ART Frontiers and Parenthood

Just as I was taking a step back to think more broadly about some of the issues I discuss here, the New York Times began a series on the promise and perils of modern reproductive technology.  There have been two articles so far, both on the front page, one yesterday and now another today.   They’re gripping and sobering, too.  Definitely worth a read. 

Today’s story opens with a harrowing account of the experiences of Thomas and Amanda Stansel.  They used intrauterine insemination (IUI) as well as drugs to stimulate super-ovulation.  This is less hi-tech, less expensive, and presumably more common that IVF.     I’ll just leave it to you to read the story, which recounts what followed from their choice.  

Assisted reproductive technology (ART) unquestionably offers new opportunities to countless people who are unable to reproduce without some sort of assistance.   At the same time it brings with it countless difficult decisions and wrenching stories, legal challenges and regrettably, some bad outcomes.   (I realize we probably won’t all agree on which outcomes are bad outcomes, but I think we probably all ought to recognize that there must be some.)

Reading these articles has made me think about ART and what the ever-expanding use of it tells us about our world.   I suppose one thing it demonstrates is the persistent desire many people experience to be parents.   After all, going the ART route is frequently neither easy nor cheap.   (It’s typically not covered by insurance.)   It’s also, as this article makes clear, potentially dangerous to both the woman who will bear children and the children who might be born. 

The Times articles seem to me to lend support to some effort to regulate or restrict access to ART in an effort to reduce the number of cases with problematic outcomes.   That might be a reasonable goal, but it might be more fully served to consider the reasons why people end up in the ART arena. 

As ART has become more and more a part of our lives and our culture, law has generally taken one of two approaches towards it.  In some states (and in the Uniform Parentage Act, which is a model for state laws)  there are special provisions governing parentage when ART is involved.  In others, there are no special provisions and the ordinary provisions of parentage generally apply.  

It’s curious that states that are hospitable to ART do not necessarily fall on one side or the other of this divide.   For example, both California and Massachusetts are states with well-developed ART industries.   California is on the UPA/ART specific law side of the line.  Massachusetts, for the most part, on the “no special provisions” side of the line. 

This interests me as I consider my overview of parentage law. It’s tidier to have one set of laws (one hierarchy, if you will) governing everything.   But one-size-fits all garments are typically not as well-tailored as those that come in sizes.   Thus, there is something to be said for special ART laws, too.  

I tend to come down on the one-size-fits all side, for reasons I’ll get to next time.   Interestingly, those who would make parental status turn on a genetic link would also choose a one-size-fits all arrangement.  So while we will part company about what the test should be, we seem to be on the same page about the value of a unitary test.

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3 responses to “ART Frontiers and Parenthood

  1. These stories are tragic. but what is seriously scary is the proposition allegedly made by doctors that IVF should be used as a first resort. IVF actually has very significant risks for not just the mother but for babies born that way. Just think for a few minutes of how a developing embryo might be significantly affected by growing in an unnatural medium for several days. It might not surprise you to hear that there are several syndromes associated almost exclusively with IVF babies and other IVF children/young adults have higher predisposition to certain disorders most notably metabolic and bowel disorders. A higher percentage of IVF conceived children and young adults are obese than their contemporaries and that is very troubling in a society where obesity is already a big problem. Also, the frequency of identical twins increases significantly with IVF since the physical manipulation of the embryo can cause the embryo to split.

  2. Lets not get ahead of ourselves here. There is a dramatic difference between a facilitated IUI which was discussed in one article and the IVF discussed in the second.

    Two different treatments, each with its own risks. An IUI does not get you past chromosomal abnormalities in the egg which may result in sick babies. And, IVF does not get you past medical decisions about the numbers of embryos transferred.

    One thing is certain, responsible reproductive endocrinologists would love to have a protocol which would lead to a single healthy baby being born following every transfer. That protocol does not exist as the anatomical and physiological issues are complex and change with each specific patient profile.

    There is one certainty, however. The number of multiples born through ART have been sharply decreasing especially over the past 5 years.

  3. Sandy May, You are right about your concerns for IVF babies.

    There is research indicating that the lack of natural growth factors in the fluid in which IVF embryos are grown could have lifelong effects on people conceived this way. See this link: http://www.news-medical.net/news/2005/02/16/7797.aspx

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