September 24, 2017

Georgia politicians react to impose restrictions – Part I

The fears of many infertile couples regarding kneejerk government reaction to the octuplets case have now been validated. On February 18, the Georgia senate referred a bill calling for certain restrictions. Here is the official wording. Many thanks to the readers who called this news to my attention.

Before we dissect this, I want to take a moment to remind everyone of one fundamental, indisputable fact of life. PEOPLE MAKE DECISIONS AND TAKE ACTIONS THAT SERVE TO MAKE THEIR OWN LIVES HAPPIER. It sounds ridiculously obvious, but I take the time to mention it because recognition of this universal truth is critical in helping us evaluate the realities of this bill. In an ideal society, the rules are set up so that when people are driven by their own happiness, it also results in the happiness of others. Win/win. Case in point. We may wishfully like to think that the mission of a restaurant owner is to provide the best food and best service for their customers at the cheapest prices. Let’s call this these the IDEAL GOALS. But in reality, from the personal viewpoint of the restaurant owner, his mission is to do maximize his own happiness, plain and simple. Depending on his personal values, that happiness might entail making more money or enhancing the reputation of his establishment (and himself) and/or minimizing the labor, time sacrifice or stress that he has to put into running the place. Usually it’s some balance of all of these. Let’s call these the TRUE GOALS. The beauty of a fairly governed society is that the attainment of the TRUE GOALS are highly dependent on the achievement of the IDEAL GOALS, meaning that in a society where people are free to make their own decisions, the owner can best achieve his goals, by providing a product that is as yummy, pleasant and modestly priced as possible. This will entice patrons to very willingly flock to his restaurant and hand him money. They do this not out of a favor to the owner, but they do it because it is worth it to them to come and enjoy sitting in a romantic environment and consuming prime rib medium-rare, amazing creamed corn, crème brulee and a bottle of fine Merlot.

Now let’s talk about politicians. The THEORETICAL GOAL of a politician is to serve the public, ie make legislative decisions that will enhance the quality of life for the people as a whole. Agreed? However, the TRUE GOAL, in their minds is to get elected, so that they can continue to enjoy the prestige, power and financial perks of their position. There’s nothing wrong with admitting that, because, in an ideally governed country (and I am clearly not so naïve as to think that we live in such), the THEORETICAL GOALS and the TRUE GOALS would go more hand-in-hand, meaning that the more that politicians do to improve the quality of life of the people, the more likely they are to get elected. But in truth, there is a greater disconnect between these two thing in politics than there is with restaurant owners or other free-market based businesses.

Bearing this in mind, let’s ask ourselves what truly motivates politician to introduce new laws? ONE, they are acting with sincerity to improve the quality of life of the people. TWO, they are promoting the illusion of busy-ness to look as if they are actually doing something. THREE, they are maneuvering to give themselves more and more power.

How can we judge which of these things is going on? By dissecting the facts of the situation, we can get clues as to which of these three things is going on.

First of all, let’s ask if this bill was conceived out of careful thought about what legislative changes would make life better for people OR was it just a knee-jerk reaction to a sensational isolated current event. In other words, did the politicians one day, after due diligence of careful homework and thought, conclude, “You know, the taxpayers who elected me really really want more restrictions regarding people’s embryos, above and beyond what the current law provides. By golly, we’re going to give it to them.” OR did they one day say, “This single isolated octuplets incident has really stirred up some emotion. Now, while the iron is hot, is the ideal chance to exploit this anger and outrage to get votes in the future. Hopefully, I can get a bill out of this with my name on it.” So which was it? I clearly know my opinion on it and encourage you to make your own as we consider things further.

The outrage in this case is that it combines two different hot topics – the increasing use of advanced technology to override nature in the arena of human reproduction AND the concept of taxpayers supporting children born to parents who can’t care for them. We can separate these two issues by changing the scenarios and seeing how it changes how we feel.

Imagine if this were a case of octuplets born to Bill and Melinda Gates after fertility treatment, who out of respect for what’s right declare “We would like to thank the doctors and nurses who worked so hard to deliver our babies safely. We know it would be unfair to force anybody else to pay for all that hard work, so we have asked for an itemized bill and have paid every penny ourselves. It’s only right. We have even voluntarily made a generous donation to the hospital. Also, rest assured that we will be working hard to support these babies of ours and not burdening anybody. We will create eight new nanny jobs with full wages and benefits paid out of our own pocket to further help the economy. Thank you for all your letters of congratulation. We have a long road ahead, but will work hard to raise eight children who will be happy, healthy and contribute greatly to society as much as Microsoft has, er with the exception of Vista, of course.”

Now imagine, if this were a case of the theoretical Suleman sisters, five women from the same family who are all single, living off of disability, unemployment, food stamps, welfare and defaulting on their debt. In the past five years, all the sisters, out of their love of having children, decided to keep getting pregnant naturally through various liaisons, and now have given birth to three or four children each, one at a time, without fertility treatment, so that now this lovely family collectively has sixteen fatherless children running around. They clearly intended to have these children deliberately, but they did it without involving doctors, but just persuaded various men with no medical education to inseminate them the old-fashioned way. Now their crowning achievements have given them access to going on the talk show circuit and crying about how difficult it is to be a single mom nowadays.

Each of these two scenarios would create buzz in itself, but the fact that Nadya’s case involves both elements really gives it media sex appeal. And as could be predicted, new legislation has been drafted to address this situation. Bear in mind that there have not been an epidemic of octuplets this past year, nor even quadruplets. Until this case surfaced, reproductive restrictions ranked well below the bottom 5% of today’s concerns.  But all it takes is one case and all of a sudden, there is the sudden NEED for changes to the law. OK. Fine. Let’s assume for a moment that there is such a need. In the next post, let’s look at this bill in detail and see what these proposed changes entail and whether or not they really are the best way to serve their intentions.

  • Campbell

    Great post. I agree with you that if a wealthy couple had octuplets no one would complain. I don’t remember similar outrage over the other octuplets born about 10 years ago.

    What I don’t understand is why all this legislation talk focuses on IVF. Doesn’t IUI cause most high order multiples?

    (By the way, in your next post detailing the bill can you explain this section: “The in vitro human embryo shall not be intentionally destroyed for any purpose by any person or entity or through the actions of such person or entity.” If they’re saying you can’t destroy an embryo, wouldn’t that be a violation of the right to have an abortion?)

  • Kari

    “Doesn’t IUI cause most high order multiples?”

    I don’t believe IUI causes high-order multiples because it’s just putting the sperm closer to the egg to increase the odds of fertilization. But, when you combine IUI with fertility-enhancing drugs that can overstimulate the ovaries to release more than one egg per cycle, you increase the odds of having multiples because now you have more eggs. I believe Jon & Kate used injectibles the cycle they conceived the sextuplets, and a friend conceived triplets after using injectibles and having an IUI. That’s why most REs will do an u/s scan before an IUI to check on the number of eggs.

    Interesting take on the wealth vs. poverty stance. No one’s complaining that the Duggars have 18 children now because they can afford to care for them. I’m still in favor of reversible sterilization for both the men & women in order to qualify for welfare. A guy on my street was bragging last week that he finally got his girlfriend pregnant because now she can go live in a halfway house for unwed, pregnant women. They don’t have ten dollars between them, and they’re bringing a child into the world . . . to qualify for free housing. And I know of women who wanted to have one more child because then they would get an apartment with 3 bedrooms instead of two on taxpayer money. Okay, I’m venting and getting off topic. Sorry.

  • http://www.mloknitting.com/ MLO

    The bill was waiting in the wings by the so-called “pro-life” Georgia branch. It is a masked attack on all reproductive rights.

  • Ann

    Hi Doctor,

    I am a regular visitor of your site and I have a question about progesterone supplements.

    I had done 3 cycles of IUI and got pregnant on 3rd time. Now I am 7 weeks pregnant.

    My RE put me on Prometrium tablets (200mg) orally twice a day after my IUI.

    I had a blood test done on 15th day after IUI and found that HCG level is 135 and progesterone level at 19.7. My doctor said even though I am on supplements the level is still low and doctor increased it to 3 times a day (200mg each).

    Then on 6 weeks and 4 days, I had one ultrasound and blood test. We found a heartbeat (126) and my progesterone is now at 56.7.

    So doctor told me to completely stop the Prometrium. But I am really scared to stop it. but my RE is not all concerned about it.

    I am really scared and I want to keep this baby.

    Do you think it’s safe to stop it now? Will my level drop again if I stop it suddenly? Do you think I should reduce the dose and continue it for some more time? Is there any harm if I continue this medicine? I have read in internet that people normally take it until 12 weeks.

    I would really appreciate your help.

    Regards,
    Ann

  • Robin

    http://www.mercurynews.com/breakingnews/ci_11845006

    Georgia ‘octomom’ bill referred for more study

    ATLANTA—A Georgia measure that would place first-in-the-nation restrictions on the number of embryos fertility doctors may implant likely won’t pass this year after it was shipped to a subcommittee on Thursday for more study.

    “The Ethical Treatment of Human Embryos Act” was inspired by California’s “octomom.” It would restrict the number of fertilized embryos a woman could create and implant through in-vitro treatments.

    The issue is expected to resurface next year. Several key state lawmakers said they supported the thinking behind the legislation but that it needed more study to avoid legal challenges. Parliamentary rules say any bill would have to reported out of committee on Monday to be considered this session, meaning the measure is effectively dead.

    State Sen. Ralph Hudgens said he sponsored the bill to avoid Georgia spawning its own Nadya Suleman. Suleman gave birth to octuplets in Bellflower, Calif., on Jan. 26. She has six other children, lives in her mother’s three-bedroom home and has relied on food stamps and disability income to provide for her family.

    At a packed state Senate hearing, opponents said the bill would be devastating to Georgia’s fertility industry, putting treatment out of reach for couples desperate to become pregnant. (the link gives the full article
    ______________________________________

    So, it seems a bill submitted by Senator Hudgens, with a background in agriculture, Shell Oil and current owner of a waste management business, might have faced “legal challenges” DUH!

    “The bill was waiting in the wings by the so-called “pro-life” Georgia branch. It is a masked attack on all reproductive rights.”

    Senator Hudgens has a 100 score from the Christian Coalition.

    Any legislation written concerning this needs to come from professionals in the field of reproductive medicine along with attorneys who are aware of all case law concerning this issue, and uh, maybe the Constitution also?

  • Robin

    Dr. Lee,
    I’m sure you’re following all these proposed legislations that are cropping up but I find this one particularly interesting because according to this article, ASRM sent a letter backing the bill. The part quoted in the letter sent is:

    “These guidelines were developed to deal with what we saw as a growing problem of triplet and higher multiple births as a result of (fertility) treatments,” wrote Sean Tipton, director of public affairs. “We can, and have removed members for violations of those policies and for failure to adhere to our guidelines. However, we do not have the ability to stop someone from legally practicing medicine. For that we look to policy makers like you and therefore support HB 810.””

    http://www.stjoenews.net/news/2009/mar/04/schaaf-targets-fertility-treatments/?local

    The bill as written is VERY simple, doesn’t go off on any tangents whatsoever like the Georgia bill:

    Be it enacted by the General Assembly of the state of Missouri, as follows:

    Section A. Chapter 334, RSMo, is amended by adding thereto one new section, to be known as section 334.350, to read as follows:

    334.350. When treating infertility, physicians within the state of Missouri shall not implant more embryos into a human than the current recommendations set forth by the American Society for Reproductive Medicine, or its successor.

    http://www.house.mo.gov/billtracking/bills091/biltxt/intro/HB0810I.htm

  • SarahW

    Regulate yourselves, or be regulated by the government.

    Kamrava has run an unethical practice on many levels. Yet he’s still defended or weakly criticized. He’s misrepresented his accreditation, his billing practices have been questioned, his success rates are poor and beyond corner-cutteing and sharp dealing, and he has put women and their children at grave risk of death and injury.

    Picking up the tab for high-order multiple pregnancy interventions in the medical system is falling to the state. Don’t be surprised when the government, seeing the harm and the lack of internal professional controls or reaction to bad practices, and not only that but ALSO creating huge monetary outlays for what would otherwise be avoidable care ( if regulated) is going to result in regulation.

    If Kamrava had been exposed, condemned, run out of any advisory “club” or professional association, at once and without reservation, there would be less backlash and rush to control what you won’t control.