On Monday the Nobel Prize in Medicine was awarded to the biologist who helped develop in vitro fertilization (IVF). As a New York Times op-ed noted, the honoree is “a man who was reviled, in his time, as doing work that was considered the greatest threat to humanity since the atomic bomb.” Thirty-two years later, there are millions of healthy, thriving individuals who were conceived through IVF, but some skepticism about the procedure remains. In this guest post, we welcome the insights of Karey Harwood, author of The Infertility Treadmill: Feminist Ethics, Personal Choice, and the Use of Reproductive Technologies.–ellen
Over the summer, I had the pleasure of seeing the movie The Kids are All Right, a comedy about an American family with two teenagers and two parents who happen to be lesbians. The moms, played by Annette Bening and Julianne Moore, have been together a long time and years ago they used the same sperm donor, a character played by Mark Ruffalo, to conceive each of their children, a daughter and a son. The plot of the movie is driven by the teenagers’ curiosity about the sperm donor and his subsequent introduction into their family life.
As the title suggests, the kids really are all right, even for coming out of a so-called non-traditional family. Skeptical or conservative audiences who might doubt that a filmmaker could make a believable and enjoyable comedy on this topic should at least admit, if they give the movie a chance, that the story succeeds in portraying a very normal family. The moms struggle with the same issues with which many long-married couples struggle in mid-life, and the kids are as earnestly attached to their parents and as ardently desirous of their independence as any typical, healthy American teenager.
When I read the Time magazine article about studies that have linked IVF (in vitro fertilization) with certain health risks for the children born through this procedure, I made an almost immediate connection with The Kids are All Right, odd as that might seem at first blush. What struck me was the notion that our society, even in the 21st century, has persistent anxiety about children being conceived and raised outside the bounds of “normal.” We worry that children raised by two moms or two dads could not possibly grow into healthy adults, and perhaps our worry about the well being of children conceived by IVF is not all that different. These are conceptions that cross lines, which could not occur without the “unnatural” intervention of science, including the collection of gametes (sperm and eggs) and their union outside the human body. Could our concerns about health risks to IVF babies be misplaced anxiety about children being conceived outside the bounds of “normal,” or does the scientific evidence that has been accumulating about IVF over the last two and a half decades suggest that some concerns have been justified? Are these kids really all right?
The first thing to say is that, of course, some degree of concern about the health risks of IVF to children and their mothers is legitimate, especially given the less-than-stellar track record within American medicine and medical research of taking big risks with vulnerable and/or non-consenting populations. The prototype of the contraceptive pill, for example, which contained a very high dose of synthetic progesterone, was tried out in the 1950s on women volunteers in Puerto Rico who could not possibly have been fully informed of the risks they were undertaking, as the risks were not yet known. A wonderful PBS documentary called The Pill, which is part of their American Experience series, discusses this research and the dangerous side effects these women endured for the sake of science and the millions of women who would eventually be prescribed a much lower dose pill.
Another obvious example from the mid-20th century is the use in pregnant women of thalidomide, an anti-nausea drug that resulted in very serious birth defects for thousands of children before it was taken off the market. The lesson learned from this tragic experience, hopefully, was to be careful. When there are risks to human health involved, let the burden of proof be on the scientist, rather than the unsuspecting public, to make sure the drug or procedure is safe. In environmental circles this has become known as the “precautionary principle”:
“When an activity raises threats of harm to human health or the environment, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically. In this context the proponent of an activity, rather than the public, should bear the burden of proof.”
So, what about IVF? What is known and unknown about the risks to human health? Are they serious risks? The latest study, published in July in the journal Pediatrics, specifically investigated the risk of childhood cancer to children conceived by IVF. It tracked 2.4 million births, including 26,692 children born through IVF, between the years 1982 and 2005. The study, one of the largest of its kind to date, did indeed find a statistically significant increase in the risk of cancer for children conceived through IVF as compared to children conceived naturally. The increase in risk was 42%. However, the absolute risk of cancer in these IVF children was still remarkably low: 56 cases of childhood cancer for the IVF kids versus 38 cases in non-IVF kids of the same age group. Moreover, the big remaining unknown seems to be whether the cancer risk is linked to the IVF procedure itself or to underlying factors related to the parents’ infertility. The researchers speculated that it might be the latter, but have been unable to pinpoint causality. We’ll need more studies.
The bottom line seems to be yes, there is some increased risk associated with IVF, but it’s not very serious. It’s certainly not serious enough to deter people who ardently desire to be parents: “While IVF may bump up a tiny risk of childhood cancer, without it, many couples may not have a baby at all,” reports Catherine Elton.
And this conclusion brings me back to The Kids Are All Right. There are risks to any parenting endeavor: children get sick, parents make mistakes, relationships go awry. In addition, there is a context of consumerism surrounding the infertility industry that creates additional reasons for concern, specifically that some potential parents might be lured into medical risk-taking, or at least drawn into spending well beyond their means, in the pursuit of a parenting dream that might not ever be realized. However, in the absence of a serious risk to the children born through IVF and without scientific evidence to justify restricting the procedure, we would be wise to let go of some of the anxiety. Let the researchers continue their research, as it is the responsible and cautious thing to do, and let the parents be parents.
I think the kids are all right.
Karey Harwood is associate professor of philosophy and religion at North Carolina State University. She is author of The Infertility Treadmill: Feminist Ethics, Personal Choice, and the Use of Reproductive Technologies. Read her previous blog posts about the California octuplets case here and here.