor in the course of her pregnancy, in light of the probable (and ultimately proven) consequences of her decision. Others claimed that the doctors had acted immorally by suggesting she selectively abort potential human beings, thus ignoring the rights of the unborn children. Perhaps most notably, some doctors began to refuse to prescribe fertility drugs for their patients, in fear that they could face the same scenario that Mandy’s clinicians’ found themselves in.

Therefore considering the case from the perspective of the 8 embryos that ultimately perished, was Mandy right to give all of them ‘a level playing field’; or should she at least have guaranteed the lives of a few of them at the expense of some of the others?

Given that amongst 5 of its ethical principles, the HFEA states that in all of its rulings “the welfare of the potential child”, “respect for the status of the embryo” and “the assurance of human dignity, worth and autonomy” must be considered, one could use such principles both for and against Mandy’s decision with regards to her embryos.

It could be argued that Mandy’s autonomy should be respected with regards to her consideration of the welfare of her embryos/potential children; and that by not aborting some of them, she (and the clinicians treating her) were respecting their status.

On the other hand, it could be claimed that by continuing her pregnancy with all 8 embryos in the knowledge that the majority would most likely perish, Mandy disregarded their status; and even if the pregnancy had resulted in the successful birth of all of the embryos, being 1 of 8 could seriously have affected their individual welfares.

The case of Nadya Suleman emphasises just such an outcome.

Case Study: Nadya Suleman

On January 26 2009, Nadya Suleman, already a mother of 6, made the headlines with the successful birth of all 8 of her octuplets, conceived as a result of IVF.

Nadya’s octuplets were the result of the implantation of 6 embryos remaining after previous IVF procedures. Her justification for requesting the implantation of all 6 embryos, was that she could not face condoning their destruction. (Two of the embryos, when implanted, then split to form two sets of identical twins.)

By the August following the successful birth of her octuplets however, Nadya admitted in a TV interview that she hadn’t truly thought about the reality that raising a total of 14 children would bring and that she had “ruined [her] kid’s lives.”