Louise Brown, the world's first test-tube baby, turns 25 today,
and it certainly seems like a reason to celebrate. Brown is
by all accounts a healthy, normal young woman, and her birth
opened the door for a million or so childless couples worldwide
to fulfill their dreams of having a family.
But once the final chorus of "Happy Birthday" fades,
we should take a hard look at in vitro fertilization and the
fertility business it has spawned. It's not just a matter of
helping the hopeless, it's also about the dubious claims of
a for-profit industry — that it can ensure healthier babies,
that we can do a better job than nature when it comes to engineering
For starters, we need to remember that IVF pioneers —
including British researcher Robert Edwards and physician Patrick
Steptoe, who crafted the embryo that became Louise Brown —
were essentially running human experiments, with little oversight,
on a vulnerable patient population.
Although so far most IVF babies seem normal — that is,
they have medical problems in about the same numbers as the
rest of us — concerns persist about the true effects of
having been conceived in the lab.
The population isn't large enough or old enough to have yielded
a complete picture. In fact, several recent studies marked increases
in birth defects and eye cancers among IVF children, and several
studies have indicated that babies conceived by a sperm injection
technique known as ICSI may be at higher risk for some genetic
It remains anyone's guess whether other susceptibilities may
begin to show up in IVF offspring in adulthood.
Questions also remain about the long-term cancer risks of the
hormones used to stimulate egg production in women undergoing
IVF or serving as egg donors. Multiple births — heavily
associated with increased genetic and developmental risks —
have skyrocketed because, to increase the chances of a pregnancy,
multiple embryos are transferred from petri dish to womb.
But more worrisome is that IVF clinics now want to convince
fertile couples that they should use their services.
The first step is to persuade them that the kinds of genetic
screening now done on fetuses should really be done on embryos
— this way, couples can avoid the difficult decision of
whether or not to abort when amniocentesis reveals Tay-Sachs,
Down syndrome or other "negative" traits.
The next step is to select for so-called positive traits. Promoters
of the designer-baby enterprise, including such luminaries as
Nobel laureate James Watson, say that in the future, the number
of traits that can be selected will be manifold, thanks to the
fruits of the Human Genome Project.
The fact is, reproductive research's goal has long been to
"improve" babies. Edwards wrote enthusiastically about
the merits of such tinkering well before Brown's birth.
But this new eugenics is problematic on both scientific and
ethical grounds. Centuries of conventional breeding and recent
gene-modification experiments with animals have revealed that
genetics is extraordinarily complex, and that even replacing
or deleting a single gene can have unforeseen consequences.
Such meddling is beyond reproductive science's powers now,
but the precursor isn't. We could, for example, select an embryo
that has inherited its parents' genes for red hair and green
eyes, or choose a baby's gender.
Any such work is unsavory because it categorizes children as
consumer objects that can be "accessorized" according
to the parents' whims. As many ethicists have argued, ideally,
love for offspring should not be contingent upon the characteristics
Despite these disturbing implications of modern reproductive
medicine, the U.S. has largely failed to engage in a substantive
public discussion about the social implications of IVF. Because
federal legislators are leery of political battles that involve
reproductive rights, IVF physicians work mainly under guidelines
set by and policed by themselves.
As a result, the U.S. lags behind other developed countries
— especially Germany, France, Britain, Australia and Canada
— in terms of oversight: We do fewer studies of IVF practices
as well as apply fewer legal limits.
This means that, as long as the IVF industry has willing guinea
pigs, clinics will continue to push the envelope, and researchers
and their clients will set the rules that have an affect on
Twenty-five years ago, early critics of IVF warned that it
would create monsters. Those fears proved hyperbolic, but IVFs'
successes so far are not a protection against problems in the
We should undertake extensive studies, formulate public policy
and join with nations worldwide to ensure that the designer-baby
enterprise never truly takes off.
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