ART in America | The Nation


ART in America

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Since Louise Brown, the first "test-tube baby," was born in 1978, more than 3 million children have been conceived by IVF worldwide. But the technology has advanced faster than the ethical and political consensus. This gap is especially conspicuous in the United States. Due to our peculiar abortion politics and free-market fetishism, the fertility industry--widely known among doctors and bioethicists as the Wild West of medicine--operates with virtually no government oversight.

About the Author

Rebecca Tuhus-Dubrow
Rebecca Tuhus-Dubrow is a columnist for Next City, an urban affairs website.

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Among the roughly 15 percent of Americans who have struggled with infertility is first-time author Beth Kohl. As a married woman in her late 20s, she was diagnosed with Polycystic Ovarian Disorder, which prevented her from conceiving the low-tech way. Embryo Culture is a memoir of her quest for pregnancy via IVF. (She lives in Illinois, where, unusually for the United States, a state mandate requires insurers to cover four rounds of that treatment.)

Unfortunately, Kohl's book is often marred by clunky prose--modifiers such as "spoony-looking" and "nonquiet"--as well as a scattered narrative. But it offers a serviceable introduction to the infertility scene. She covers an IVF cycle in detail: countless hours in the waiting room of the fertility clinic; daily self-administered injections of hormones; bloated discomfort and teary mood swings. Her husband, Gary, "worried about me, about us. He wanted to be of help, but I was becoming too much for him to handle. I was becoming too much for Freud or FEMA to handle." The ordeal is punctuated by moments of encouragement. When an ultrasonographer monitors the drug-induced follicles in her uterus, she thinks, with a touching desire for normality, "I was getting ultrasounds, just like any old pregnant woman."

Kohl's aim is not only autobiography; she wants to explore the ethical territory of ART. While she gamely acknowledges the standard concerns, however, her probing is perfunctory. When Gary suggests considering adoption, she replies, "Trust me.... I just know that this is the right thing for me. For us." This assertion of intuition is always the gist of her answer. In her foray into religious questions, she wonders "if I should put my faith in an all-knowing yet benevolent God who shall, at an unspecified miraculous point in the future, deliver a son or daughter unto me, patient member of His flock." She then confides her uneasiness at the prospect of spending more money to create a child than most parents spend to raise one. Her response to these worries: "But a force, an inner drive, is pushing me toward IVF." Ultimately, she fails to do the work of grappling with her reservations and spelling out why they are insufficient to override her decision.

Perhaps Kohl embodies a common attitude--the deep irrational drive to reproduce, in the face of which qualms are defenseless. But she is more a symptom of this tendency than a diagnostician. Two other recent books on the subject do a better job of analyzing the intense hunger for parenthood, as well as the fertility industry's manipulations of it. In Waiting for Daisy, Peggy Orenstein describes the incremental steps she took down a path of treatments she'd sworn she'd never try, such as egg donation, because, "What if this worked? What if it was the only way I could have a baby?" As Debora Spar argues in The Baby Business, this logic could lead to cloning: not out of an egomaniacal desire for self-replication but as a last recourse for patients who have tried everything else. It's not that infertility patients lack a moral compass, Spar suggests, but that they are vulnerable--which is an argument for policies setting certain legal limits.

Kohl was relatively lucky: although her first IVF cycle failed, she subsequently had two successful rounds. In the end, her story is quite conventional. The sole obstacle to a traditional family was her medical condition. She always expected to have kids, and when a problem arose, the remedy was available. Thanks to insurance coverage, she was spared the commercial excesses that are common in the United States. Hand-wringing notwithstanding, Kohl's essential feeling toward infertility treatment is gratitude. Her true worries center not on the ethics of assisted reproduction as a method but on its effects: whether IVF poses risks for the babies it brings to life. According to her research, it might. One study found an appreciably higher incidence of birth defects, especially heart problems and urinary- and genital-tract problems, in IVF children.

The apparent health of Kohl's three daughters, two of whom are twins, appears to reassure her on this point. Her agonizing then shifts to another question: what to do with the seven excess frozen embryos? Knowing and loving what the embryos could become, she is reluctant to discard them like so many leftovers. As the book ends, the embryos are still in the limbo of the freezer.

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