WCR This Week

Elizabeth Ring-Cassidy

Women who undergo in vitro fertility (IVF) treatments are often pressured to abort one or more babies if they have triplets, a psychologist told a seminar in Gatineau, Que.

An associate with the Toronto-based de Veber Institute, Elizabeth Ring-Cassidy told the annual Catholic Organization for Life and Family (COLF) seminar March 19 the goals of IVF have changed.

Initially, success was "an achieved pregnancy." Now success is defined as "a single, take home baby," Ring-Cassidy said.

In many jurisdictions, IVF involves a single-egg transfer and only one embryo is implanted, she said.

"That doesn't say they fertilize only one – there may well be 15 others, but only one is being implanted for a higher success rate," she said.

But regulations are fuzzy, and while there are guidelines on the maximum numbers of embryos that can be implanted, there is no enforcement.

Some countries allow up to five embryos to be implanted. What's happening in clinics across North America is "multi-fetal pregnancy induction," meaning multiple embryos are implanted, she said.

But fetuses in multiple pregnancies are being aborted to ensure one healthy take home baby, said Ring-Cassidy.

While pregnancy reduction used to be offered as an option for women facing risky multiple pregnancies, it is now being advised, she said. This pressure to reduce triplets to twins or singletons "permeates" the medical literature. What began as a choice you could make has now become something you need to do.

"We have this happening in the name of good health," Ring-Cassidy said.

Childless couples are so psychologically desperate to have a child that they buy into the argument, because the fear of losing the pregnancy altogether is very high, she said.

She spoke of two IVF pregnancies resulting in triplets. One mother chose to reduce triplets to twins. The other chose not to reduce, but lost two of the babies through miscarriage.

"You have to understand how difficult this choice is for people who are desperate."

These are men and women who long for children, and reducing a multiple pregnancy to one or two "has a lifelong impact" on their lives, she said. The children who are born "stand as a lifelong reminder" of the child or children they lost through abortion.

Cassidy said the intensity of grieving is severe, whether the "reduction" was done at 10 weeks or 18 weeks. The parents face "conflicting emotions," and ambivalence. They often become consumed with fear of losing the child who remains alive.

"They feel abandoned because of their decision," she said. "It's not something they can talk about."

Some women or couples attempt to distance themselves from the decision by having the doctor choose the fetus to abort, she said.

FETAL ABNORMALITIES

Thus the detection of a fetal abnormality might be met with rejoicing rather than despair, because that seems to justify the decision that selection reduction was the right thing to do.

They think allowing the child with a fetal abnormality to be aborted will produce less guilt, but a study on abortion for that reason show families suffer greatly, because they wanted children.

Ring-Cassidy noted no controlled studies have been done on childless couples who choose not to do IVF. Nor is there any discussion in the mainstream medical literature about the "commodification of children" – of "making them something you want as objects."

The nature of autonomy has taken over all medical decision-making, she said. Other problems with IVF concern the many embryos that are created, frozen and eventually destroyed.

Though there's a moratorium on using those embryos for research in Canada, Ring-Cassidy does not expect it to last long.

Going through the process of IVF is extremely traumatizing if the treatments are unsuccessful, she said.

In the past, infertile couples had to learn to accept it. There is little information on Catholic couples who accept the Church's teaching and do not use IVF.

No one is telling the couples they should not do this, she said. The doctor is always willing to work with a couple to get a pregnancy.

PSYCHIATRIC DISORDERS

Ring-Cassidy said 30 per cent of people who show up at IVF clinics meet the criteria for a psychiatric disorder.

Women diagnosed with infertility have high levels of arousal anxiety, depression and other symptoms. One woman said she didn't like going to church because there were too many babies; others couldn't go to baby showers.

"They are trying to appear as if everything is all right, but they are not," she said. "They are very distressed."

If they feel desperate and hopeless as well as depressed, they could become suicidal, she warned. "These couples believe they can control their fertility the way they control everything else in their lives.

"The message to a generation has been you can do anything you want, and that when you want it, it will happen and all of a sudden it doesn't happen," Ring-Cassidy said. "The reality of infertility is quite jolting for them."

DID EVERYTHING RIGHT

They pursued their careers, bought a home, finally got married and did everything right, but then their infertility nightmare began, she said.

Having a child becomes the prime focus and many marriages do not survive the roller coaster of IVF treatments, the disappointment when pregnancies fail to occur and the effect of drugs trying to trick the woman's body into thinking she is pregnant, she said.

This distress makes them vulnerable to the pressures to reduce pregnancies for health reasons to ensure one healthy take home baby, she said.