When bundle of joy turn to sorrow

Source: The Sunday Times 13 Feb 2011

Childless couples can seek medical help or turn to adoption, but be aware of the risks 

I have a 32-year-old family friend who has been married for more than six years but had not been able to conceive. So she turned to Assisted Reproduction Technology (ART) treatments at one of Singapore’s public hospitals.  Since September 2008, for couples who have difficulties conceiving, the Government has co-funded 50 per cent of the cost of ART, up to a maximum of $3,000 per course. My friend went for three courses, the maximum the Government will co-fund, stoically putting up with the discomfort. She did not conceive.

That is not surprising as the average success rate of ART is just 30 per cent – and the rate falls as the woman grows older. What is more, if my friend had conceived by ART, there would have been a 20 per cent risk of multiple pregnancies – that is, having more than one baby in the uterus. This risk is also age dependent, being higher in younger women. Multiple pregnancies have an increased risk of pre-maturity, and premature babies are prone to a variety of permanent handicaps.

There are rules in Singapore to reduce the risk of multiple pregnancies:

  • Singaporeans and permanent residents must be under 40 years old to qualify for co-funding. They are allowed to transfer only two embryos each time.
  • Patients who are not receiving co-funding are allowed to transfer up to three embryos, regardless of their age.
  • If patients are above 35 and have failed twice or more, they are allowed to have four embryos implanted. This improves the chance of delivering a living baby but also increases the risk of multiple pregnancies and thus premature babies.

I was not happy when the Government announced it would co-fund ART because of its high cost, relatively low rate of success and the possibility of having a handicapped child. The rules governing ART in cases that do not require government funding are lax. The number of handicapped children as a result of ART is not public. But I am also aware of the anguish of women who desperately want a child but fail to conceive. It is easy to reduce the risk of multiple pregnancies: Transfer only one fertilised ovum each time, and try again if that fails to produce a living baby.

This is already being practised in Denmark, where 6 per cent of children in primary school were conceived by ART. More courses of ART will obviously cost more. But the cost of handicapped citizens who need lifelong care certainly outweighs the cost of multiple courses of ART.

My friend, having failed three courses of ART, turned to adoption. She found a Chinese baby girl from Malaysia who was checked by a doctor and pronounced normal. Now my friend is a happy mother. When I spoke to her on the phone, and questioned her, she called out to her husband, “Daddy”, for the answer. Within three months of adopting her baby, she became pregnant naturally. Needless to say, she and her husband are delighted and so are my father and I.

In treating infertility, both husband and wife should go for a medical checkup. Some problems are easy to overcome, others may be insurmountable. In the latter case, ART may be tried. If that too fails, adoption is an option. But assessing a baby for future intelligence or even hearing ability is not easy. Early in life, babies can only sleep, wake and cry. As they grow older, they begin to focus their eyes on objects, especially human faces, smile responsively, reach out for objects, hold their heads up steadily by three months of age, sit steadily by eight months, and walk a few steps and say a few words and know their meaning at the age of one year. By 13 months, they should be able to walk without support.

The milestones indicating cognitive function – such as recognizing and smiling at a familiar face, or realizing that the person approaching is unfamiliar and responding by crying – are subtle. All in all, even a careful assessment of a baby cannot tell us how intelligent the child will be at school age. Even hearing impairment may be missed because the baby may hear low frequency sounds but not high frequency sounds, which is what we depend on to distinguish speech sounds. I have seen a significant number of adopted babies who turn out sometime after adoption to be deaf, mentally retarded, suffer from cerebral palsy or have congenital cardiac and other malformations. It is possible that a parent willing to give up a baby for adoption – especially in Singapore – does so because there is something wrong with the parent or the baby or both.

I know of a couple who adopted from a Chinese woman. They underwrote the entire cost of her pregnancy and delivery and received an apparently healthy Chinese baby girl. The baby subsequently was found to have a hole in her heart, but that has not adversely affected her health. A few years later, the couple wanted another baby, and went back to the same woman. Again she became pregnant, the baby grew to term, and the couple happily carried back an apparently normal baby boy. I wondered how this woman was able to produce babies on demand. The couple had no information on who the father was. At the age of six, the boy suddenly developed severe seizures which have been impossible to control. Worse still, over the next few years, his intellectual ability dropped. Now he is a handsome tall teenager, with an IQ less than that of a child in kindergarten, and which continues to drop. His temperament also changed. He has become aggressive, even attacking his parents and sister. He has ruined the lives of his adoptive parents and sister. I advised the parents to institutionalise him as they could afford to, but they were too attached to him to do so. I cannot pinpoint what is the underlying disease that is causing his brain to change so dramatically.

But I have a suspicion it is genetic in origin, probably autosomal recessive, meaning it shows up only if the patient has two of the bad genes. Autosomal recessive diseases are more likely to occur if the parents are related. I wonder whether he is the product of incest. Adoption carries a risk of adopting a handicapped baby. The best chance of a normal baby is to find one whose parents are known to you, and who are willing to give up the baby because they already have too many children. Even so, if the baby is a Chinese boy, think long and hard before adopting him. Chinese are more than willing to give away baby girls, but not baby boys. Couples who have difficulty conceiving have some options, but none is risk-free.

So dear reader beware if you are trying hard for a baby. The baby may ruin your life.

The writer is director of the National Neuroscience Institute.