Limiting reproduction

The Baltimore Sun

Hard on the heels of the sensational story of Nadya Suleman - the California woman who has added octuplets to her family of six children - comes the news that a 60-year-old woman recently gave birth to twins in Canada.

So we are reminded yet again that doctors are getting better and better at delivering what, in years past, would have been reasonably described as miracles. And important questions are being asked as a result, such as: Is it responsible for a woman to bear children regardless of her age or the number of babies involved? Is it ethical for fertility clinics to facilitate a paying customer's pregnancy simply because they know how?

To that mix, here's one that's equally controversial: Is it time for federal and state governments to consider legal rules and boundaries for the fertility industry? A new research-based report by the Evan B. Donaldson Adoption Institute, "Old Lessons for a New World," suggests that the answer may finally be "yes."

The report points out that adoption and assisted reproductive technology have much in common as "nontraditional" means of forming families, and that adoption's far-longer history of research, experience and evidence-informed policies therefore could help to improve practices in the world of assisted reproduction.

The report's recommendations include such applicable adoption issues as the problematic effects of secrecy, the need for a child-centered focus and the impact of market forces. Most pointedly, the Donaldson Institute suggests that the legal and regulatory framework for adoption provides a model that assisted reproductive technology could utilize.

Thoughtful guidelines on a broad range of activities in assisted reproductive technology - how many embryos should be implanted, how much egg donors should be paid, etc. - already have been promulgated, and there is every reason to believe most clinics try to adhere to these identified "best practices." For example, the American Society for Reproductive Medicine recommends that a physician place no more than two embryos in a woman under age 35 (Ms. Suleman is 33). Children in multiple births are far more susceptible to grave problems such as cerebral palsy, respiratory illness or even death. And late-age pregnancies can also be detrimental to the women who experience them; the 60-year-old Canadian woman, Ranjit Hayer, now has diabetes and high blood pressure as a result of her pregnancy, which she achieved by traveling to India for in vitro fertilization because Canadian doctors deemed it unethical to treat her.

The organizations working to promote good practices deserve credit for their efforts and their successes. But their guidelines are not mandatory, and as the evidence before our eyes clearly shows, not everyone in any industry - including adoption - follows voluntary standards.

As the current economic crisis vividly demonstrates, it's not always sufficient to let the free market reign and hope everyone does the right thing; sometimes, laws have to be enacted to reduce the possibility of abuses, promote and regulate ethical behavior, and protect everyone involved.

Artificial reproductive technology, like adoption, has provided enormous comfort to people who want families. There are more than 400 fertility clinics in the U.S.; the government estimates that 10 percent of American women have received some kind of infertility services; and more than 50,000 children may be born annually through assisted reproductive technology. So this is no small population that needs the attention of our nation's policymakers.

Other nations have imposed legal limits on various aspects of artificial reproduction practice. Those, along with the Donaldson Institute's recommendations and the existing professional guidelines, provide a strong basis for debating and shaping laws and regulations in our country.

Let's not wait until the headline reads: "Woman, 82, gives birth to 10."

Adam Pertman, executive director of the Evan B. Donaldson Adoption Institute, grew up in Baltimore and is the author of "Adoption Nation." His e-mail is apertman@ Naomi Cahn, a professor at the George Washington University Law School, is the author of "Test Tube Families." Her e-mail is ncahn@

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