REPRODUCTIVE TECHNOLOGIES :
How far should science be allowed to go in helping women of nearly any age to conceive a child? And what about the possibility of cloning human embryos? Kwame Holman looks into the controversy in a background report, followed by a panel discussion with Phil Ponce.
KWAME HOLMAN: For a moment last month they belonged to the world: seven infants born within minutes of each other, the first surviving septuplets. Reproductive technology played a central role in the creation of Bobbie and Kenny McCaughey's four boys and three girls. It was because of the fertility drugs Bobbie McCaughey took that her body produced the multiple eggs that resulted in her seven children.
A RealAudio version of this segment is available.
June 9, 1997
A presidential blue-ribbon commission recommended a legislative ban on the cloning of human beings.
April 24, 1997:
Miracle Mom? The baby is apparently healthy and normal, but the mother is most unusual.
March 10, 1997:
An Online NewsHour Forum exploring the cloning of adult mammals, like Dolly, the Scottish sheep.
March 5, 1997:
The NewsHour analyzes the ramifications of cloning.
February 24, 1997:
A report on the cloning of sheep in Scotland.
February 24, 1997:
A technical discussion on the science of genetic engineering.
February 24, 1997:
A discussion on the ethics of genetic engineering and cloning mammals.
January 27, 1997:
Advances in science and a continued demand has led to an explosion in assisted reproduction. Fred de Sam Lazaro reports.
January 1, 1997 :
Paul Solman looks at what has been a banner year for gene research.
Browse the NewsHour's coverage of Science
BOBBIE McCAUGHEY: It was just incredible. I can't wait until I can hold all of them.
KENNY McCAUGHEY: If we have the arms.
The growth of reproductive technology.
KWAME HOLMAN: Such fertility treatments first were developed during the 1970's mainly to help women who had difficulty conceiving achieve one healthy birth. But the drugs also dramatically increased the likelihood of multiple births. With the wider use of fertility drugs, multiple births in the United States have quadrupled since the 1970's. And the record for number of children born kept rising from two to three, four, five, and then six babies born at once before Bobbie McCaughey's septuplets. Reproductive technology also has re-written the rules on when women can give birth, shattering the so-called biological clock.
DR. RICK PAULSON, University of Southern California: We wish to announce the unusual occurrence of the successful outcome after fertility therapy of a pregnancy and delivery in what appears to be the oldest woman on record. The patient was 63 years old at the time of the fertility therapy and 63 years and nine months at the time of the delivery.
KWAME HOLMAN: That patient was Arcely Keh, who gave birth to a healthy baby girl late last year. A donor egg from a younger woman was united with Keh's husband's sperm in the laboratory. The fertilized egg then was implanted in Keh. The Kehs proved what scientists have known since 1990; that the age of a woman's uterus is not a significant obstacle to pregnancy, that pregnancy can occur even after menopause. Barriers also recently have been broken in terms of the age of viable eggs. In August, an anonymous woman in Georgia gave birth to healthy twin boys, the first births in the United States from donor eggs that were frozen for years, then thawed before being fertilized.
The case widens the possibilities older women can have successful pregnancies using long-frozen eggs. The new options also mean women who face medical treatments that may threaten fertility can freeze their eggs for later use.
Julie Garber, a 28-year-old real estate developer, needed radiation therapy to treat her leukemia, treatment that could leave her infertile. Some of her eggs were removed prior to the radiation treatment. They were fertilized using anonymously donated sperm, and the resulting embryos were frozen. However, Garber succumbed to her cancer last December. Her parents had their daughter's embryos implanted in a surrogate to bear their deceased daughter's child.
The process, though medically sound, ended in a miscarriage. And this year brought the most fascinating and controversial news yet in reproductive technology, a successful cloning. Scottish scientists used the cells of a sheep to produce Dolly, the first genetic copy of an adult animal. And more recently, researchers announced new cloning experiments in sheep that produced a human blood-clotting gene that could bring about a life-saving treatment for hemophiliacs. Despite such potential benefits of the technology, the cloning of animals raises the controversial issue of what science will do if it ever is able to achieve human cloning.
ELIZABETH FARNSWORTH: More on this year's developments and to Phil Ponce.
PHIL PONCE: To discuss some of the issues raised by recent technology changes we're joined by Dr. Jamie Grifo, director of reproductive endocrinology at New York University Medical Center. He's a member of the ethics committee of the American Society of Reproductive Medicine; Dr. Christo Zouves, medical director of the Pacific Fertility Center in San Francisco; Pamela Madsen, executive director of the New York chapter of "Resolve," a national support group for those coping with infertility. She's a parent of two boys through in vitro fertilization. And law professor Lori Andrews, who specializes in reproductive technology at Chicago-Kent College of Law. And welcome all.
"Do this year's developments in reproductive technology leave you feeling troubled or hopeful?"
Dr. Zouves, do this year's developments in reproductive technology leave you feeling troubled or hopeful?
DR. CHRISTO ZOUVES, Pacific Fertility Center: I think it's been a tremendous year in reproductive technology. And whenever we have technology advancing, you know, this rapidly, there are obviously scary sides to it, and there are also wonderful potential benefits for, you know, for human beings.
PHIL PONCE: Dr. Grifo, your reaction to the year's developments.
DR. JAMIE GRIFO, New York University Medical Center: Well, I think a lot of these developments are exciting, yet, I am very afraid of what the whole reason we're doing our speciality is, which is our patients at the end of these technologies. And I'm afraid that some of these developments and the way we react to them may interfere with our ability to help this group of patients.
PHIL PONCE: Pamela Madsen.
PAMELA MADSEN, "Resolve" Support Group: Well, I think the year has been exciting, but like Dr. Grifo was saying, we have to remember why these technologies have been created, and that's to help the couple try to have that very, very special baby that's uniquely theirs. And we need to remember that that is why we're doing this, is to help a couple who is dealing with infertility.
PHIL PONCE: Lori Andrews.
LORI ANDREWS, Chicago-Kent College of Law: Well, we've seen the notion, the fundamentally important notion of reproductive rights, taken to absurd extremes this year. We've seen women who claim they have a right to use their dead husband's sperm, individuals who claim they have a right to clone themselves. So we're seeing new social relationships being created. And we don't have a national body or some other organization to determine where we should draw the lines in this area.
Drawing a line.
PHIL PONCE: Dr. Zouves, one of the areas people think that perhaps a line should at least be considered has to do with age, the age at which a woman can get pregnant. How do you feel about the upper limit of when it's appropriate for a woman to get pregnant?
DR. CHRISTO ZOUVES: I think we start, Phil, looking at competing rights here because, you know, there are rights that an individual couple have to bear a child, and a lot of these rights may be protected by, you know, by the Constitution. We also have rights of society, and we have the rights of the unborn child. So I think that we have to try and take into account all of these competing rights when we, you know, when we look to make decisions. Personally, I think that, you know, older parents, mature parents have a lot more to offer young children and in child-rearing because having recently heard General Colin Powell speak here in the Bay area, we have an epidemic in this country of children having children, of, you know, children being brought up in unstable situations. So I think a lot of times mature parents, mature women are in a very good position to give a child a very nurturing, loving, and excellent start to life.
PHIL PONCE: And Dr. Zouves, in your own practice, what's the oldest patient you've helped achieve a pregnancy?
DR. CHRISTO ZOUVES: The oldest patient that we've helped achieve a pregnancy was 59 at the time that we actually did her procedure, and she turned 60 just before her delivery.
PHIL PONCE: And how are they doing?
DR. CHRISTO ZOUVES: They're doing very well. And this was probably almost 18 months ago.
PHIL PONCE: Pamela Madsen, are you comfortable with that age range?
PAMELA MADSEN: Well, the thing that comes to mind is with "Resolve" and with the community base that we work with, we're trying to help couples in their naturally occurring reproductive years have families. And that's somewhere in their 20's, their 30's, their middle or latter 40's. And ovum donation is a wonderful, wonderful technology that enables these women who've had premature ovarian failure, who don't have ovaries, or are in their 40's and their egg polity has gone down, achieve a pregnancy.
And I'm certainly a lot more comfortable with these technologies being used for couples in their naturally occurring reproductive years, rather than, you know, helping, you know, grandparents become parents. I would like to concentrate that resource on couples who are struggling with infertility in their naturally occurring reproductive years.
PHIL PONCE: Do you think it's a mistake to go to the age range that Dr. Zouves went to with that one patient?
PAMELA MADSEN: It is really hard. It is a very, very individual decision that has to be made with a couple and their physician, and "Resolve" supports everyone making these decisions for themselves and their families. But these eggs are a very limited resource, such as other organs that would be donated for other types of diseases. And I would rather see those eggs go to couples in their naturally occurring reproductive years to try and treat infertility, rather than trying to turn back the biological clock.
PHIL PONCE: Dr. Grifo, when you practice, do you have any age limitations or guidelines?
DR. JAMIE GRIFO: Yes, we do. Age 49 is an arbitrary number that we have chosen because it mimics the natural "age of menopause" approximately. You know, we're concerned about older women giving birth, and really what we're concerned about is the medical issues. There really hasn't been that many women in that age group go through the rigors of pregnancy, and we don't know what effects that has on the individual's, you know, physiologic capacity. And I think that's what concerns us. But I was amazed at the amount of press that this 63 year old woman got.
You know, there are very few women in this age group who really want to get pregnant, and I think we spend too much time discussing these issues, when there is a group of 13 year olds, unmarried 13 year olds, giving birth left and right, and you know, I think if you're going to regulate one group, then you really have to regulate the other group. And I think really the solution is that people have to regulate themselves. And I don't know that there's a governing body that should be saying what should and shouldn't be done regarding these particular areas.
PHIL PONCE: Ms. Andrews, do you think there should be any regulation involving the age that people can get impregnated?
LORI ANDREWS: Well, we've run into some problems with age discrimination laws. I think actually allowing women to become pregnant post menopause does level the playing field between men and women, since men can have children into their 70's and 80's and, in fact, we applaud men who reproduce at that age. I think that it points to really the need for some social solutions. Why do some women choose to have children at a later age?
Part of it is because that there isn't effective day care that would allow them to bear children at their most fertile times, in their 20's and 30's, when they're trying to pursue education and a profession. And so I think that we're looking too many times to the high-tech solution to infertility, rather than to social solutions, more research into the causes of infertility and the prevention of it, more study of devices such as inter-uterine devices, before we implant them in women, which is a cause of a lot of the infertility problems and necessitating in vitro fertilization, so let's look at other alternatives than the high-tech fix once there's a problem.
The McCaughey case.
PHIL PONCE: Dr. Zouves, are there any lessons to be drawn from the McCaughey experience with multiple births?
DR. CHRISTO ZOUVES: I think multiple births are clearly a major, major problem for us, and as Dr. Grifo mentioned, instead of focusing on these, you know, one in a hundred thousand cases, we should focus on the really common issues, and certainly multiple pregnancy is a major nightmare for not only the mother carrying the multiple pregnancy but also potentially for the fetuses if they, you know, if they are born early. Now, I think with the McCaughey septuplets in Iowa, unfortunately, this case has moved the goal post for people having to consider, you know, how many babies to carry themselves, and, you know, I think we've been inordinately lucky that this septuplet pregnancy went as long as it did.
PHIL PONCE: And yet there are many multiple births, for example, that don't necessarily have quite as happy of an outcome, is that correct?
DR. CHRISTO ZOUVES: Absolutely. Even with twins or triplets, you know, we are seeing some people who run into medical problems, and we see pregnancies that end earlier than they should. So, you know, one of the major breakthroughs of this last year has been the ability to maintain pregnancy rates at a high level and transfer fewer numbers of better quality embryos. And that's the day five of the blastocyst transfer. And this is a very, very significant breakthrough to enable us to limit the risk of multiple pregnancies significantly.
PHIL PONCE: Ms. Madsen, you wanted to say something.
PAMELA MADSEN: Yes. Back to what Lori was saying, really had some concern for me. You know, I don't think anyone who's experiencing infertility is looking for any kind of high-tech, quick fix for social issues. Infertility is a disease of the reproductive system, just like the diseases of any other part of the body. We're not victims of society; we're victims of disease, like anyone else. And I think that--
LORI ANDREWS: But some women do postpone child-bearing until their 30's because of their job and so forth and find the natural decrease that occurs with age. And many of them might have been willing to have children at an earlier age if social supports were in place.
PAMELA MADSEN: Well, a lot of us go to college.
LORI ANDREWS: Sure.
PAMELA MADSEN: But, you know, the early 30's is not late to have a child, and I was 24 when I started to have a child. I got married at 20, and I still experienced infertility. It wasn't my fault. We started young, and the fact is that one in six couples across this country experience infertility, and it's not just an age-related problem. It's 30 percent female; it's 30 percent male; 20 percent combined problems; and 10 percent unexplained. And I think where couples are going to need help with in this wonderful time when more and more couples are coming home with those babies is guidance. Consumer organizations such as "Resolve" can offer support and education, and help couples guide them through this experience.
Are women becoming "experimental guinea pigs"?
PHIL PONCE: Dr. Grifo, to what extent--how motivated are the patients that you see?
DR. JAMIE GRIFO: Oh, they're extremely motivated. This is--some of the most motivated patients that you'll ever come across. They read, they read the literature before you have; they come at you with new research before you've even had a chance to digest it. I think that in and of itself explains how devastating it is to have this disease. It is a horrible disease, and these patients are desperate to have a child. And most of us take that for granted, and yet, 18 to 20 percent of couples suffer infertility. And I think that's a tremendous health problem and a tremendous social problem that really has been ignored, especially by our policies on research. The NIH will not fund any embryo research because of politics, and that stance has really been a great disservice to our patients.
We spent years doing in vitro fertilization under sub-optimal conditions because we were never given the opportunity to do the proper embryo research that would help these patients. And I think that was really a great disservice to this group of patients. It took us a long time to learn to get better with the IVF technology. And that's really a shame.
LORI ANDREWS: And one of the things that is happening then is that women become the experimental guinea pigs since the government is not funding research, and so it's being used as a clinical tool before adequate research has been done, and sometimes that means that couples aren't told in advance what the actual risks are. For example, a technique's been used where a single sperm is injected into the egg for men with very low sperm counts, and that's been used for years. And it's only been recently in the past year that data has been coming out to suggest that those children have a greater incidence of chromosomal abnormalities. I agree with Dr. Grifo that research is needed. What's happened is that women who are paying customers have been the research subjects in the infertility industry.
PHIL PONCE: Dr. Grifo, do you want to respond to that?
DR. JAMIE GRIFO: Yes. I'd like to make a point. First of all, we don't use patients as experiments. We do give informed consent to our patients. We tell them about the potential risks and benefits of these procedures. And ever since we started doing the intro-cytoplasmic sperm injection technique that Ms. Andrews was referring to, patients were required to read and sign consents that said we don't know some of the long-term effects of these things and we don't--we have to do research to figure these things out. And I think it's a great disservice to imply that most reproductive endocrinologists don't have these discussions with our patients, because most of us do.
LORI ANDREWS: The point is that you're telling them it's experimental. You don't know what's going to happen. And that's very unusual in terms of other areas of medicine. And--
PHIL PONCE: Let's move on--
LORI ANDREWS: --part of it is because there aren't controlled studies.
PHIL PONCE: Ms. Andrews, let's move on to another big question, and let me address this to Dr. Zouves. Dr. Zouves, to what extent--and we've been talking about a number of different options--how do you respond to the lingering concern that many people might have, and that is that technology is essentially playing God by giving people options, which simply didn't exist for older people, or for multiple births, and that sort of thing?
DR. CHRISTO ZOUVES: I think if you look at medicine, in general, you know, technology has advanced. We're able to remove appendices when they become infected. We're able to transplant organs. So, you know, technology is part and parcel of development, and I personally feel wonderful working in the field that I do, where we can help people achieve having a family.
PHIL PONCE: Ms. Andrews, ever get the feeling that technology is taking on a God-like aspect?
LORI ANDREWS: Well, I agree that throughout medicine we are changing what is natural and so forth. I think the question is who makes the decisions, and I think in large measure we need to show that women get adequate information to make these decisions. For example, with the multiple births and in vitro, one in three in vitro attempts results in a multiple birth. And women aren't told that what the actual risks of that are. Babies when they're born as triplets are 12 times as likely to die during the first year, about the cost of taking triplets home from the hospital is $100,000 for the labor and delivery; that they have a one in twenty-six chance of cerebral palsy.
I haven't seen informed consent forms for in vitro that talk about those sort of things, so I'm very much in agreement with the activities that I've seen of "Resolve," in order to get more information to infertile couples, and also to help them make some judgment among the clinics that are out there. There are hundreds of clinics in the United States all competing for that consumer dollar. Some are very excessive in the sort of ads that they use and so forth. There have been five investigations and various actives by the Federal Trade Commission for practices in the in vitro industry, and so, you know, we need to assure that the people making decisions are getting adequate information.
PHIL PONCE: And a quick--a very quick reaction from Ms. Madsen.
PAMELA MADSEN: Well, I don't know where Ms. Andrews is, but all I can tell you is that in New York and in my role with "Resolve" and with the physician community and patient community here, we have a lot of informed consent. We have a tremendous patient-physician dialogue. We have a very educated group of patients, and I feel that we are getting the information that we need. I was horrified to have been called a guinea pig. I was a woman, part of a couple--we kept saying, women, women--these are couples. These are men and women who desperately want what everyone else in America or, indeed, of course, the world value the most in their lives, a child. And what better use of our medical technologies than to help this dream come true?
PHIL PONCE: That will have to be it for now, and I thank you all very much.