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Everything Conceivable: How Assisted…

Everything Conceivable: How Assisted Reproduction Is Changing Our World

by Liza Mundy

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Mundy's chatty tone coexists beautifully with the huge amount of technical and emotional detail presented in this riveting book. Deals with every aspect of assisted reproduction, including some I never thought of- and I was an infertility patient for 8 years. Very topical and completely engrossing. ( )
  satyridae | Apr 5, 2013 |
This was a FANTASTIC work of non-fiction that I read last weekend. I highly recommend this book to anyone looking for a good read, but especially to those interested in ethics, medicine, and family issues. Mundy mostly focuses on ART in the US, but provides a number of points of comparison with the EU, mostly to illustrate how they regulate it much more closely than in the US.

Let me just preface my remarks by saying that I have some strong, probably irrational, feelings about assisted reproductive technologies (ART). My issue with ART has always been “why not just adopt?” I don't really have any right to have these opinions, having never had to deal with the problem of fertility or infertility, since I have no kids and am not trying to have kids. But I have them, nevertheless. The author, a Washington Post journalist, really tried to present all of the debates about an issue from multiple perspectives and succeeded, for the most part. Consequently, this was one of those rare works of non-fiction that actually made me a more compassionate, less dogmatic person.

Mundy's thesis is essentially that the proliferation of ART has radically changed what we mean when we say "reproductive rights." Mundy asks: "What does “choice” mean, given the range of medical and scientific procedures that are rather suddenly possible? If you support reproductive freedom, do you support everything now offered in the reproductive marketplace?" She argues that the choice to have a baby is often now more fraught with ethical dilemmas than the choice to not have a baby.

Mundy addresses the social changes brought about by IVF and other techniques. These technologies are changing how we define a family, “creating unprecedented kinship patterns, altering our sense of who parents are and what parents do.” Mundy talks to parents who wonder how they will relate to their child if it is only biologically related to one of them – if donor gametes replace only one parent’s gametes. Or if the child is biologically related to neither of them but is carried and delivered by the woman.

ART is also encouraging many women to further delay having children, which Mundy acknowledges is one of the most controversial aspects of ART to even mention. “Any effort to educate women—and men—about consequences of delayed childbearing is seen by some feminist leaders as tyrannical, oppressive, retrograde.” She cites those horrid, annoying biological clock ads that so offended many women, including me, as an example of this. Mundy argues – and I agree – that the parade of celebrities having children in their 40s (most of whom probably HAD to use some sort of ART but most of whom do not acknowledge this) clouds the issue for ordinary women and makes delaying childbearing seem natural. “Even now that “biological clock” has become a grim cliché, women can be forgiven for not knowing exactly when the alarm bell goes off.”

Mundy also addresses the medical issues – which has always been my biggest issue with ART. It seems to me – from a position of layman’s logic, rather than any hard facts – that some kinds of infertility should not be circumvented. That if two people are trying and failing to have a kid “naturally”, this is nature’s way of weeding out a genetic issue that should not be passed down. But “thanks to the new techniques, infertility itself is being passed from father to son. Heritable infertility sounds like a contradiction in terms, but now, thanks to science, it isn’t. Other genetic problems are being transmitted as well, and possibly magnified. Evolution is being thwarted.” Mundy points out that people have often been concerned that assisted reproductive technologies would allow the creation of “designer babies” who would grow up to be some sort of super race. She – and the scientists she interviews – argues that is it far more likely that these technologies are having the opposite impact on human genetic fitness.

ART are fueling a rise in multiple births, which – despite popular fetishization of them – are really quite dangerous, has led to an increase in the number of children with low-birth weight and other serious medical conditions. This, in turn, has placed an increasing strain on parents who now sometimes must care for multiple children of the same age who have one or more developmental disabilities.

What emerges, as Mundy interviews doctors, patients, surrogates, practitioners of ART, bioethicists, is a rather scary picture of a world that is essentially unregulated and that is practicing medicine without a solid understanding of the techniques being used. This is – in part – due to the long-standing ban on using human embryos in research. “This ban on embryo research meant that no federally funded experiments could be conducted on the safety or efficacy of IVF, even as the field itself was surging ahead, unfunded and unregulated.” Many of the AR techniques appear to have been invented by accident and the ban means that after a certain point, if scientists want to see if something works on humans, they have to implant the cells in women and see what happens. This was one of the scariest quotes in the book: ‘There are crucial territories of assisted reproduction that remain a mystery to science. “At a certain point, what you want to be able to do is to fertilize the egg and then study its development to make sure it’s okay,” Trimarchi told me. “The only alternative, eventually, is just to put it into a uterus and see what happens. This is pretty much what happens with every lab technique for IVF. You fool around in the lab as much as you can; you test it and observe it and inject markers, but what you cannot do is fertilize it to see how the embryo would develop. At a certain point—and the point comes pretty soon—you just have to jam it into the uterus and see what happens.” ART has essentially created an entire universe of experimental pregnancies and experimental children.

But this lack of regulation – the idea that anyone who can afford to pay can have a baby – has provided a way for “unconventional” couples to start families: gay men, lesbians, straight single women who are tired of waiting for a man to commit and decide to co-parent one or more children with another straight single female friend. “ART offered some people who want to have families a way to make an end run around the people who don’t want them to have one.” And that’s fantastic. But what’s curious is how the mainstream feminist movement kind of hates gay men using ART: ‘“Any man with a checkbook can buy a baby,” objected the bioethicist Barbara Katz Rothman, speaking at a 2003 conference convened by Planned Parenthood. “The pieces are all for sale.”’ The idea that women’s bodies – probably multiple women’s bodies: a pretty, highly-educated young woman to provide the eggs and a fecund, lower-income woman to gestate them – have become a commodity yet again is rather disturbing and further complicates the issue.

There is so much more in this book – the rights of children born through ART, the rights of gamete donors, the debates over what to do with frozen eggs or embryos – are they “children in waiting” or just tissue, but I’ve gone on for far too long.

I’ve focused mostly on the negative in my thoughts, but I think it is really important to point out that Mundy always humanizes these debates by bringing real people and real children into the story. The people she interviews have struggled to conceive and are truly thankful to the scientists, the donors, the surrogates, etc. that have allowed them to have a child. And although I don’t personally care, I do understand on some level that the desire to have a kid exists and is powerful. Still, I couldn’t help wondering – why not just adopt? Why endure dangerous pregnancies and experimental treatments and years of trying and failing and the associated expenses to give birth to a child that is not biologically yours? Why such effort to bring a child into this world when there are already children waiting for homes and families? So perhaps, upon reflection, I am not really much more compassionate….

Additional Related Reading
The Perfect Baby (Glenn McGee), Redesigning Humans (Gregory Stock), Our Posthuman Future (Francis Fukuyama), The Girls Who Went Away: The Hidden History of Women Who Surrendered Children for Adoption in the Decades Before Roe v. Wade (Ann Fessler), The Empty Cradle: Infertility in America from Colonial Times to the Present (Margaret Marsh and Wanda Ronner), The Genius Factory: The Curious History of the Nobel Prize Sperm Bank (David Plotz), Merchants of Immortality (author unknown) ( )
1 vote fannyprice | May 9, 2009 |
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Skyrocketing infertility rates and the accompanying explosion in reproductive technology are revolutionizing the American family and changing the way we think about parenthood, childbirth, and life itself. In this work of investigative reporting, journalist Mundy captures the human narratives, as well as the science, behind what is today a controversial, multibillion-dollar industry, and examines how the huge social experiment that is assisted reproduction is transforming our most basic relationships and even our destiny as a species.--From publisher description.… (more)

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