Regulating the Transfer of Multiple Embryos

By Anne-Marie Gagné B.A.Vincent Richard

B.A. Dany Joncas, LL.B, LL.M, M.A.

Used worldwide for the last twenty-five years, in vitro fertilization (IVF) has helped millions of infertile couples realize their dreams of becoming parents. However, the increasing number of multiple births resulting from IVF reveals a serious phenomenon which is associated with numerous complications for both mothers and their babies. In IVF, multiple births result from the transfer of multiple embryos.

Is it possible to respect and encourage procreation among infertile couples without compromising the woman’s health and that of her unborn child? What are our priorities? What are our success rates? How do we treat the infertile couples and how do we care for the health of the future child? And above all, why are these the priorities?

This presentation is the result of collaborative work and its purpose is to examine the global problem of transferring multiple embryos during IVF, all the while considering the biomedical, ethical and legal aspects of this issue. These three aspects will be discussed at length in ensuing issues of this journal.

Biomedical Aspects

The first of the next three articles will deal with the biomedical aspects of the transfer of several embryos. We see that multiple births, as a result of IVF, cause harmful effects similar to those of spontaneous multiple births. The main difference between spontaneous multiple births and, multiple births made possible by IVF, is their frequency. In North America and in Canada, in particular, the frequency of multiple births is almost fifteen times greater with IVF than with spontaneous multiple births. Approximately one-third of all IVF births in Canada are multiple births, placing the child, the parents and even society at risk.

The immediate consequence of multiple births is the strong likelihood of premature birth and/or low birth weight. With more than one fetus growing in the uterus, the risk of complications is increased. Consequently, the more embryos implanted in the uterus, the higher the risk. The overall risk of a child being handicapped also increases with the number of fetuses in gestation in the uterus. Other minor complications are also observed in children born of multiple pregnancies, including learning difficulties and language problems which require the help of specialists. However, the most devastating consequence involves neonatal mortality and infantile mortality which are always higher when it comes to multiple births .

For any new parent the birth of a first child brings major lifestyle changes. When the situation changes from a couple without children to parents with two newborns, the impact can be considerably more challenging. In addition, parents expecting twins have twice the probability of experiencing the additional psychological trauma of experiencing a still birth.

Society also bears the repercussions of multiple births. In Canada, with medical costs covered by the government, costs inherent to complications before, during and after birth are the responsibility of society in general.

Bioethical Aspects

Four considerations come to mind: respect for autonomy, respect for the individual’s integrity, respect for the professional’s integrity and the principle of justice.

The principle of autonomy seeks to ensure respect for human liberty. This principle seeks to protect the freedom of the person involved; in this context, the woman’s freedom. However, there is another person that needs to be considered — the unborn child. Should we transfer several embryos at the couple’s request, knowing the health risks to the child?

Respect for professional integrity requires that we consider the consequences for the individuals involved in the procedure, in order to determine the level of acceptable risk. This principle, as it applies here, forces the specialist to consider the instructions specified by his/her professional order.

The principle of justice is to ensure the fair distribution of limited resources among members of the same society.

As we will see in ensuing articles, by applying these four principles we conclude that the transfer of several embryos in IVF treatment leads to unacceptable risks.

Legal Aspects

One of the reasons that professional medical associations fail to oppose the transfer of multiple embryos in IVF is because there is a lack of legal supervision of these practices. However, general rules of law, in particular those under civil responsibility serve to protect the fundamental rights of individuals created from these medical techniques. Interpretation of certain Canadian laws clearly indicates that health problems caused by medical intervention are subject to compensation. The risks are well defined for IVF children as is the fact, that these complications can be avoided by the transfer of a single embryo. Consequently, children in ill health following medically assisted multiple births could claim compensation for resulting damages. This will be discussed further in a later article.

Conclusion

The incidence of IVF multiple births is much too high. From an ethical standpoint, the transfer of several embryos is unacceptable. Laws state that IVF children who have been adversely affected have recourse. We wish to caution future parents about the often unimagined repercussions that could destroy their dreams. We demonstrate that transferring more than one embryo is unacceptable if it increases the risks for the children, women, health professionals and society.

About the Authors: Anne-Marie Gagné is a Master’s student in experimental medicine, more specifically in psychiatry at the Robert-Giffard Research Center at Laval University. Her work relates to depression. Vincent Richard is Research Assistant at the Reproductive Research and Biology Center in the Animal Sciences Department at the Laval University. As a Master’s student in philosophy, he is interested in ethical questions surrounding the development and use of biotechnologies. Dany Joncas is a doctorate student at the Laval University Law Faculty and a Research Professional at the Sherbrooke University Law Faculty. His work is related to the study of Law and Ethics.

The authors wish to thank Raymond D. Lambert, Professor of Obstetrics and Gynecology and Researcher at the Reproductive Biology Research Center at Laval University and Patricia Monnier-Barbarino, Director of the Reproductive Medicine and Gynecology Unit at Regional Maternity University and Professor at the Faculty of Medicine in Nancy, France.