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