Wednesday, November 22, 2017
Health

Newborn's death raises new questions about regulation of fertility clinics

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Kathleen Steele was 61, a widow and raising two young children alone when a New York fertility clinic agreed to help her have a third child.

Less than two weeks after Steele gave birth, the newborn died after being tossed and pummeled by her 6-year-old brother when she left them alone in a minivan.

The death of Steele's baby this week has raised new questions about the regulation of fertility clinics and their part in making childbirth an option for women well beyond traditional child-bearing age.

The American Society for Reproductive Medicine recommends physicians discourage women older than 55 from seeking fertility treatments. It warns there are increased likelihood of health risks for both mother and child, and that parents' ability to care for their children diminishes as they age.

But those are only recommendations intended as guidance for physicians. No state has set an age limit on fertility treatments and there is little regulation of clinics, said Arthur Caplan, professor of medical ethics at New York University's Langone Medical Center.

"There are huge questions about what went on," Caplan said of Steele's fertility treatment. "There are still clinics that will do whatever you want for money. You have the cash, they'll do it."

Steele may have had to travel to New York to find a doctor willing to treat her.

"I don't think there's anyone in the Tampa Bay area who would do that," said Dr. Catherine Cowart, a reproductive endocrinologist in Tampa.

Most clinics won't treat women older than 50 and very few treat women older than 55, said Dr. Rafael Cabrera, a reproductive endocrinologist with Brown Fertility Clinic in Orlando.

His clinic will treat women who will deliver by age 55, but on a case-by-case basis.

"We want to stay within the guidelines," Cabrera said. "Yes, there are some patients who will take any risk because they're desperate to have a baby, but that's when we as doctors, with our knowledge and training, have to say no."

Fertility treatments were developed to make childbirth an option for young couples with medical issues preventing them from starting a family.

Doctors soon realized they could use the same techniques for women even after menopause, which occurs at an average age of 51.

Roughly 680 U.S. women over the age of 50 gave birth in 2013, the Centers for Disease Control and Prevention reported in its National Vital Statistics Report. The number of births in women aged 50 to 54 has risen by more than 160 percent since 2000, the report shows.

Some other countries have pushed fertility treatment even further. In May, an Indian woman gave birth to her first child at 72.

Pushing nature's boundaries has fueled an intense ethical debate.

For Caplan, the medical ethics professor, it's wrong to take on the responsibility of a child when the ability to care for them through to adulthood will likely wane.

"It means you're likely to be entering a nursing home when they're entering high school," he said.

But other academics question whether anyone should be given authority to make such a pivotal life decision for someone else.

As long as a woman is in good health and able to carry a healthy child to term, doctors should not be asked to decide who has the right to be a mother, said Jay Wolfson, USF professor of public health, medicine and pharmacy, and associate vice president for health law and policy.

"Once you ask that question in this society, you create the potential domino of very dangerous questions," Wolfson said. "The next question should not be is she too old to have a baby or too poor to have a baby."

That older people have the ability to care for children is difficult to deny. Child welfare agencies, for example, often place children with grandparents rather than with unknown foster parents.

According to 2010 U.S. census data, 4.9 million American children are being raised solely by their grandparents. The number is almost double that of the 2.4 million recorded in the 2000 census.

Steele's mental state after the death has also raised questions about whether prospective parents should be screened before receiving fertility treatment. After she discovered the injuries to her newborn, she did not call 911 but called a friend who is a nurse. She was also described as appearing "aloof" about the tragedy.

Cabrera, the Orlando endocrinologist, said his clinic refers patients to a psychologist for screening and counseling. Among the questions discussed are whether parents have a good support system in place in case of illness, senility or death.

Patients can be turned away because of red flags such as drug abuse or serious mental health issues, he said. They are not required to submit mental health records, however.

"They can hide things from us," he said. "We're don't play detective and we have to go by what the patient tells us and what the psychologist finds. You try to do the best you can but there's no fail-proof system in place, unfortunately."

Contact Christopher O'Donnell at [email protected] or (813) 226-3446. Follow @codonnell_Times.

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