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Interview With Neonatologist Carlo Bellieni

ROME, JUNE 7, 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, 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?

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Keywords

Fertilization, Children, Vitro, Medical

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