Hope Is Alive

Science Beyond Appearances
Prenatal life, between techniques of in vitro fertilization and sincere observation of the data. An interview with Carlo Bellieni, neonatologist at the Siena Hospital

edited by Giampaolo Cerri

Everyone talks about it, and without much modesty. Everybody weighs in on in vitro fertilization, pre-implantation diagnosis, and embryos as if they were talking on Monday about Sunday’s football games’ disqualified goals or coaching errors. One, instead, who speaks with competence is 42-year-old Carlo Bellieni, a neonatologist at the Siena Hospital and member of the European Society of Pediatric Research. At the hospital, Bellieni helps bring to the light children for whom there seemed to be no hope, some weighing only one pound, in the fifth month of gestation. As a researcher, he is the author of studies on prenatal life.

Doctor, what strikes you most about this controversy on the law governing assisted conception?
The insistence on only the strictly moral aspects, which certainly is important, but which doesn’t consider whether the techniques are truly safe; in fact, it takes for granted that they are.

Aren’t they?
The scientific literature speaks of above-average risk of cerebral damage, malformations, and low birth-weight related to these techniques. And various scholars have shown that the damage is tied not only to the fact that in vitro fertilization “produces” numerous twins. Even in the case of a single implant, the risk remains high.

Why isn’t this spoken of?

Because these discussions rarely start out from observation of the data. One journalist wrote the provocative title, “Is it a sin to want a healthy child?” Well, it’s precisely this combination of the idea of “want” and the word “child” that makes people myopic and generates error. A child isn’t a possession. Otherwise, parents become “makers,” and this generates the anxiety of not succeeding in “producing” or “producing well.”
This anxiety generates excesses that are dangerous for health, like choosing to generate the first child at an age that is very far from the physiological one. But this is not the only concern.

What else?

Every year, in Italy, about 100,000 amniocenteses are performed. And since this technique has a mortality risk of about one in every 200 cases, every year we have to deal with 500 accidentally interrupted pregnancies in women with perfectly healthy fetuses. What other medical practice would tolerate a similar rate of grave side effects?

What can you tell us about “pre-implant diagnosis”?

It involves removing a cell from an embryo, to see whether or not it is healthy, or, perhaps, to identify the sex for selective purposes. To date we don’t know a lot about the effects of this cellular removal. Shouldn’t we apply the principle of caution? Even the so-called ICSI, with insertion of the whole spermatozoid into the ovum, piercing its wall, appears not to be free of dangers. In France, Claire Brisset, a laicist, the Parliament spokesperson for children, has requested the suspension of this practice, because there is the suspicion of deleterious effects on the child to be born.

There are those who say that the embryo is not a person…

Only because it’s so tiny! But science serves precisely for seeing beyond appearances. A man’s life begins at the moment of fusion of the chromosomal patrimonies of the two cells of his parents. From that point, a process begins that makes no qualitative leap. The embryo, just like the newborn baby, or the old man, is nothing other than a different form of the same person.