ART in America
Even prochoice patients tend to think of their frozen embryos as, in Liza Mundy's words, "souls on ice." In Everything Conceivable, Mundy reports that some 400,000 frozen embryos are in storage in the United States. They belong mostly to American parents but also to foreigners who come here for the "reproductive tourism" they enjoy under the United States' relaxed laws. These parents haven't yet made the "disposition decision": whether to discard the embryos, give them to a different couple, try for another pregnancy themselves or donate them to science (a daunting prospect, thanks to religious-right activism against embryo research). In Louisiana, such embryos have been designated "juridical persons" entitled to some legal rights--a source of alarm for Roe v. Wade supporters. And like other outgrowths of the fertility industry, this one has spawned its own lucrative niche: companies devoted to managing the ever-growing embryo inventories of clinics. The staffs of such companies sometimes find themselves offering impromptu counseling to patients, who typically receive little guidance from any other source.
Mundy, a staff writer for The Washington Post Magazine, thoroughly explores this and other aspects of ART in America, bringing to bear impressive reporting skills and a sharp analytical mind. With empathy and wit, she illuminates the ironies and absurdities, the tragedies and dilemmas, but also the joys, of assisted reproduction. As she observes, "Parenting has been divided up; it has been compartmentalized; it has been outsourced. At the same time it has been made deliciously possible."
Mundy writes accessibly about science, but the human dimension is at least as prominent in her work. Her accounts vividly dramatize the resolve of aspiring parents and the improvisatory pluck ART calls for. She also looks at the new types of relationships formed--between egg donors and intended mothers, sperm donors and their genetic children, gay parents and surrogates. Among her sources these relationships tend to be warm, as opposed to, say, the conflict between Sarah and Hagar or the infamous case of Baby M, whose biological mother, hired as a surrogate, fought a legal battle to keep her. Like Kohl, Mundy has a rosy view of the fundamental premise of ART; she scarcely addresses philosophical objections. But she is by no means blind to its practical problems. Her book identifies serious flaws in its implementation and makes persuasive policy recommendations for ameliorating them.
Mundy ventures beyond the confines of Kohl's first-person narrative, finding several patterns that diverge from that conventional scenario. We encounter women who deferred parenthood--due to career pressures, nonexistent or reluctant partners, or their own ambivalence. When they have at last prepared to start a family, some find that their fertility has diminished with age. (An increasing number of this group purchase eggs from younger donors for anywhere from about $5,000 to $50,000 a batch.) We also meet would-be moms who refuse to wait for Mr. Right--or, rather, seek him on the website of their local sperm bank instead of on Match.com. There are lesbians who employ the same method, while gay dad wannabes go to even greater lengths. Consider the case of Eric Ethington and Doug Okun. In an increasingly typical instance of "collaborative reproduction," this San Francisco couple hired a surrogate to carry twins, using the eggs of a second woman. The twins, while gestating in the same womb, were half-siblings; each egg had been deliberately fertilized by one of the men.
The beautiful twins and their devoted dads make a happy ending (except, of course, for those offended by the notion of plural fathers in a single family). But the surrogate who carried them, Ann Nelson, hemorrhaged dangerously from the delivery, necessitating a hysterectomy. Nelson, an environmental activist and counselor of pregnant teens, considers surrogacy part of "a grassroots thing. I thought, 'I could help these poor people.'" Married to a firefighter paramedic, she had given birth, via C-section, to four of her own children and one for a different gay couple. This time, although her doctor had cleared her to bear twins or triplets, she suffered from placenta accrete, a condition more likely after a previous C-section, in which the placenta is not fully expelled upon delivery. Nelson's generosity strains belief--she calls surrogacy her "passion" and claims she accepted payment only for her family's benefit--but others object to what they call the exploitation of women like her, who are paid about $20,000. As Mundy notes, such arrangements manage to elicit disapproval from both the left and the right. She quotes feminist bioethicist Barbara Katz Rothman: "Any man with a checkbook can buy a baby.... The pieces are all for sale."
The commercialization of ART is not just unseemly; it carries real risks. Clinics competing for clients want to boast high rates of successful pregnancies, leading them to transfer greater numbers of embryos to increase the chance that at least one will bloom into a baby. This tendency has contributed to an "epidemic" of multiple births in the United States. (There are other factors at play, too: fertility drugs alone tend to produce the quintuplets and sextuplets that make the evening news.) The twinning rate, Mundy reports, has risen by 300 percent in three decades, while the rate of births involving higher-order multiples has increased by about 1,000 percent. "If Nature thought it was appropriate for homo sapiens to have litters, Nature would not have selected against it," one doctor tells her. Multiple births have a much greater incidence of prematurity, low birth weight and other risks. Mundy describes the calamitous pregnancy of Tammy LaMantia, who, having told her IVF doctor she wanted no more than twins, conceived triplets, all of whom died at or before birth.
A significant chunk of Everything Conceivable is devoted to the phenomenon of multiples. When they survive, they are more likely to suffer from long-term disadvantages. One couple, unable to afford IVF, used fertility drugs and conceived quadruplets. Born at twenty-five weeks, three of the babies survived and stayed in the hospital for months; at age 3, one was preparing to learn Braille and walk with a cane. Even in the absence of such problems, parents are often utterly overwhelmed. "The theme of uncontrollable crying," Mundy notes dryly, "entered into many conversations I had with mothers raising high-order multiples."