Dr Anthony J. Caruso is a Chicago doctor who worked in the field of in vitro fertilisation for 15 years before he quit in 2010. We interviewed him by email about the reasons for his change of heart.
MercatorNet: You ran a successful IVF practice in Chicago for ten years. Why did you leave?
Anthony Caruso: I was a member of several infertility practices since joining the field in 1995. In 2008 I was increasingly concerned about the kind of procedures we were doing. Initially it was the demands of same-sex couples. Then it was the way in which everybody looked at the embryos that had undergone pre-implantation genetic diagnosis.
Finally, it was the realization that the embryos that we were producing were just as important as the embryos that were transferred. I could not change my practice to accommodate the way I was looking at the process. I wish I could say that I had an “Aha!” moment, but I left my last position largely due to financial realities. They needed to pare salaries and I was next to go.
How did your colleagues react?
The reaction came at an officers’ meeting of the Chicago Association of Reproductive Endocrinologists. I was the President-Elect and I resigned at the officers’ meeting because of my religious and ethical positions. To say that my colleagues were disappointed or angry would probably be too strong, but they probably really think that I am insane. I fear that I have lost many friendships that I had over the years.
Is there one event that crystallised your decision to stop?
The reading of a 2008 document from the Vatican, Dignitas Personae, was the first blow. That instruction is written beautifully, and uses all of the current statistics in its analysis.
Bioethically speaking, what distressed you most about the process of IVF?
One of the basic purposes of marriage is blurred with IVF. Children as gifts from God have become desires and pawns in the life process. IVF breaks the very tenet of the principle of double effect. The nature of the act is not good. The good effect is a wanted child. However, that desire does not outweigh the negative nature of the act. One need look no further than the way in which embryos are treated to see this.
Do most people understand the stress that IVF brings with it?
Absolutely NOT. People who are going through IVF largely refuse to seek emotional or psychological support. And people who have not gone through the process do not understand what it entails. Perhaps the most interesting response that I have gotten to the presentations I am giving is from those who did not know exactly what happened during this process. Once they learn, the spectrum goes from rationalization to horror.
“Every child is a wanted child” is a slogan for IVF clinics. But does that mean that children become commodities?
What you see in this statement is the problem. One of the reasons for the delay in my response to your questions was a challenge that I was involved with to an IVF clinic being proposed within one block of a Catholic Church. The first meeting with the city council went well. We were able to make both ethical and practical arguments against the clinic. Once the city council tabled the bill for another meeting, though, you should have seen the number of couples and single people who showed up and showed off their IVF kids!
This is not the issue when it comes to IVF. Every child is a gift from God. However, the process that brought them into existence has led to an attitude towards the embryo that is no different than any other commodity.
If you add pre-implantation diagnosis into the equation, then you really have a situation that is no different than an auto dealership or a department store. “I will take two of these and then freeze these and toss these.” The very people who are showing off their beautiful children will not answer questions about how many frozen embryos are still present or how many they asked to be destroyed.
Also, I doubt that anyone has ever thought how they might describe these things to their children — the fate of their siblings — because they are not seen as such. They are seen as simply a means to an end.
Is selective reduction a common feature of IVF?
Selective reduction [editor’s note: aborting some foetuses in a multiple pregnancy to allow others to grow] is a feature of every IVF consent. Fortunately, it was the rarest discussion I ever had with a couple. However, it is an issue that is slowly growing in popularity. The New York Times recently reported that couples are reducing twins and triplets to singletons. Since the Octomom fiasco, the number of high order pregnancies has dropped as they try to stay more faithfully with the guidelines published by the American Society of Reproductive Medicine.
What happens if a couple learns that a child will not be “perfect”?
There is a spectrum here as well. While many will continue to love their child no matter what, there is a true desire to quickly determine the health of the child, so that, if somehow defective, the option of termination is still viable. What we know now about the possibilities of pre-implantation diagnosis may further change that, with the focus being on the “perfect” genetic child.
Will having an IVF child bring happiness to a couple who have been longing for children?
Hard to answer. Children can salve much unhappiness. Remember, though, couples that go through IVF are approaching the procedure with a mindset of “I want this baby, I need this baby.” One can only surmise what possibilities exist down the road. But, at least on discharge, they seem happy.
What effect does the process of IVF have on women?
The data is slowly coming in. Certainly, it is well-known that there are dangers in over-stimulating a woman’s ovaries. Ovarian hyper-stimulation syndrome can be severe, especially in the environment of a pregnancy. Though the other immediate risks are very small, there is a risk of bleeding, injury to the intestines and infection.
There is also a risk of blood clots and their sequelae. The long-term effects are now slowly coming into focus. Remember, the first IVF pregnancy was in 1978, but the first IVF pregnancy from a stimulated ovary was in 1981. That was only 30 years ago and the women going through that procedure are largely just entering the age of chronic disease. One study from the Netherlands suggests that 15 years after an IVF pregnancy, there is an increased risk of ovarian cancer. While there are no controlled trials, many reproductive endocrinologists anecdotally describe women who present with breast tumours after IVF stimulation.
The websites of IVF clinics feature joyful stories about couples who are finally cuddling their bundle of joy. But are there features of IVF practice which are kept from the public?
Of course, that is the focus that keeps the public happy. Babies are happy things! But most people only know that part of it. They don’t know anything about the drugs and the process that leads to the babies. And we don’t discuss it openly because if we did, I think more of us would be against it.
Doing IVF is certainly an accomplished technical feat. But is it really medicine if it doesn’t cure infertility? Has it become more a business than medicine?
IVF does not cure infertility. It bypasses the barriers to natural fertility. As such, it is really a business. Just think about the number of clinics that offer cash-back programs. They guarantee that if the couple does not conceive within a certain number of cycles, they will get some or all of their money back. Where is the “medicine” in that?
What do you advise infertile couples to do now?
I encourage people who are having challenges to conception to have faith and ask God for help. There are several clinics in the United States that do offer more natural options. Of course, my own dream is to open a clinic in Chicago that provides care for these couples in line with the ethical and religious directives for Catholic health care. But that is in God’s time and in the hands of the people we are asking to support it.
You participated in an amicus curiae brief recently to the US Supreme Court which warned that “IVF poses an array of serious dangers to women, children, medicine,and society at large”. How is IVF a threat to society? What about the future?
I think I have answered that above. But let me use the words of Dr Robert Edwards, Nobel laureate and laboratory director of the laboratory which “created” the first IVF baby, Louise Brown, in 1978. He stated in a 2003 interview with the London Times marking the 25th anniversary of that birth:
“I wanted to find out exactly who was in charge, whether it was God Himself or whether it was scientists in the laboratory – it was us! The Pope looked totally stupid. You can never ban anything. You can say, ‘hang on a minute’. But never say ‘never’, and never say that this is the worst decision for humankind, otherwise you can look a fool. Now there as many Roman Catholics coming for treatment as Protestants.”
He also said in this very enlightening interview that the IVF process was not designed to make couples happy. “It was a fantastic achievement”, he conceded modestly, “but it was about more than infertility. It was also about issues like stem cells and the ethics of human conception.”
In other words, it was the next step to be taken, the next obstacle to be overcome on the road ahead to the Brave New World which technology will bring us. Now, as this ageing scientist looks to the future, he is all in favour of cloning. With regard to pre-natal sex selection (whereby parents would be allowed to abort babies of unwanted gender) he says, “go ahead and use it. Those parents have to raise those children. Why should a politician tell me what I can and can’t do?”
And Dr Peter Brinsden, Edwards’ successor at the Cambridgeshire clinic he founded, predicts that “in 50 years assisted conception will have almost become the norm. This is because screening techniques will have improved to such an extent that parents can make their children free of even minor defects.”
I doubt if many in the field have seen these quotes, and the article itself is difficult to get (I have it through a secondary source). But after meeting Dr Edwards, which I did a few years ago when the University of Chicago conferred on him one of its highest honours, I can believe all of it.
This is a good summary of the problem with IVF and its potential impact on the society at large.
And we haven’t even scratched the surface. We haven’t talked about the donor gametes and the possibilities of progeny to meet somewhere, or more immediately, the effects on the donors themselves, particularly the oocyte donors.