Making babies: highly questionable research

Is there any greater sign of the modern over-enlarged sense of entitlement than the ART ("assisted reproduction technology") business? [Yes, I know, I was lucky enough not to have go looking into that to have kids of my own, but high abortion rates means that it's not for a lack of embryos in the West that there is a shortage of babies born. Indeed, despite the problems inherent in international adoption, I would still prefer to see more of that than kids left in the pathetic orphanages that exist in some countries.]

There have been quite a few stories of interest about ART this lately, and some really bad reporting. This will be a long post.

First: Let's oversell "Two Mums is good". It was widely reported, as in this example from the Sydney Morning Herald short report, with the jolly title "Two Mums Better than Dad":

"..researchers found children born to and raised by lesbian couples were better off socially, academically and more competent than their peers."

All complete with happy photo of (impliedly) happy lesbian family, although as they are not identified, for all I know they could be a couple of Fairfax reporters who posed with the bosses' toddler.

Anyhow, the study was based on following 154 pregnant (from artificial insemination) lesbian women from the 1980's and comparing them to heterosexual families. Beginning to suspect this study might have some flaws? Your suspicions would be right. As economist blogger David Friedman notes, one obvious way it might be unreliable would be if the two groups of parents were not closely matched for other factors that may very well be relevant to having a "better off" child:

The two groups might differ in important ways other than their sexual preferences. Most obviously, since the lesbian parents had conceived via artificial insemination, their pregnancies were all planned and all desired. If the comparison group contained a significant number of children from unplanned and unwanted pregnancies, that might explain why more of them had behavioral problems. One could imagine a variety of other possible explanations as well—and the news stories did not provide enough information to confirm or reject them.

He then reads the paper and reports:

The two groups were not closely matched, due to data limitations, a problem that the authors noted. They differed strikingly in geographic location, since the lesbian couples were all recruited in the Boston, D.C., and San Francisco meteropolitan areas, while the data on children of heterosexual couples, coming from another researcher's work, was based on a wider distribution of locations. They were not matched racially—14% of the heterosexual couples were black, 3% of the lesbian couples were. They were not matched socio-economically—on average, the heterosexual couples were of higher SES than the lesbian couples.

As someone commented in the Sydney Morning Herald guessed:

This study may be more about the socio-economic than about gender! In that regard it simply confirms what we already know: advantaged parents are able to raise advantaged children. It is not that "2 mums better than dad". Rather, it is that "2 advantaged parents are better than 2 less advantaged ones".

David Friedman then finds another startling problem with the research:

Questionaires went, at various points in the study, to both mothers and children. But the conclusion about how well adjusted the children were was based entirely on the reports of ther mothers. A more accurate, if less punchy, headline would have read: "Lesbian Mothers Think Better of Their Kids than Heterosexual Mothers Do."

Friedman is not out to criticise the authors, as the inadequacies are there to see in the paper. It certainly seems to me, though, that the authors are not above overselling their report to the media, such as when they are quoted as follows:

"Our findings show that adolescents who have been raised since birth in planned lesbian families demonstrate healthy psychological adjustment and thus provide no justification for restricting access to reproductive technologies or child custody on the basis of the sexual orientation of the parents."

Hmm. Does that sound just a tad like they have the view that they have a message to sell? Their funding did come from lesbian friendly foundations. What a surprise.

I don't think many people expect lesbian couples to be atrocious at parenting; at the same time, this is a bit of peer reviewed research that proves nothing and is being oversold by its authors.

Second: Let's not report a survey that indicates some kids are not so happy about not knowing their Dad:

OK, OK, this is not a peer reviewed bit of research and it comes out of a conservative foundation and was partly conducted by a person with a personal interest in the issue. But it got a run in Slate, which was kind of brave of them, as it would clearly upset many liberals because, you know, everyone is entitled to get knocked up via an anonymous sperm donor and who are we to question whether that's a wise thing to do?

The report is a survey which compared attitudes between 3 groups: "18- to 45-year-olds includes 485 who were conceived via sperm donation, 562 adopted as infants, and 563 raised by their biological parents." Some of the findings:

Regardless of socioeconomic status, donor offspring are twice as likely as those raised by biological parents to report problems with the law before age 25. They are more than twice as likely to report having struggled with substance abuse. And they are about 1.5 times as likely to report depression or other mental health problems.

As a group, the donor offspring in our study are suffering more than those who were adopted: hurting more, feeling more confused, and feeling more isolated from their families. (And our study found that the adoptees on average are struggling more than those raised by their biological parents.) The donor offspring are more likely than the adopted to have struggled with addiction and delinquency and, similar to the adopted, a significant number have confronted depression or other mental illness. Nearly half of donor offspring, and more than half of adoptees, agree, "It is better to adopt than to use donated sperm or eggs to have a child."

Of course, there may well be biases in the selection of the subjects here (although I haven't read anyone pointing out precisely how yet), and it's not "peer reviewed", but is it all that surprising that some adults from anonymous sperm donation would worry about things like whether someone they meet might actually be their half sibling? This is particularly so in America, which for some reason is still allowing anonymous donors to remain anonymous all their life. (This has been changed in Australia and much of Europe, with the result that very few men are now willing to be sperm donors. In Australia, the donor can't even be paid!)

Everyone knows that adopted kids, as adults, often feel that the fact of their adoption is an important issue about their life, hence all the shows and stories about the desire to re-unite with their biological parents. It makes many of them feel more complete.

So it should be no surprise at all that many sperm donor kids should feel the same way.

I reckon there is likely to be more truth and accuracy in this study than the lesbian parent one.

Of course, if you are going to allow companies to provide this service, the anonymity should be illegal. It is cruel to deliberately create a kid with this uncertainty in its future.

Yet, of course, it wasn't mentioned in the media much at all.

Third: just how many defects does ART create in babies?

There was some reporting of a new study that at first sounds like it should be a big worry for those considering IVF:

Slightly more than 4% of babies born via assisted reproductive technology such as in vitro fertilization (IVF) may have major birth defects, such as heart and urogenital tract malformations, according to a new study...

The major birth defects seen in babies born via IVF and/or ICSI included heart defects and malformations of the urogenital tract, such as hypospadias (an abnormality in the position of the opening of the urethra in boys). In the study, 110 children had genetic disorders, including six children with Beckwith-Weidemann syndrome, which is marked by body overgrowth, and may increase risk of certain cancers. Five children also had bilateral retinoblastoma (cancer of the eye's retina).

Children born via assisted reproductive technology had a five times higher rate for minor birth defects such as angiomas (a benign tumor of small blood vessels causing a red growth on the skin). Angiomas were twice as common in girls as in boys, the study found.

But:

U.S. experts are quick to point out that these risks are not much different from what would be expected in the general population. And the risks are much lower than what has been found in some other studies of babies born as a result of fertility treatments.

This research came from surveys in France, and the lead authors Geralidine Viot (see above link) is quoted as saying:

"our results are not so different from the general population and I consider them rather reassuring as some previously reported studies showed increased risk of major malformations around 9% to 11%," she says.

Wait a minute: why is so much discrepancy between the rate of defects in these studies? Just how hard is it to record defects from babies from IVF?

And what's going on here: in the report of this study from The Independent, we read:

The study, the largest of its kind, found evidence of a higher-than-expected rate of serious congenital abnormalities.

Research leader Geraldine Viot said: "We found a major congenital malformation in 4.24pc of the children, compared with the 2-3pc that we had expected from previous published studies.

"This higher rate was due in part to an excess of heart diseases and malformations of the uro-genital system. This was much more common in boys.

Those comments regarding what they expected from previous studies doesn't seem to match the earlier quote, where she was relieved that their rate was half that of previous studies.

There's some explaining that needs to be done about all this. There are studies from Australia indicating defect rates "twice" that of naturally conceived children, and an American report from 2 years ago that found:

The CDC reports that certain birth defects -- including heart wall problems and cleft lip/palate -- may be two to four times more common among babies conceived with assisted reproductive technology (ART) than babies conceived naturally.

They are also keen to note:

The study doesn't prove that ART was to blame for the birth defects.

"Subfertile women might have a higher risk of having a child with a birth defect regardless of whether infertility treatments are used," write Reefhuis and colleagues.

So it may not be the ART process itself that "causes" it, instead it may be the decision to use ART to get a baby with a higher risk of a major defect when your natural infertility would have prevented it. Well, I hope that IVF clinics make this subtle "it's not us, it's you" distinction known to their clients.

In fact, it seems to me ART doctors are dead keen to downplay the significance of increased rates of defects. For example, this is from the Melbourne Herald Sun report on the recent French study:

Dr John McBain, Melbourne IVF director and head of reproductive services at the Royal Women's Hospital, said the definition of "major" congenital abnormalities was contentious, and included conditions such as clicky hips and club feet.

He said it was difficult to compare the health of children conceived naturally and through ART.

"The children born from assisted conception have more rigorous physical examinations," he said.

This is self interested excuse making, if you ask me.

And funnily enough, when you go to the glossy IVF Australia website and search it for terms such as "birth defects", "congenital defects" or "birth abnormalities", you score nothing that talks about increased rates of these for IVF babies. (That's not to say that they don't give appropriate information to those who contact them, but I would be curious as to how they explain the risks, given the apparent conflict between results of studies over the last decade.)

I remain very cynical about virtually all aspects of "Assisted Reproductive Technologies", but it's a good little earner I'm sure.