In Vitro Children and the Risks They Face
Interview With Neonatologist Carlo Bellieni
ROME, JUNE 6, 2004 (Zenit.org).- In vitro fertilization, apractice that entails high risks for the health of a child, reflects atrivialization of conception, warns a neonatologist.
In this interview with ZENIT, Dr. Carlo Bellieni, professorof neonatal therapy at the School of Pediatrics of the University of Siena,talks about the dangers of artificial procreation for the child conceived, as
revealed in recent scientific studies. Accompanying hisstatements are key references to medical research.
Q: What are some factors in the in vitro fertilizationdebate?
Bellieni: Reflections on in vitro fertilization relate totwo opposing factors: the safeguarding of the conceived embryo on one hand andthe pressing request of some couples to have a child on the other.
Leaving to one side for the moment the fact that one canalso have a child by adoption, it is strange that no thought is given to thefate of the children conceived in this manner [IVF], as though once the horrorof
spare embryos has been overcome, a child conceived in a testtube is comparable to one conceived normally.
Obviously, I am not referring to emotional differences: achild is always a child, regardless of the way he was conceived. However, wewish to consider if the risks of IVF are such as to impose at least some
caution.
Q: What are the risks for children conceived in vitro?
Bellieni: Three studies on large numbers of childrenconceived in vitro were published in 2002 in prestigious internationalscientific journals and the conclusions are not at all comforting.
The conclusions verify that "Children who areunderweight at birth run the risk of incapacity and death. The use of IVFimplies an increase of children who are underweight at birth in the U.S.because it is
associated with a high rate of twin births. Until 1997, IVFwas the cause of 40% of triple births. Likewise, studies show that there aremore underweight children at birth by IVF than in normal pregnancies"
[Citation from Schieve, L.A. et al: "Low and Very LowBirth Weight in Infants Conceived with Use of Assisted ReproductiveTechnology," The New England Journal of Medicine, 2002; 346:731-737].
"Our study suggests that children born by IVF have anincreased risk of developing cerebral problems, in particular cerebralparalysis" [Stromberg B. et al: "Neurological Sequelae in ChildrenBorn after In-Vitro
Fertilization: A Population-Based Study," The Lancet,2002; 359: 461-5].
"Children conceived with the use of 'IntracytoplasmicSperm Injection' (ICSI) or IVF run a double risk of presenting a greater defectat birth in relation to the general population" [Hansen, M. et al:"The Risk of
Major Birth Defects After Intracytoplasmic Sperm Injectionand In Vitro Fertilization," The New England Journal of Medicine, 2002;346 (10): 725-30)].
These studies were used in other pediatric journals thatemphasized: "In February of 2002, a team of Uppsala, Sweden, referred to aretrospective work on 5,680 children born by IVF: it showed that in general,
children born by IVF have greater need for rehabilitationcenters in relation to the normal population and the risk (OR) of cerebralparalysis is 3.7. The greatest difference is observed among children of singlebirth,
while the risk of those born as twins is similar to that ofthe normal population. In an Australian study, 8.6% of children born by IVF hadgreater defects at birth, double that of the control group" [Koren, G.:
"Adverse Effects of Assisted Reproductive Technologyand Pregnancy Outcome," Pediatric Research, 2002].
The risk of having a handicapped child by opting for IVF is11% compared to 5% by normal conception [NN: "Neurological Sequelae andMajor Birth Defects in Children Born after In Vitro Fertilization or
Intracytoplasmic Sperm Injection," European Journal ofPediatrics, 2003; 162:64].
Multiple-births are one of the great risks of IVF and cancause premature birth [Greisen, G.: "Multifoetal Pregnancy andPrematurity: The Costs of Assisted Reproduction," Acta Paediatrica, 2002;91:1449-50].
Now, these observations seems obvious to the neonatologist:Multifetal pregnancy and prematurity, though trivialized by the press,represent a great risk for the health of the child -- and of the mother.
But the new fact is this: including in the case of theconception of a single child, the rate of risk for his health, if born by invitro fertilization, is greater than for the normal population. A recentanalysis of 25
scientific studies published in the British Medical Journalconcludes that single pregnancies from assisted reproduction have asignificantly worse perinatal result in relation to the normal population,although it
adds that in twin pregnancies, perinatal mortality is about40% lower after IVF in comparison with natural conception (Frans M. Helmerhorstet al.: "Perinatal Outcome of Singletons and Twins After Assisted
Conception" A Systematic Review of ControlledStudies," British Medical Journal, 2004; 328:261).
Q: Are there risks from the genetic point of view?
Bellieni: Certainly. The intracytoplasmic injection ofspermatozoids can increase the risk of the deficit of the"imprinting" [Cox, G.F. et al.: "Intracytoplasmic SpermInjection May Increase the Risk of Imprinting
Defects," American Journal of Human Genetics, 2002;71:162-4]. Feindenberg and DeBaun of Johns Hopkins University were impressed bythe fact that 4.6% of their patients with Wideman-Beckwitt syndrome
had been conceived by IVF. [Usually] the illness is presentin one newborn out of 15,000.
More recently, five Dutch children conceived by IVF havesuffered retinoblastoma, a child cancer of the retina which appears in onenewborn out of 17,000. Some researchers fear that to increase the duration ofthe
incubation might prejudice the development, as observed inthe study of rats. "We are using humans as guinea pigs," Kelle Moleysuggested, who studies pre-implantation rat embryos at Washington University in
St. Louis [Powell, K., "Seeds of Doubt," Nature,2003; 422:656-9].
Q: And from the psychological point of view?
Bellieni: A recent book published by a famous Frenchpsychiatrist, Benoit Bayle, entitled "L'Embryon sur le Divan.Psychopathologie de la Conception Humaine" (The Embryo on the Couch.Psychopathology of
Human Reproduction), makes one reflect on the long-term riskson the serenity of children born by in vitro fertilization. He speaks of"survivor's syndrome" for numerous children born by IVF.
This pathology, verified in the first place in survivors ofconcentration camps, is manifested with guilt feelings --"another died tolet me live" -- or a sense of omnipotence -- "I succeeded because Iam
indestructible."
The child thinks that his parents have so wanted him to thepoint of sacrificing other children to have him. If he is alive, if he ischosen, is it not a sign that he is worth more than the others, that is, thanthose who did
not survive?
The child subjected to the desires of others is anomnipotent child for whom it is perhaps difficult to set limits. His parents... have done away with one or more "children," in the end becausethey so desired him, so
that he could live. How much is he worth, then, for whomsuch a sacrifice was made?
Q: In face of such a complex picture, what conclusions canbe drawn?
Bellieni: We can affirm that we are moving toward a worryingtrivialization of conception. The methods used at present for IVF are not exemptof risks for the "nasciturus."
Prematurity and multiple-births induced by IVF are a risk.IVF itself is also a risk. Can it be used or should it be suspended until it isperfected?
The "Defender of Children" created by the Frenchgovernment has requested a moratorium on the ICSI technique, which is the mostused, because of the risks it entails. The Minister of Health, FrançoisMattei,
has spoken against this "procreative fury," andthe French National Consultative Ethics Committee is of the same opinion.
Q: Can one accept a risk for one's child, which in no wayseems low, in order to satisfy one's own desire?
Bellieni: In vitro fertilization is a technique "inprocess." Spermatozoids that are often altered must be used, sometimesintroducing them directly and integrally in the cytoplasm of the ovule cell,something which
does not happen in nature.
One last question that many ask: In generating children withdefective spermatozoids, do we not perhaps condemn the children themselves tohave to take recourse in the future to artificial procreation, in the not
improbable case that they inherit the same alteration of thepaternal spermatozoids?
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