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Considering tomorrow's children today

17 January 2005
By Dr Jess Buxton
genetics editor, BioNews
Appeared in BioNews 291
The wellbeing of children conceived using assisted reproduction - and the suitability of their prospective parents - has triggered debate in the UK media this week. First came the launch of the Human Fertilisation Authority (HFEA)'s consultation on the Welfare of the Child, entitled 'Tomorrow's Children', the results of which it aims to use when drawing up new guidelines for clinics in this hard to interpret area. It triggered a flurry of newspaper headlines claiming that 'IVF parents face police checks' - misinformation based on a journalist's enquiry at the accompanying press conference, rather than anything in the consultation document itself.

Then came yesterday's news that a 66-year-old Romanian woman has given birth to a baby girl, making her the world's oldest recorded mother. The event provoked outrage in the usual quarters, but in a particularly barbed piece for the Times (see Recommends), Cristina Odone managed to tie the two stories together. She concluded that we should not add to the number of 'children scarred by their unsuitable parents' by 'refusing to check on those who rely on IVF'. What Cristina is saying is that some people should face rigorous medical, psychological and social checks before embarking on parenthood, simply because they require medical treatment to conceive.

But as Kate Brian, who has two children conceived by IVF, explained to BBC News Online (also in Recommends), people who have invested a huge emotional and financial commitment to having children 'probably would be as good a parent as anyone else'. In fact, research carried out by Susan Golombok and colleagues on families with children conceived using assisted reproduction technologies (ARTs) show they are characterised by 'stable and satisfying marriages, psychologically healthy parents, a high level of warmth between parents and their children, accompanied by an appropriate level of discipline and control and well-adjusted children'. As for children born to post-menopausal mothers, such individuals are clearly very committed to beginning a pregnancy, and obviously feel they have the physical and financial resources to raise a child. The vast majority of women, on reaching their 60s, will be biologically unable to have children, even if they had the necessary time and money. So such families are hardly likely to become a major issue for society, as Odone seems to believe.

The current HFEA consultation lays out a number of options for the guidelines it must give to clinics, on the need to consider the welfare of children born following any treatment they provide - a requirement of the 1990 Human Fertilisation and Embryology Act. These range from minimal medical checks, to those which also take account of any social factors that might affect any future children. They include a suggestion that future parents of children conceived using donor eggssperm or embryos might require additional assessment or information when beginning treatment.

No parent can know how 'suited' they will be to bringing up a child until they have one, and no amount of information can fully prepare them for the pitfalls and rewards of parenthood. Where there are likely to be extra challenges, such as telling children they were conceived using donated eggs or sperm, there is a clear role for patient support groups and the option of counselling. But subjecting people who require medical assistance to conceive to legally enforced, rigorous vetting procedures, as Odone and others advocate, would achieve little more than add to the already considerable stress of undergoing IVF.

In the fourteen years since the HFE Act has been in operation, there has been no evidence that children born following ART suffer any psychological harm as a result of not enough attention being paid to their welfare prior to conception. In fact, the opposite is true - most ART children studied seem to be flourishing. Many patients and their clinicians must hope that this is one area of the legislation that might be deemed unnecessarily burdensome in the ongoing and forthcoming reviews of the Act. In the meantime, the HFEA is aiming to make the best of what many fertility doctors feel should already be part of good medical practice, rather than a legal requirement.

SOURCES & REFERENCES
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