Interview With Neonatologist Carlo Bellieni
ROME, 6 JUNE 2004 (ZENIT)In vitro fertilization, a practice that
entails high risks for the health of a child, reflects a trivialization of
conception, warns a neonatologist.
In this interview with ZENIT, Dr. Carlo Bellieni, professor of 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 his statements are key
references to medical research.
Q: What are some factors in the in vitro fertilization debate?
Bellieni: Reflections on in vitro fertilization relate to two opposing
factors: the safeguarding of the conceived embryo on one hand and the
pressing request of some couples to have a child on the other.
Leaving to one side for the moment the fact that one can also have a child
by adoption, it is strange that no thought is given to the fate of the
children conceived in this manner [IVF], as though once the horror of
spare embryos has been overcome, a child conceived in a test tube is
comparable to one conceived normally.
Obviously, I am not referring to emotional differences: a child is always
a child, regardless of the way he was conceived. However, we wish 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 children conceived in vitro
were published in 2002 in prestigious international scientific journals
and the conclusions are not at all comforting.
The conclusions verify that "Children who are underweight at birth run the
risk of incapacity and death. The use of IVF implies 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, IVF was the cause of 40% of
triple births. Likewise, studies show that there are more underweight
children at birth by IVF than in normal pregnancies" [Citation from
Schieve, L.A. et al: "Low and Very Low Birth Weight in Infants Conceived
with Use of Assisted Reproductive Technology," The New England Journal of
Medicine, 2002; 346:731-737].
"Our study suggests that children born by IVF have an increased risk of
developing cerebral problems, in particular cerebral paralysis" [Stromberg
B. et al: "Neurological Sequelae in Children Born after In-Vitro
Fertilization: A Population-Based Study," The Lancet, 2002; 359: 461-5].
"Children conceived with the use of 'Intracytoplasmic Sperm Injection' (ICSI)
or IVF run a double risk of presenting a greater defect at birth in
relation to the general population" [Hansen, M. et al: "The Risk of Major
Birth Defects After Intracytoplasmic Sperm Injection and In Vitro
Fertilization," The New England Journal of Medicine, 2002; 346 (10):
725-30)].
These studies were used in other pediatric journals that emphasized: "In
February of 2002, a team of Uppsala, Sweden, referred to a retrospective
work on 5,680 children born by IVF: it showed that in general, children
born by IVF have greater need for rehabilitation centers in relation to
the normal population and the risk (OR) of cerebral paralysis is 3.7. The
greatest difference is observed among children of single birth, while the
risk of those born as twins is similar to that of the normal population.
In an Australian study, 8.6% of children born by IVF had greater defects
at birth, double that of the control group" [Koren, G.: "Adverse Effects
of Assisted Reproductive Technology and Pregnancy Outcome," Pediatric
Research, 2002].
The risk of having a handicapped child by opting for IVF is 11% compared
to 5% by normal conception [NN: "Neurological Sequelae and Major Birth
Defects in Children Born after In Vitro Fertilization or Intracytoplasmic
Sperm Injection," European Journal of Pediatrics, 2003; 162:64].
Multiple-births are one of the great risks of IVF and can cause premature
birth [Greisen, G.: "Multifoetal Pregnancy and Prematurity: 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 the conception of a
single child, the rate of risk for his health, if born by in vitro
fertilization, is greater than for the normal population. A recent
analysis of 25 scientific studies published in the British Medical Journal
concludes that single pregnancies from assisted reproduction have a
significantly worse perinatal result in relation to the normal population,
although it adds that in twin pregnancies, perinatal mortality is about
40% lower after IVF in comparison with natural conception (Frans M.
Helmerhorst et al.: "Perinatal Outcome of Singletons and Twins After
Assisted Conception" A Systematic Review of Controlled Studies," British
Medical Journal, 2004; 328:261).
Q: Are there risks from the genetic point of view?
Bellieni: Certainly. The intracytoplasmic injection of spermatozoids can
increase the risk of the deficit of the "imprinting" [Cox, G.F. et al.: "Intracytoplasmic
Sperm Injection 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 by the fact that 4.6% of their
patients with Wideman-Beckwitt syndrome had been conceived by IVF.
[Usually] the illness is present in one newborn out of 15,000.
More recently, five Dutch children conceived by IVF have suffered
retinoblastoma, a child cancer of the retina which appears in one newborn
out of 17,000. Some researchers fear that to increase the duration of the
incubation might prejudice the development, as observed in the study of
rats. "We are using humans as guinea pigs," Kelle Moley suggested, 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 French psychiatrist, 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 risks on 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 of concentration
camps, is manifested with guilt feelings
—"another
died to let me live"
— or
a sense of omnipotence
— "I
succeeded because I am indestructible."
The child thinks that his parents have so wanted him to the point of
sacrificing other children to have him. If he is alive, if he is chosen,
is it not a sign that he is worth more than the others, that is, than
those who did not survive?
The child subjected to the desires of others is an omnipotent child for
whom it is perhaps difficult to set limits. His parents ... have done away
with one or more "children," in the end because they so desired him, so
that he could live. How much is he worth, then, for whom such a sacrifice
was made?
Q: In face of such a complex picture, what conclusions can be drawn?
Bellieni: We can affirm that we are moving toward a worrying
trivialization of conception. The methods used at present for IVF are not
exempt of 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 is
perfected?
The "Defender of Children" created by the French government has requested
a moratorium on the ICSI technique, which is the most used, because of the
risks it entails. The Minister of Health, François Mattei, has spoken
against this "procreative fury," and the French National Consultative
Ethics Committee is of the same opinion.
Q: Can one accept a risk for one's child, which in no way seems low, in
order to satisfy one's own desire?
Bellieni: In vitro fertilization is a technique "in process."
Spermatozoids that are often altered must be used, sometimes introducing
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 with defective
spermatozoids, do we not perhaps condemn the children themselves to have
to take recourse in the future to artificial procreation, in the not
improbable case that they inherit the same alteration of the paternal
spermatozoids? ZE04060620
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