HEALTH

A second chance

Grappling with new reproductive technology

NORA UNDERWOOD November 26 1990
HEALTH

A second chance

Grappling with new reproductive technology

NORA UNDERWOOD November 26 1990

A second chance

HEALTH

Grappling with new reproductive technology

After a 12-year courtship, former civil servant Christiane Bergauer and accountant Ian Free married in 1981 and planned to start a family. But after a year of marriage, Bergauer-Free did not become pregnant and, finally, the couple sought medical help. Now 37, Bergauer-Free says that she and her husband found the following three years physically and emotionally distressing while doctors put them through dozens of tests and exploratory surgery—only to tell them that their infertility was “unexplained.” Finally, in 1986, the Toronto couple resorted to so-called in vitro (or “in glass”) fertilization (IVF), a high-tech method of producing what many people call “test-tube babies.” On Aug. 2 of that year, doctors at Toronto’s East General Hospital placed one of Bergauer-Free’s eggs into a sterilized laboratory dish, fertilized it with her husband’s sperm and then implanted the egg into her womb. Nine months later, their son, Tristan, was born. Although three subsequent attempts at in vitro fertilization failed, Bergauer-Free says that “the desire is still there.” But now, there is a growing controversy over the whole IVF procedure, which a royal commission is investigating.

The new age of human reproduction began with the birth of a girl in July, 1978, in Lancashire, England. Louise Brown was the first in vitro baby, the first child ever to be conceived outside a woman’s body. Since then, researchers have developed new ways of treating infertility, a steadily growing and often devastating problem that now affects at least one in she Canadian couples. But all forms of the technology have raised medical, legal, economic and ethical issues. To address them, on Oct. 25, 1989, Prime Minister Brian Mulroney called

for a Royal Commission on _

New Reproductive Technologies, which began hearings in Yellowknife on Sept. 11 and continues this week in Toronto and Montreal, before moving to Vancouver and Victoria next week for its final public stages. By the time it completes its investigation on Nov. 29, the commission will have heard from 350 groups and individuals concerned with the technologies, and it may report to the government as early as October, 1991.

The nine-member com-

mission faces a formidable task. Its mandate is to examine and report on the causes, treatment and prevention of infertility, as well as the scientific and medical developments in reproductive technology and their implications. In addition, the commissioners are investigating

special arrangements, including surrogate childbearing, and the ethical issues involved in embryo freezing and research. The commission’s aim, according to its chairman, Dr. Patricia Baird, is to recommend acceptable policies and safeguards. Said Baird, who is on leave _ from the medical genetics department at the University of British Columbia: “We are hearing that Canadians are coming to realize that these are powerful technologies with new choices. How should they be used? How should they be controlled? There are some real-life issues here for real people.”

In the 12 years since Brown’s birth, medical researchers have developed a i number of ways to help infer1 tile couples. In Canada alone, g 13 IVF fertilization clinics I have started operations since

the early 1980s. Two of them, in Toronto and Vancouver, have each been responsible for the birth of 300 babies. The method has become so popular, and infertility so large a problem, that in many cases the waiting list at hospital clinics is well over a year. Other couples have turned to surrogate mothers, who, for a fee of as much as $20,000, allow themselves to be implanted with a woman’s egg fertilized by her partner or, in cases where the would-be father is infertile as well, will receive an artificially inseminated egg, and carry a couple’s baby.

Dr. Christo Zouves, director of the IVF program at UBC, says that he expects infertility rates to increase for many years. Experts, including Zouves and Dr. Murray Kroach at East General Hospital, say that about one-third of all problems in conception are the result of disorders in the woman’s reproductive

system. Many of those are the result of previous use of contraceptive intrauterine devices, of such sexually transmitted diseases as chlamydia and, to a lesser extent, of postponing pregnancy until a woman is in her 30s.

Male infertility, which accounts for another third of the problem, may be the result of developmental abnormalities, of infection by mumps during puberty or adulthood, or by an inherited or genetic low sperm count. The remaining couples suffer from other factors, including problems with sexual intercourse. In a few cases, doctors cannot explain the infertility in couples like Bergauer-Free and her husband. In all cases, however, the diagnosis is usually devastating. “It’s like losing someone you really love,” said Bergauer-Free, who appeared before the commission on Oct. 29. “But this is a death within you. The question is always, why?”

Although reproductive technology has opened doors to infertile couples, many critics and supporters of the procedures have expressed concern about the health risks to

women. During the process, a woman takes special drugs to help her ovulate. Critics say that, in addition to potential side effects, including bloating and ovarian cysts, the drugs may also increase the rate of miscarriage and socalled ectopic pregnancy, which occurs when an embryo implants itself in the Fallopian tubes. But Kroach says that because doctors can establish a pregnancy at a much earlier time, they can also identify miscarriages that may go unnoticed in natural conceptions. He cited a fourto five-per-cent ectopic pregnancy rate “because we’re dealing with people with damaged tubes,” and said that the only real difference in IVF pregnancies is a higher rate of multiple births. Said Kroach: “That is a side effect—if you consider it a negative.”

In its brief to the commission on Oct. 29, the Ottawa-based National Action Committee on the Status of Women severely criticized surrogate arrangements. Said NAC president Judy Rebick: “Contract motherhood represents a new form of reproductive prostitution.” She added, “The potential is to create a breeder class of women to sell their capabilities.” And Winifride Prestwich, a director of Campaign Life, a Toronto anti-abortion group that is presenting its opinions to the commission this week, says that she strongly feels surrogate arrangements should be banned. “What it’s likely to lead to is poor women carrying babies for others,” she said.

An equally contentious aspect of the technology is embryo freezing. During the initial stages of IVF, doctors may remove several eggs from a woman, freeze them and store them for later use. At Zouves’s clinic, unused embryos are thawed and left to disintegrate, a practice that Dr. William Deagle, a Halifax-area family doctor, for one, says is tantamount to murder. Said Deagle: “Once an embryo becomes a distinct entity, it should be treated with respect. Killing is killing.”

What also worries many people, including Dr. Edward Keyserlingk of McGill University, is that flawed embryos or embryos of an unwanted sex could be discarded. Said Keyserlingk, a member of the university’s Centre for Medicine, Ethics and Law: “The fear in this area is a very real one. You could have clinics accepting gametes [eggs or sperm] from people with certain characteristics.” Even more reprehensible, Deagle adds, is the possibility that scientists could create embryos for research, in such areas as drug toxicity, as an alternative to trials on animals. “It opens up a real Pandora’s box,” he said. “There are very serious implications for human rights in general.”

Campaign Life’s Prestwich says that all embryo research should stop. “A human embryo is a human being from the first cell,” said Prestwich. “At that point, it has all the rights that are attached to other living human beings. I don’t think we have the right to use them like they were animals.” For his part, Keyserlingk said that freezing and experimenting on embryos left over from in vitro fertilization for research directly related to infertility is acceptable, if the woman consents and has some

control over their use. He added: “Legitimate experimentation should be legitimate. I think the argument not to do so would be unethical.” Without the technology, many of those couples would have been denied the chance to be parents. But most people who have appeared before the commission expressed concern about the cost of in vitro fertilization, which is as much as $4,000 for each attempt. In Canada, the only province that covers the cost of IVF is Ontario. Even there, a couple must pay as much as $800 for fertility drugs for each attempt. Rebick, for one, says that the cost creates inequalities among women. “If we’re going to have them, they should be financially accessible to everyone,” she said.

Rebick and Keyserlingk, like others, also say that fertility clinics’ screening process is unfair. Some doctors agree to provide in vitro fertilization to couples only after they determine that the relationship is stable. “People do get married who make a botch of it and who aren’t great parents,” said Keyserlingk. “Why do we screen people for IVF? Why should we be able to do that here and not in the normal parenting situation? It’s an additional discrimination on someone who is already infertile.” The cycles of hope and despair experienced by a woman receiving help for infertility is a concern that most witnesses expressed—and one that Bergauer-Free says that she remembers well. “It’s devastating,” she said. “In the beginning, you think it will work out. As time passes, it wears on you. You begin to doubt yourself.” Doctors say that there is only about a 20-per-cent chance in each of the first three tries that in vitro fertilization will result in a pregnancy. After that, the possibilities decrease. Of those pregnancies, about 12 per cent will result in success. The whole process, said Zouves, is extremely stressful. He added: “There’s the emotional side. There’s the financial side. There’s the low success rate. It’s a roller coaster, for sure.”

Most people involved with reproductive technology claim that government guidelines are urgently needed. Kroach, for one, called for a ruling on whether single or older women and lesbians should be entitled to IVF. He added, “I would like to have a bit of help in that area so I’m neither putting myself in jeopardy nor withholding the treatment.” Others, including Zouves and Rebick, recommend equal access to the procedures for all women. But, declared Christine Overall, a philosophy professor at Queen’s University in Kingston, Ont., “It has to be absolutely clear that the chances of success are low, the shortand long-term risks are unknown, and that the women are participating in an experimental procedure.”

Baird acknowledged that it is extremely difficult to come to terms with the implications of science’s advances. Added Baird: “You don’t have a choice but to face it if you have any sense of responsibility as a society.” But, for Christiane Bergauer-Free and her husband, Ian, the issue is clear: those advances enabled them to have a family—something that would have been impossible 15 years ago.

NORA UNDERWOOD