September 3, 2006


No Middle Ground (JONATHAN RAUCH, NY Times Book Review)

My friends Jenny and Greg were still digesting the news that Jenny was pregnant with triplets when, only moments later, their fertility doctor sat them down. After recounting the many things that might go wrong in a triple pregnancy, he said, “You really should consider reducing.”

Overwhelmed by the prospect of triplets, they were now horrified by the doctor’s casual attitude toward abortion. “Honestly,” Greg says, “I felt like there was no regard for human life.” He and Jenny did not “reduce,” and today their triplets are healthy toddlers. Asked how she feels now about the thought of aborting one of her children, Jenny gasps, “Oh, my God,” then chokes up before mustering the composure to say, “I guess that’s my answer.”

As it happens, Jenny and Greg both think abortion should be legal. They think people have a right to control their own bodies. But they also find the abortion issue distressing and difficult, and believe abortion should be reserved for special circumstances (theirs didn’t qualify). Ramesh Ponnuru, a senior editor at National Review, is out to tell them their position is nonsense. In “The Party of Death: The Democrats, the Media, the Courts, and the Disregard for Human Life,” he seeks to debunk what he views as an incoherent centrism while, as Marxists used to say, “heightening the contradictions” of abortion-rights advocates.

Ponnuru is at his best doing the latter. Gleefully and persuasively, he skewers the excesses and “tactical pirouettes” of abortion-rights absolutists: Because they would allow abortions even in the latest stages of pregnancy (and through “partial birth” procedures), their position gives them no firm purchase from which to oppose infanticide. They reject common-sense regulations requiring parents to be notified if minors seek abortions. They insist that abortion must be not just legal but subsidized. They deny that what Jenny and Greg’s doctor called “reducing” is more complicated morally than an appendectomy.

This “party of death” — “those who think that the inviolability of human life is an outdated or oppressive concept” — is not perfectly congruent with the Democratic Party, but in Ponnuru’s words, it has made the Democrats a “wholly owned subsidiary.”

A fine book that would be much stronger if Mr. Ponnuru forthrightly confronted the Darwinian Right, which correctly understands him to be implicitly undermining them.

Posted by Orrin Judd at September 3, 2006 7:09 AM

Can anyone imagine explaining to the "twins" how it came to be that they were not triplets?

Posted by: Lou Gots at September 3, 2006 6:46 PM

Oj, you must be really upset that you didn't make the New english Review's list of their "favorite people".

Posted by: Jim in Chicago at September 3, 2006 9:42 PM

Hmm, realized that that last comment could be misread.

I was aiming for sarcasm.

What I really meant was that I need a shower after reading the Derb and checking out the motley crew he has assembled over there, so therefore you'd no doubt be rightly ashamed to be numbered among their "favorite people".

Posted by: Jim in Chicago at September 3, 2006 9:46 PM

It seems that people who create large numbers of embryos for implantation also have a casual attitude towards human life. Why couldn't they have had only one created, or implanted?

Posted by: Alison at September 3, 2006 11:15 PM

I'm pregnant with twins after infertility treatment, and although we didn't do IVF per se, I think I have enough experience in the area to hold an educated opinion.

First, to answer Alison, the reason that people create, and transfer, more than one embryo is because IVF is still such a scattershot process. You retrieve as many eggs as possible from the mother's ovaries and attempt to fertilize all of them, because the majority of them won't fertilize, and many of the ones that do will divide once or twice and then stop developing. When you retrieve 10 eggs, you can reasonably expect to get two or three embryos out of it. If you're lucky enough to get more than that, the embryos are frozen for use in your next cycle; the odds indicate that your current one isn't likely to succeed, and a frozen-embryo transfer is much less expensive and physically difficult than a fresh cycle of egg retrieval and fertilization.

The decision about how many embryos to transfer (NOT "implant" -- if we knew how to do that, success rates would skyrocket) is likewise driven by the odds. The overall success rate of IVF is about 40% for women under 35 (and declines to less than 20% by age 41-42), meaning that in the majority of cases, none of the embryos transferred continue to develop inside the mother's uterus. The current research shows that the success rate is higher with a two-embryo transfer than a single-embryo transfer, but that in the average patient, transferring three embryos only increases the multiple birth rate. The general policy these days at most US clinics is to transfer two, though individual patients may transfer more under certain circumstances of age or diagnosis.

Other countries, particularly the UK and Italy, actually have laws about the number of embryos which may be transferred, and have correspondingly lower success rates. These countries also have nationalized health care, so IVF cycles are publicly financed. In this country, IVF is largely paid out-of-pocket (it's usually not covered by insurance), so it would be much more difficult for the government to institute such a policy.

I would dispute the assertion that all people who "create large numbers of embryos" have a casual attitude about them. I think it's quite clear to anyone who's actually going through IVF that every one of those embryos is a potential baby. I know quite a few people who are generally pro-choice, who (rightfully) have a great deal of difficulty reconciling their opinions about abortion with their feelings toward their embryos.

Finally, I would point out that the percentages of high-order multiple conception are very low, and that the chief reason that people take the risk is because nobody thinks it will happen to them. About 33% of IVF pregnancies are twins, and 5% are triplets or higher. Since you've only got a 40% chance of getting pregnant at all, that means that when you start a cycle, you've got a 13% chance of conceiving twins, and only a 2% chance of conceiving triplets or more. Human psychology doesn't distinguish very well between a 98% chance and a sure thing -- rationally, you know that someone has to be part of that 2%, but it's hard to believe it's going to be you, especially when you've been made desperate by years of infertility. Personally, I didn't really believe I would get pregnant at all, much less with twins (and possibly a triplet I may have lost very early on). We knew the risk was there, had talked about what we'd do if it happened, but it felt about as realistic as talking about winning the lottery.

Posted by: Atlee Breland at September 4, 2006 11:06 AM

The best of luck to all of you.

Posted by: erp at September 6, 2006 2:07 PM