WASHINGTON -- The nation's infertility clinics need increased scrutiny, including more research on the health of test-tube babies conceived with different techniques, bioethics advisers to President Bush will report Thursday.
They also are urging Congress to ban experimental procedures that might produce human-animal hybrids -- as well as conception "by any means other than the union of egg and sperm," essentially another call to prohibit reproductive cloning.
In-vitro fertilization is intensely popular. More than 1 million babies have been born with the help of different assisted-reproduction techniques since the birth of the first test-tube baby 25 years ago. With one in six couples thought to struggle with infertility, interest is growing.
Yet the field is subject to minimal regulation and surrounded by mystery about success rates of different techniques at different clinics, and even how many people try IVF at what cost.
The President's Council on Bioethics proposed what it called "a series of modest measures" designed to improve Americans' information about IVF choices and increase federal scrutiny of both IVF and other techniques increasingly used at the same time.
"This is really the first comprehensive overview of the state of assisted reproduction technologies as they stand on the threshold of being augmented by genetic screening and possibly genetic manipulation, sex selection and the like," Dr. Leon Kass, the council's chairman, said in an interview Tuesday. "We point out the absence of a lot of important knowledge."
The recommendations are significantly different from an initial draft that last year was condemned by fertility specialists and patient advocates, who objected to such recommendations as tracking the ultimate fate of every IVF-created embryo.
Those critics, including the American Society for Reproductive Medicine, praised the council for eliminating the controversial initial provisions.
But they were cautious about the need for legislation and its wording. For example, Pamela Madsen of the American Infertility Association worries that saying a child can be conceived only with an egg and sperm could inadvertently prohibit new IVF techniques that combine the DNA from an older mother's egg with supporting material from a younger donor egg.
"The council appears to have struck a more balanced tone," Madsen said. But when it comes to wording legislation, "we have to watch this very carefully."
The council, which previously has issued reports calling for curbs on cloning, recently made headlines when critics blasted the replacement of a prominent scientist who opposed Bush's restrictions on embryonic stem-cell research. Its members remain ideologically divided, and Kass stressed that the new report includes only recommendations that all could agree to.
Among them:
•The government should fund studies to monitor the long-term health of IVF babies, and health effects of related techniques such as genetic screening that require removal of cells from the tiny days-old embryo. While there aren't huge health concerns, there are some reports of slightly higher birth-defect rates with certain IVF techniques.
•Congress should ban the transfer of a human embryo to a woman's uterus for any purpose other than to produce a live-born child; attempts to conceive "by any means other than the union of egg and sperm;" production of human-animal hybrids or the transfer, for any purpose, of a human embryo into an animal's womb.
•Congress should limit scientific research on human embryos to no more than 10 to 14 days after fertilization, a time frame similar to one Britain mandates. Experts say such research usually involves even younger embryos.
•The government should require better infertility clinic reporting of the frequency of use of different IVF procedures, genetic embryo screening and gender selection; and average prices, including the total cost of the multiple attempts usually required for a successful pregnancy.
Each IVF attempt can cost thousands of dollars; insurance rarely pays. A current government database provides limited information about clinic success rates that are self-reported.
