Thursday, January 9, 2014

IVF Babies at Enhanced Risk. But Why, and So What?

This Australian study in PLOS One shows significant risk of health problems in babies born from assisted conception as opposed to spontaneous conceptions. Compared to spontaneously-conceived singletons, singletons from assisted conception were almost twice as likely to be stillborn, more than twice as likely to be pre-term, almost three times as likely to have very low birth weight, and twice as likely to die within the first four weeks after birth. Outcomes varied by type of assisted conception. Very low and low birth weight, very preterm and preterm birth, and neonatal death were "markedly" more common in births from IVF and, to a lesser degree, in births from ICSI. Use of frozen embryos elminated the risks of ICSI, but not of IVF. But frozen embryos also had increased risk of macrosomia.

The study mentions, but doesn't linger on, data showing that kids spontaneously born of parents with untreated infertility problems also have adverse outcomes compared to kids of non-infertile parents. Compared to spontaneously conceived children of women with no infertility problems, spontaneously conceived children of women with infertility problems were nine times more likely to have very low birth weight, seven times more likely to be very pre-term, and almost seven times more likely to die within the first 28 days of birth. Some experts say that this may mean that the problems experienced by children of assisted reproduction may be more due to parental infertility than to infertility treatment.

Let us leave aside the possibility that many or most IVF-related risks are really just infertility-related risks. The sort of data discussed in this study always brings to my mind some variations on the "non-identity" problem invented by Derek Parfit. Suppose a child of IVF is born with low birthweight, and experiences lifelong significant complications which were foreseeable by the parents when they decided to used IVF. Has that child any complaint against the parents? One possible answer is, "No, because the condition of the possibility of that particular child's ever existing at all was his or her parents' use of the IVF which caused both his or her existence and his or her low birthweight. Only a child whose life was so wretched as to literally not be worth living could complain about his or her parents' use of IVF." The argument in this form seems sound but it also troubles me, because (for example) one can easily imagine the circumstances in which one might accurately say to a slave, "You have no right to complain about being born a slave, because without the institution of slavery, you would never have been born at all."

If IVF is risky, and a child of IVF is born with a disability, and the child would not have been born without IVF, what sort of complaint can one mount, from the child's point of view, about the disability?


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