Octomom Phenomenon: Fertility Is A Fertile Business

By Elayne Clift, Womens Feature Service

When Nadya Suleman, dubbed 'Octomom' by the US media, gave birth to eight babies in January, she not only made medical news, she shone a light on America's fertility clinics and renewed a debate swirling around the ethics of assisted reproductive technology.

Suleman has another six children also conceived through in-vitro fertilisation. An unemployed psychiatric technician, she lives with her mother and children in a three-bedroom house in California. The house is scheduled to be sold at auction in May because of mortgage default. Her father has returned to Iraq to work as a translator and driver in order to support his daughter and her 14 children. "Something has gone terribly wrong when a 33-year-old single woman - who has no home of her own, no job, and a mother who worries her daughter is 'obsessed' with having children - winds up with 14 of them," says Dr Arthur Caplan, Director, Center for Bioethics at the University of Pennsylvania.

Caplan notes that there are no known cases of octuplets in which all escaped severe disabilities, a concern that raises ethical issues which include "the hijacking of health care dollars." Caplan estimates the cost of neonatal care for the eight babies probably exceeded $1 million (46 medical personnel were needed to deliver the octuplets); he also notes that millions more in medical costs will be needed as the children grow. He believes the government needs to establish rules for assisted reproduction as it does for adoption and foster care.

Some fertility doctors disagree. "Who am I to say that six is the limit?" asks Jeffrey Steinberg, a fertility specialist with clinics in Los Angeles and New York. "There are people who like to have big families." Another expert at New York University concurs. "I don't think it's our job to say how many babies are allowed. I'm not a policeman for reproduction in the United States." Caplan calls this attitude "ethically bonkers."

The physician who treated Suleman, Dr Michael Kamrava, is now under scrutiny by the California Medical Board. In addition to several malpractice suits against him, Kamrava is being criticised for implanting large numbers of embryos instead of the two recommended by the American Society for Reproductive Medicine. Critics charge that he does multiple implantations in order to keep up his success rate, reported to the Centers for Disease Control and Prevention annually. (Despite multiple implants, Dr Kamrava's success rate is low.) In February, Kamrava was removed from the American Fertility

Association's Physician Network pending the outcome of the Medical Board's findings.

Further concerns about Dr Kamrava's practice include the fact that his clinic is among those now advertising the "coming" availability of embryo screening for "gender, eye colour, hair colour and complexion."

Known as PGD or "pre-implantation genetic diagnosis" it is already being used for sex selection. "Assisted reproduction in America has been a Wild West for too long," says Marcy Darnovsky, Executive Director, Center for Genetics and Society (CGS). "Responsible oversight of extreme reproductive technologies such as embryo selection based on skin colour is long overdue." According to Darnovsky, "the US is notorious for its inadequate regulation and oversight of assisted reproduction, which has become a $3 billion business in this country alone. A large majority of industrialized countries, including Canada, the UK, most of Europe, Japan, Israel, china and Australia, prohibits non-medical sex selection."

The CGS points out that "women's well-being must be a central concern" in human biotechnology and underscores that "reproductive rights must be firmly protected." It also sounds further alarms: While assisted reproductive technologies have helped many people become parents, the technologies are costly and invasive, and success rates remain low. Long term risks to women and children have yet to be well studied.

Treating infertility is now a highly competitive business and is "notoriously" under-regulated. Experimental techniques are used clinically before being adequately tested. There are other ethical and practical concerns. For example, paying economically vulnerable women to provide eggs for other women's fertility treatment or to become surrogates is on the rise. Questions about what might be next include reproductive cloning and inheritable genetic modification, already being used in animals.

As CGS points out, "it is not uncommon for those advocating these technologies to appropriate the language of reproductive choice to argue that parents should have the 'right' to choose their children's characteristics. But there are important differences between choosing when and whether to bear a child and creating a child with specified traits," often referred to as "enhancements" by technology advocates.

A day after Suleman gave birth to her eight babies, California state senator Gloria McLeod introduced a bill that would place fertility clinics and cosmetic surgery providers in the state under the jurisdiction of the California Medical Board for the first time. Under the legislation, cosmetic and fertility clinics would face a new set of regulations based on accreditation standards established by the Board. Inspection and reporting would be routine and required.

In Georgia, a bill has been introduced to provide oversight of the fertility industry. However, it has been supported by the Georgia Right to Life and includes banning embryonic stem cell research as well as human cloning and the sale of sperm or eggs.

While several states are beginning to respond to the need for legislation around reproductive technology, proposed laws vary widely, creating what one policy analyst calls "a cumbersome patchwork." Clearly, voluntary guidelines established by industry organizations have not been effective. That is why many are now calling for Congressional oversight of an unregulated industry.

"We need carefully crafted policies that don't infringe on reproductive rights and that bring responsible regulation to the baby business," says Darnovksy. "Surveys show that large majorities [of Americans] oppose the creation and marketing of so-called 'designer babies'."

Womens Feature Service covers developmental, political, social and economic issues in India and around the globe. To get these articles for your publication, contact WFS at the www.wfsnews.org website.