Nadya Suleman's laissez fertility

In the U.S., when it became clear that octomom Nadya Suleman was already a single mother of six other children—and on disability and food stamps and living with, though publicly chastised by, her own mother—the big collective question was: "How could she do such a thing?" In western Europe, the real puzzler is: "How could she have been allowed to do such a thing?"

There is no good answer. Suleman's bizarre circumstances, although impossible to ignore, are really just a cherry on top of an absurdity sundae. The most appalling fact remains this: a doctor transferred six embryos into one woman. Even if that woman were a rich, childless, blissfully married paragon of emotional stability, that act would be an outrage, for it would still pose a serious risk to her life and health, and to her potential children. It would still require that prodigious resources and expertise be poured into a strenuously self-created medical emergency. Therefore, in an even semi-rational environment, it would be expressly prohibited, as indeed it is in many other countries.

Experts will say that it's not that simple. In the world of reproductive technology, it would appear that nothing is simple. Even at its best, the whole business is mentally, physically, emotionally, financially, morally, and ethically complicated. It’s unsurprising, then, that the regulatory frameworks that do exist are built on a host of variables.

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Even so, how has the U.S. allowed itself to become, comparatively speaking, a fertility-treatment free-for-all? Maybe it has to do with a larger polarization: perhaps Americans see a Nadya Suleman and immediately retreat to their reproductive politics corners. It's as if people with a pro-life mindset—at least those who don't condemn IVF outright—hesitate to criticize anything at all about the choice to give birth, especially if that choice involves refusing “selective reduction.” Meanwhile, pro-choice types resist regulation anywhere near the womb, even to protect women's health. Then there's the more general disinclination to impose one's views on the life choices of other people. Choice is a fine thing. But this is choice on psychedelics.

Come on, guys. In Belgium, a doctor who implants more than one embryo in a woman of Suleman's age and fertility-treatment track record is breaking the law. In Britain, any doctor who transfers more than three embryos into any woman for any reason is very likely to lose his license. In the U.S., Dr. Michael Kamrava implanted Suleman with six embryos—two of which later became twins – and the California state medical board promises to investigate whether he has violated the standard of care. If so, it can censure him, but not close his clinic. This is insanity.

No one wants to thwart the dearest dreams of people who long for children, and who will accept the risk of transferring a bunch of embryos at once because they can't afford to bankroll round after round of lower-intensity fertility attempts with lower success rates. Nonetheless, considering the stakes, even that kind of sympathy has to be tempered. It is periodically noted, and rightfully decried, that the U.S. has a higher infant mortality rate than almost any other industrialized nation. Given that the U.S. also has less fertility-industry regulation than almost any other industrialized nation, that should not come as such a shock. That's not to say that IVF is the only culprit; gaping holes in the health-care system are undoubtedly to blame as well, along with the spike in the rate of older, more-complication-prone mothers. But there is no denying the link between IVF and multiple births, nor the link between multiple births and infant mortality, among other truly sobering outcomes. As of 2005, to take one of many statistics, some forty per cent of triplet births in the U.S. resulted from fertility treatment. Triplets are almost 15 times more likely than singletons to die in the first month of life. Perhaps it's time to show less deference to the idea that parents deserve to have children, and more deference to the idea that those children deserve to live, and live well.

Inevitably, Suleman has become the whipping girl of a grossed-out nation, provoking diatribes up to and including death threats. But all that is just so much leering and jeering at a troubled woman. It would be so much more productive to rethink a troubled system.