German mom expecting quadruplets at 65

Excerpted from “German Mom Expecting Quads at 65 Is 'Irresponsible': Bioethicist,” NBC News. April 14, 2015 — Berlin school teacher Annegret Raunigk is proudly prolific and, at age 65, not done making babies — pregnant with quadruplets that would enlarge her family from 13 to 17 children. Raunigk said she became pregnant again because her 9-year-old daughter asked for a younger sibling. (Her first 12 children — by five men — are ages 22 to 44). She told German tabloid Bild that donated eggs were fertilized and implanted at a clinic in Ukraine. Multiple attempts were required to get the eggs to fertilize. She did not say whose sperm was used or if the egg donor was paid.

What she is doing is unethical. She doesn't think so. But she left her country to receive an infertility treatment that's illegal in Germany due to her age. And she sought that help on the sole grounds that her youngest daughter wants a sibling. Of course, given that logic, future requests by any of her newest kids apparently guarantee no end to her pregnancies.

The number of reasons why this very-late-in-life pregnancy is morally wrong nearly equates to the number of children Raunigk has conceived. But let's stick to the main issues. First, she likely will not live long enough to raise her current children, much less any new kids. It is not fair to children, as adoption agencies know when they limit adoption to those under 55, to intentionally create a family where mom and dad will enter a nursing home as the kids enter junior high.

Making four kids in a 65-year-old body also is irresponsible. The quadruplets are likely to be premature and, if they survive, may pay a steep price for this decision in terms of their health. Her older body makes the pregnancy extremely high risk all the way around. There will be a C-section, which is dangerous for her. And there certainly will be no breast-feeding by mom.

And what clinic would agree to accept as a patient a woman with 13 children — simply because her daughter wants a sibling? What clinic would not insist on a surrogate mom? What clinic would not demand she stay nearby during the pregnancy? What clinic would even let her try to deliver four fetuses?

The answer: One looking to gain fame and clients by engaging in a publicity stunt with nascent lives. Then again, this theoretically could have happened as well in the U.S. where there are no restrictions about who can use technology to have a baby — grandparents, mentally ill, very old single parents, even child molesters. Despite the headlines babbling about "miracles" and "gifts," and despite Annegret Raunigk's insistence that she should be free to reproduce however and whenever she wants, what's needed is a far more thoughtful, moral stance to govern reproductive technology.

Commentary

CMDA Member John Pierce, MD: “The case of Annegret Raunigk is another clear example of doing what is ‘…wise in your own eyes’ (Proverbs 3:7a, NIV 2011). In the world, there are arguments for age limits on IVF including the multiple health risks for the older mother and her infant, as well as arguments against age limits purporting reproductive freedom, equality for women (as older men can father a child) and social factors ‘to help fulfill lifelong dreams.’ Moral arguments might ask questions such as, ‘Is it right to have a child when the average life expectancy (about 80 years old for women in the developed world) means the child would be without a mother before driving a car?’ or ‘On what grounds do you deny the patient her rights?’

“Clear thinking using the principles of autonomy, beneficence, non-maleficence and justice has been supplanted with situational ethics incorporating intense emotions and cultural relativism. Why would we not have these struggles when there is no standard and a crumbling foundation? The law is silent on age in reproductive rights and most medical organizations provide weak recommendations,ⁱ leaving the decision up to individual clinics,ⁱⁱ or refute the need for practitioners to use their conscience.ⁱⁱⁱ

“Solomon sincerely asked the Lord, ‘So give your servant a discerning heart to govern your people and to distinguish between right and wrong...’ (1 Kings 3:9, NIV 2011). While we may argue vehemently, the loudest voice will be undeniable examples of healthy relationships, thriving marriages, happy families and renewed minds.”

ⁱEthics Committee of the ASRM. Oocyte or Embryo Donation to Women of Advanced Age: A Committee Opinion. Fertil Steril, 2013;100:337-40.
ⁱⁱ Fisseha S and NA Clark. Assisted Reproduction for Postmenopausal Women, AMA Journal of Ethics, Jan 2014, Vol 16, No 1:5-9.
ⁱⁱⁱCommittee on Ethics. ACOG Committee Opinion: The Limits of Conscientious Refusal in Reproductive Medicine. Obstet Gynecol, 2007 (reaffirmed 2013);110:1203-8.

Resources

CMDA’s Assisted Reproductive Technology Ethics Statement
Standards4Life – Infertility and Reproductive Technology

Rise in IVF popularity leaves thousands of babies in limbo

Excerpted from “Rise in IVF popularity leaves thousands of babies in limbo,” World Magazine. October 25, 2013 -- More women are using donated eggs for in vitro fertilization (IVF) and more healthy babies are being born through the process, according to a study released in October. While this is good news, the process also creates more embryos than can be implanted, leaving hundreds of thousands of frozen embryos in fertility clinics. For women with viable eggs who cannot become pregnant, IVF involves extracting their own eggs, fertilizing them and then re-implanting them in the uterus. Women who do not have viable eggs go through a similar IVF process using eggs from other women. The number of women who attempted IVF from another woman’s eggs increased from 10,801 in 2000 to 18,306 in 2010. The percentage of healthy outcomes from donated eggs, defined as a baby born after 37 weeks weighing 5.5 pounds or more, increased from 18.5 percent in 2000 to 24.4 percent in 2010.

The study also found that women are increasingly implanting only one embryo in an IVF cycle. Because doctors are unable to predict with certainty which embryos have the best chance of resulting in a healthy baby, many women implant more than one embryo during an IVF cycle, increasing the odds that at least one of the embryos will survive. However, between 2000 and 2010, the percentage of women who transferred only one embryo, and thereby avoided the possibility of multiple births, increased from less than 1 percent to 15 percent.

However, the process is wrought with ethical controversy, as many clients don’t know what to do with the extra embryos created: An estimated 600,000 frozen embryos are stored in fertility clinics throughout the United States. “The vast majority of people don’t have a plan,” says Daniel Nehrbass, executive director of Nightlight Christian Adoptions, an organization that does embryo adoptions. “They don’t want to destroy them because there is finality to that. So they store them and the years go by.” In the face of many grey ethical issues, including the question of whether couples should pursue IVF at all, Nehrbass said NightLight sees two things as black and white: “Embryos are human life, and they deserve a chance to be born.”

Commentary

Medical Director for the National Embryo Donation Center Jeffrey Keenan, MD: “Currently there are more than 600,000 cryopreserved embryos in liquid nitrogen tanks in U.S. fertility clinics alone. Although some 80 percent of couples say that they plan to use these for future reproduction, the reality is that a large percentage of these will never be thawed and replaced in the genetic mother’s uterus. Because cryopreservation has only been performed for about 25 years, no one really knows what the ultimate fate of these embryos will be. It is possible that many will eventually be destroyed, donated to destructive and unfruitful embryonic stem cell research or even left as a sort of ‘inheritance’ for the children (genetic siblings).

“What created this problem is the marked improvement in IVF success rates, an increase in the number of procedures and the more prevalent use of donor eggs as noted in this article (donors generally produce more eggs of better quality with higher pregnancy rates). At the same time, most clinics have not changed their practices which typically involved inseminating ALL eggs regardless of the number or likelihood that there will be additional embryos remaining long after the couple has completed their family building plans.

“Unfortunately, the American College of Obstetrics and Gynecology and other professional bodies do not even consider an embryo a viable being until it has implanted in the uterus. This view has at least contributed to the almost complete disregard for the lives of embryos by most members of our profession.

“The National Embryo Donation Center was founded with the assistance of the CMDA and performed its first embryo transfers in 2003. So far, more than 400 children have been born or are awaiting birth as a result of the NEDC’s efforts, making it the largest and most successful provider of embryo donation/adoption services in the world. The NEDC advocates limiting the number of eggs inseminated with each IVF cycle, as well as increasing the excellent alternative of freezing eggs rather than embryos. NEDC is currently seeking affiliates in multiple cities around the country to perform adoptive embryo transfers.”

Resources
www.embryodonation.org
http://embryoconnection.org
Embryo Adoption: One Family's Testimony
Beginning of Life Ethic Statement
Assisted Reproductive Technology Ethic Statement