•

Dr. Hutton checks a patient and the baby.

this a tremendous mitzvah. But not
all will agree?'
One who does not agree is Rabbi
Meilech Silberberg of the Bais
Chabad of West Bloomfield. Rabbi
Silberberg has been studying the
issue of reproduction and Jewish
ethics.
"The Ibrah does not ask us to go
through heroic means to fulfill our
mission as Jews," Rabbi Silberberg
said. "At this point, many authorities
in Jewish law are reluctant to give
their okay because the process is still
experimental.
"When a cell is fertilized you're
dealing with life, and Jewish law does
not allow us to put life in a hazardous

Dr. David Brinton, a physician at the
center at Beaumont Hospital.
When a couple comes to the clinic,
they are informed of the time and
money involved in the process. Each
cycle costs $4,000 — the same fee
charged at Hutzel — and the success
rate is only one out of four.
"It's draining both financially and
emotionally;' Dr. Brinton said. "Most
people come to us after years of being
discouraged somewhere else."
Once a couple is approved for IVF,
they are put through a battery of tests
including checks for active diseases
such as hepatitis, syphilis and AIDS.
The woman is brought in on the third
day of her menstrual cycle and given
medication to stimulate the release of
more than one egg.
"The bottom line is that patients
want to take home a baby," Dr. Brin-
ton said. "Most women produce only
one egg, and that's not much room for
error. This way, you spread the risk
and maximize the chance for
pregnancy?'
"Sometimes it took two or three
position. However, 10 to 20 years from hours, every day for two or three
now, when the process is perfected, weeks;' Susan Grey recalled of the
authorities may change their minds?' procedure. "Each day there was an in-
Rabbi Nelson is not surprised that jection, ultrasound and blood drawn.
a couple like the Greys would try IVF But if they had told me to do hand-
without religious counseling.
stands down Middlebelt, I probably
"A couple in that position would have done it at that point; I was
wouldn't come to me for advice," Rab- so desperate."
bi Nelson said. "They will have
A final injection triggers ovula-
already made their decision and
tion
and produces maturation of the
wouldn't feel compelled to get their
rabbi's opinion. They are not being eggs about 36 hours later, Dr. Brinton
motivated by Jewish law, but by their said.
Timing is crucial. The eggs must
family and personal needs."
rad and Susan Grey's desire be harvested before they are released
for a child brought them to or retrieval becomes impossible.
the IVF clinic at Beaumont. It When IVF was first attempted, a
is a place of last resort, according to surgical procedure, performed under

B

The IVF clinic is
a place of last
resort, and hope,
for infertile couples.

anesthesia, was necessary to retrieve
the eggs. Now, doctors guided by an
ultrasonic picture use a needle to
reach the eggs. This process- is less ex-
pensive, safer and recovery is more
rapid.
Once the eggs are out, they are
checked and placed in a tissue culture
dish along with the husband's sperm.
The dish is then put into an incubator.
An average of six eggs are
harvested from each patient. Usual-
ly, not all are mature enough, and the
best eggs are selected to fertilize. Of
the eggs chosen, some 70 percent will
fertilize.
Three days after the eggs are fer-
tilized, the embryos are replaced in
the woman's uterus. The average
number replaced are three. Usually,
if pregnancy takes place, only one em-
bryo survives. In the Greys' case five
eggs were fertilized, and three were
transplanted back into Susan's
uterus.
Not all patients make it as far as
the embryo transfer. "All the way
through, there are day-to-day goals
and hurdles;' Dr. Brinton said.
"Something can go wrong at any

Cutting Edge Of Technology

I

11.

n vitro fertilization meant a
miracle for Brad and Susan Grey.
Without the procedure, they
would not have their son Steven.
Many Jewish authorities- say the
method they used, taking an egg
from Susan and combining it with
Brad's sperm, is permissible under
Halachah. But there are other
issues connected to IVF that concern
those who may otherwise approve.
The possibility of fertilizing too
many eggs and ending up with more
embryos than can be safely carried
by the mother is one major problem.
When Michele and Raymond
L'Esperance ended up with seven
viable embryos, they insisted that
all be implanted, resulting in the
birth of quintuplets.
Although they advise against
replacing so many embryos into the
mother's uterus, doctors do not have

the final say in the situation, said
Dr. David Brinton, a member of the '
IVF team at William Beaumont
Hospital.
"We ask the couple in advance
to think about how many eggs they
want fertilized," Dr. Brinton said.
"Hopefully, we don't fertilize more
than what the patient is willing to
take back. But they are not our em-
bryos. They belong to the couple?'
An option for the mother who
finds herself carrying more babies
than can be safely delivered is selec-
tive termination. In this process,
doctors decide which fetuses are the
weakest and remove them from the
uterus.
Dr. Mark Evans of Wayne State
University is one of the few physi-
cians in the country to have perform-
ed the procedure. One case involved
reducing octuplets, of which there is

no recorded history of live birth, to
twins, who were born healthy.
Selective termination is not the
same as abortion," Dr. Evans said.
"Abortion ends a pregnancy. Selec-
tive termination takes someone who
wishes to have children and allows
her to do so."
Dr. Evans said he would perform
selective termination only in cases
of medical necessity.
"There are a lot of ethical pro-
blems with it;' he said. "There has
to be a legitimate medical reason for
selective termination. We would not
do twins because a mother felt like
carrying only one. We would not
touch that."
Dr. Fred Rosner, author of
Modern Medicine and Jewish
Ethics, believes that when utilized
as described by Dr. Evans, Judaism
permits selective termination.

"The question would be are you
allowed to go from eight babies to
three or four babies when, if you do
nothing, you would end up with zero
chance of success;' Dr. Rosner said.
"In such a case, it should be allow-
ed."
Selective termination may no
longer be an issue in relation to IVF.
Cryopreservation offers a new
technology that allows fertilized
eggs not implanted in the mother to
be frozen for use in the future.
Of the two area hospitals that
have IVF programs, Hutzel has
cryopreservation in place, and Beau-
mont has received approval and
should have the equipment
operating shortly.
In the future, the issue of selec-
tive termination will arise more
often when the patient has been
given the fertility drug Pergonal,

THE DETROIT JEWISH NEWS

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