IVF 7: Ethics

I wasn't planning on getting into the ethical implications of IVF, but after reading some of the angry online comments to Alex Kuczynski's piece in the Times Magazine this week on gestational surrogacy, it felt pressing.

The arguments against IVF fall into three main categories:
1) If you can't have kids, there's probably a reason, and IVF only circumvents Nature by letting you pass that problem on to the next generation.
2) Why not adopt a child in need, rather than spend time and money pursuing "biological" children?
3) It's a giant waste of money and medical training for a problem that is not directly related to health.

In addition, there is a widespread perception (as reflected in the comments to the Times article) that couples who choose IVF are narcissists, people who cannot imagine loving a child that did not spring from their own loins.

Dr Hyde and I discussed all of these issues before deciding to try IVF. Some of these arguments have validity and still worry me; others don't. Let's take them in turn.

1) IVF circumvents natural selection.
First off, there are many reasons for infertility, and not all of them are heritable. Age, especially of the female partner, is the most obvious one, but there are others, including certain types of injury. Often, the cause of infertility is not known, making it impossible to say with any confidence whether it is heritable.

In our particular situation, we know the cause (or think we do), and doctors simply don't know if it's heritable. After all, it's only recently that couples with our problem have been able to have children. In this respect, we think of ourselves as being on the forefront of a giant experiment. Yay, experiments!

Would we still have tried IVF if we knew that any affected children would also be unable to conceive? I don't know. Of course, if we can conceive through unnatural means, then they would be able to, as well. Still, it's a heavy burden to put on them. There are no known health problems associated with our particular situation; if there were, we would have spent longer on this issue.

In any case, the point is that people who do have genuine, heritable health problems are not usually looked down upon for having children. Bad backs run in your family? Nobody says, "How dare you have children and put them at risk? Lower back pain is a sign that you are not genetically fit to continue the line!" So if you think IVF is immoral because it passes on bad genes, all I can say is: good luck defending your decision to propagate your family's hypertension, heart disease, bad teeth, and fallen arches.

2) Why not adopt?
Well, we still may. If a couple of rounds of IVF don't take, or if we want to add to the family later on but don't want to go through the medical hassle, we will adopt.

Adoption is not hassle-free, though. One friend who is working on her second international adoption listed all of the countries that have recently cut back on allowing babies to be adopted by foreigners. The list ran roughly, "All of them." Waiting lists are long, and if the rules change mid-process, you may not get a child at all.

I don't know anyone who has recently adopted domestically, but I do have one friend in her sixties who adopted her children in what she described as "the halcyon years for adoption--after the war but before Roe v Wade." I'm a firm supporter of all types of abortion rights, but there is no denying that legalizing abortion reduces the number of babies available for adoption. I have heard both good and awful adoption stories; like any method of acquiring a child, it's fraught with uncertainty.

Again, though, the proponents of adoption (in online commentaries, that is) usually seem to believe that infertile couples have a special responsibility to take care of the world's neglected babies. You just don't hear them saying, "Due to the population explosion and the number of needy children out there, everybody, including me, should adopt." No, somehow it's always the infertile folks who have to lead the charge of moral rectitude.

3) Should we really be using medical training for such a frivolous pursuit?
Three words: elective plastic surgery.

Now, I'm not of the belief that just because we can do it, someone else should pay for it. I don't think IVF should normally be covered under basic health insurance, because it's both expensive and medically unnecessary. However, Dr Hyde's health insurance is willing to cover one round of IVF, and we may be hypocrites, but we're not fools: we're taking the money.

4) You're all narcissists.
Interestingly, people often say this in the same breath that they claim that the only reason anyone wants kids is because society "brainwashes" women into thinking that they're not whole without children.

As a biologist, I find these statements make me laugh like a hyena. Wanting kids? Is normal, and biological, and without that drive the species would die out. Wanting kids that are genetically related to you? Again, totally normal. Adoption is, biologically speaking, somewhat perplexing.

Of course, we use our giant brains to make decisions that run contrary to our biology all the time, and thank goodness, because otherwise there might be more fighting, more rape, and fewer scientific conferences. But I don't think that someone can be labeled a narcissist for wanting biological children.

I'd also point out that the very fact that so many people are willing to spend $10,000 or so per cycle of IVF, even to go into debt for this purpose, says something important about our urge to have children. (It also says something important about the American willingness to go into debt, but that is more Ben Bernanke's problem than mine.)

I do think that some people have trouble knowing when to stop. When you are running out of money or ruining your quality of life by endless cycles at the infertility clinic, it is time to let go. But I can say that with sympathy, rather than with rancor or judgment. I can see all too well how difficult it would be to turn away from a particular vision you'd held of how the future looked.

It looked like an embodiment of the love between you and another person.

That's not easy to give up.