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Everything Conceivable: How Assisted Reproduction Is Changing Men, Women, and the World

Everything Conceivable: How Assisted Reproduction Is Changing Men, Women, and the World

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by Liza Mundy

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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 riveting work of investigative reporting, Liza Mundy, an award-winning journalist for The Washington Post, captures the human narratives, as well as


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 riveting work of investigative reporting, Liza Mundy, an award-winning journalist for The Washington Post, 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.

Based on in-depth reporting from across the nation and around the world, using riveting anecdotal material from doctors, families, and children—many of them now adults—conceived through in vitro fertilization, Mundy looks at the phenomena created by assisted reproduction and their ramifications. Never before in the history of humankind has it been possible for a woman to give birth to an infant who is genetically unrelated to her. Never before has it been possible for a woman to be the genetic parent of children to whom she has not given birth. Never before has the issue of choice had such kaleidoscopic implications. If you support reproductive freedom, does that mean you support everything being offered in the reproductive marketplace? Thawing frozen embryos and letting them expire? Selecting the sex of your baby? Conceiving triplets and “reducing” the pregnancy down to twins? Everything Conceivable explores the personal impact on individuals using assisted reproduction to conceive, and the moral, ethical, and pragmatic decisions they make on their journey to parenthood. It looks at the vast social consequences: for hospital neonatal wards, for family structure, for schools, for our notion of genetic relatedness and whether it matters, for adoption; for our nation as a whole, and how we think about the earliest human life-forms. The book explores questions of social justice: the ethics of buying or borrowing some part of the reproductive process, as with egg donation and surrogacy. It looks at entirely new family structures being created by families who have conceived using sperm donors, so that children may have half-siblings around the country with whom they are, or are not, in contact. And it looks toward the future, to the impact today’s technology may have on coming generations.

Fascinating, commanding, keenly observed and reported, rich in personal drama as well as in the science of evolution and reproduction, Liza Mundy’s Everything Conceivable is a groundbreaking consideration of the changes sweeping through our culture and the world.

Editorial Reviews

Polly Morrice
…much of the information in Everything Conceivable is fascinating—and scary. Who knew that the drop in teenage pregnancies may have less to do with effective sex education than with unexplained fertility declines in young men? And the book gains considerable depth from Mundy's reportorial urge to dig into all aspects of a story.
—The New York Times
Publishers Weekly
A revolution is taking place and it's being driven by the most fundamental of all human urges-the desire to reproduce. This revolution is the subject of Mundy's utterly fascinating book on assisted reproduction. The breadth and thoroughness of Mundy's investigation makes it nearly impossible to come away without having your opinions challenged if not changed altogether. Mundy, a feature writer for the Washington Post, combines a science reporter's objectivity with a mother's understanding, and she delivers her emotionally charged and often scientifically complex material in clear, bright and eminently readable prose. Mundy's research starts with the facts: 80 million people worldwide suffer from infertility; 500,000 frozen embryos exist in America alone; and fertility drugs are a $3-billion a year business. From there she interviews mothers, fathers, infertility doctors, surrogate mothers, egg donors, sperm donors and adult children conceived through surrogacy and in vitro fertilization. The picture that emerges is one of a social experiment so new and untested-legally, medically, ethically and socially-that it behooves us all to be as informed as possible. There couldn't be a better starting point than this book. 75,000 first printing. (Apr. 24) Copyright 2007 Reed Business Information.
Library Journal

Is assisted reproduction a miracle for childless parents, or a morally distasteful industry that earns $3 billion a year for drug and medical device companies? It appears to be both in Washington Post Magazinefeature writer Mundy's account of the technological innovations that have allowed us to "cure" infertility. She interviews heartbroken would-be parents and those who worry about the social ramifications of generations of children who don't know who their biological parents are. Moreover, she explores the far-reaching effects of such medical technologies as fertility drugs, in vitro fertilization, sperm and egg donation, surrogacy, and genetic testing. More and more children have older parents; multiples (twins, triplets) are being born with greater frequency. What should be done with "excess" frozen human embryos? Should the industry of birth be better regulated, or is that allowing the government into the bedroom? Fans of Jodi Picoult's fictional account of the hazards of designer reproduction, My Sister's Keeper, may be interested in these real-life moral dilemmas. Recommended for public and academic libraries. [See Prepub Alert, LJ12/06.]
—Elizabeth Williams

Kirkus Reviews
Washington Post Magazine feature writer Mundy examines the cultural impact of reproduction technologies through the stories of individual men and women and the people helping them create the babies they have been unable to conceive naturally. The author puts the present status of assisted reproduction in perspective with a brief history of the science behind the new technologies and some revealing statistics about the number of people and dollars involved. While sperm banks have been around for decades, it was the discovery that eggs could be retrieved vaginally that sparked the rapid growth in fertility clinics. Childless wives and heterosexual women whose biological clocks are ticking are not the only clients seeking help at these centers. Demonstrating how the traditional family unit is being changed by reproductive technology, Mundy includes in her cast of characters a gay male couple who acquired twin daughters, using both an egg donor and a surrogate mother, and bisexual or lesbian women who turn to sperm banks to conceive their own babies, many of them having struck out with adoption agencies. Fertility is big business, generating three billion dollars in annual revenues, and it's largely unregulated in America, the author notes. She identifies many medical and moral issues that must be addressed. The sharp rise in multiple births poses dangers to the health of both mother and babies. Donors' rights to privacy can conflict with their progeny's desire for information and/or a relationship. Hundreds of thousands of unused frozen embryos currently have an ambiguous legal status. Male IVF babies appear to have higher rates of physical defects. Many professionals are troubled by the useof reproduction technology to select a child's sex. A stimulating, illuminating look at the booming baby-making business and the knotty questions it raises. First printing of 75,000

Product Details

Knopf Doubleday Publishing Group
Publication date:
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6.57(w) x 9.54(h) x 1.39(d)

Read an Excerpt

Chapter One: The New Reproductive Landscape

"Eye Hoop They All Have Babies"

Every industrial convention has its own eccentric flavor, and the 2005 gathering of the American Society for Reproductive Medicine was no exception. That year the annual meeting of American fertility doctors was held in conjunction with the annual meeting of Canadian fertility doctors; the massive conference, which took place in Montreal over five days in October, was attended by emissaries from North America as well as from England, France, Europe, Japan, China, Africa, India, Asia, Israel: anywhere that humans live and wish, as humans usually do, to be fruitful and multiply. So numerous were the babymakers that airport immigration was bogged down and the city's downtown was transformed; the hospitality rooms of the Fairmont Queen Elizabeth were booked for events like "Cocktails with the Middle East Fertility Society." Converging on the downtown convention center, reproductive endocrinologists, embryologists, andrologists, urologists, therapists, and psychologists attended courses in packed seminar rooms. But the real action was in the cavernous exhibition hall, where an array of twenty-first century conception technology was on display, rivaling anything unveiled by the military-industrial complex.

At the entrance to the hall, unavoidable to all who entered, was a booth maintained by Scandinavian Cryobank, a subsidiary of Cryos, one of the world's largest sperm banks. As one might expect, Scandinavian Cryobank specializes in Scandinavian sperm donors: specifically Danish donors enrolled in graduate programs at "major Scandinavian universities," men so mentally and physically superior that they passed "some of the most exacting genetic testing in the industry." Deliberately recalling another era when northern European men inflicted their genes on women of other nations, sales staff were distributing wry little buttons announcing "Congratulations! It's a Viking!" underneath which was a photo of a very blond, very sturdy-looking baby. A banner advertisement noted that the company caters to gay and straight, black and white, male and female. Under the happy we-are-the-world tableau of patients, it added that it serves patients "as energetically as our ancestors once grabbed countries."

Not far away, one of the other principal players in the realm of international genetic redistribution, Los Angeles-based California Cryobank, was advertising its sperm bank by means of an indoor hockey game. It was not clear what hockey was supposed to symbolize. Maybe it was an homage to Canada. Maybe it was supposed to underscore the importance, in this crowd, of being deft and competent enough to shoot a small, frenetically moving object into a stationary target. No matter: setting down the espressos and Belgian chocolates that were being freely dispensed, the medical men and women lined up to whack away at the puck, cheering whenever a colleague, you know, scored.

Nearby, Cryogenic Laboratories was hoping to edge out this competition by offering a service called Lifetime Photos. For a price, clients can obtain photos of a sperm donor, from infancy to adulthood, and thereby see how their child's own appearance might unfold if they select that donor's genetic product to conceive their baby.

The conference was dominated and underwritten by the pharmaceutical industry. Standing everywhere were cheerful representatives from Ferring Pharmaceuticals, Organon USA, Serono Inc., Wyeth Pharmaceuticals, and others, who together do an estimated $3 billion a year business selling the drugs and medical devices that are an integral part of childbearing through assisted reproduction technology (ART). By now, ART comprises a spectrum of procedures of varying levels of sophistication. They include the fertility drugs that control and stimulate ovaries to produce more eggs; artificial insemination, or the injection of washed and treated sperm directly into a woman's cervix or uterus; in vitro fertilization, the more high-tech laboratory procedure in which sperm and egg are removed from the body and brought together in a culture dish; and a host of speedily developing related technologies such as genetic testing of embryos.

There were booths operated by the companies that make products to facilitate these procedures—sometimes all of them at once—there were booths operated by the companies that make media (Life Global: The ART Media Company!) for culturing embryos; flexible catheters for removing eggs and transferring embryos into uteruses; and long, terrifying surgical scissors for—one didn't want to think what. There were companies that make specialized petri dishes (test-tube babies are never made in test tubes); incubators for keeping developing embryos warm; freezers for keeping frozen embryos cold. There were software programs with names like BabySentry, for keeping track of the contents of all those dishes and incubators and avoiding that most dreaded of laboratory mishaps: the wrong embryo going into, oops, the wrong uterus.

There were microscopes with joysticks controlling hollow needles that enable lab technicians to suck a single cell out of a three-day-old, eight-cell human embryo. That cell can then be fixed onto a slide and sent off to a lab so that its chromosomes might be tested for any one of almost a thousand genetic diseases. After the testing is done, embryos that carry a genetic disease can be discarded and only unaffected embryos used, with the hope that these will grow into healthy children. "Cystic Fibrosis Testing: There is a difference!" said the advertisement for one of the labs that weeds out defective embryos. "RMA Genetics: Technology for New Beginnings, Offering Power through Knowledge!" said another.

Nearby was a booth run by the Genetics and IVF Institute, a Fairfax, Virginia-based fertility clinic that was distributing pink or blue M&Ms, scooped into urine specimen cups, as a way of advertising a patented sperm-sorting technique called Microsort(r), which offers parents a way to select the sex of their baby.

The hall was an enormous rectangle. The biggest and most profitable entities were located prominently at the front, where they lured passersby with everything from sperm-shaped pens to ice cream pellets (a favorite way to advertise any technology involving cryopreservation). But equally interesting were the smaller outfits located toward the back of the hall, jostling to attract browsers to their bunting-covered folding tables, and often not prosperous enough to be offering freebies. There were support groups for women with endometriosis and polycystic ovarian syndrome. There were general advocacy groups for the infertile. There were cutting-edge groups dedicated to helping women find ways to delay childbearing and still bear children. One of these is Fertile Hope, run by a cancer survivor named Lindsay Nohr Beck, whose mission is to help cancer patients preserve their fertility during treatment. One of Beck's mentors is a businesswoman named Christy Jones, a former dot-commer who now runs a for-profit company called Extend Fertility, which offers career women the chance to freeze their eggs with the hope of becoming pregnant later, when relationships and/or work schedules permit.

Since egg freezing is in its infancy, however, what the modern woman often needs to conceive—if things have been left too long—are the eggs of a younger woman. Snuggled against the back wall were egg-donation agencies, none of them as large or gleaming as the front-of-the-room sperm banks, since it is not—yet—possible to stockpile human eggs in the mass-market, quasi-industrial way in which human sperm can be stored and shipped. Egg-donation agencies are a sort of cross between a real estate brokerage and a dating service: for a fee, they connect infertile patients with live, real-time egg donors, and manage what is, legally, a property transfer. Egg donation is an invasive, time-consuming medical procedure, requiring physical risk on the donor's part. Which is not to say you can't build up a decent inventory: all of the banks were offering databases of winsome yet wholesome, sexy yet motherly young women, with profiles that detailed their height, weight, SAT scores, and lifetime goals. You could see how hard the agencies had to work to recruit them. One booth belonged to Global ART, an international outfit with a branch in Richmond, Virginia, that procures egg donors from Romania. Circumventing those aspects of reproductive technology (like egg freezing) that do not work reliably yet, and taking advantage of those (like sperm freezing) that do, Global ART rather ingeniously conducts transactions by shipping a prospective father's frozen sperm to the lab in Bucharest, where it is thawed and used to fertilize the eggs of a Romanian donor. The resulting human embryos—half-American, half-Romanian—are then frozen and shipped back to the United States, where they are thawed and transferred into the prospective American mother, all for much, much cheaper than can be done with a U.S. donor, in part because Romanian egg donors are paid so much less than U.S. donors are. And you don't even need a passport for the embryos!

Also there was an L.A.-based agency, Fertility Futures International, which does a brisk trade in providing egg donors to gay men, another rapidly growing customer base. Surrogacy agencies were also there, catering to straight and gay alike.

There were also, of course, lawyers. Not so long ago, running a "family-building" legal practice meant handling adoptions, foreign and domestic. Increasingly, attorneys are called upon to negotiate scenarios that involve a transfer of sperm or egg—part of the babymaking process—rather than the entire baby. "Half adoptions" you could call them: adoption of half the child's genetic makeup.

And then were the companies that have evolved to deal with the problematic presence of the frozen embryo. Though it's still pretty hard to freeze and successfully thaw human eggs, it is strangely easy to freeze and thaw human embryos. Embryos don't get freezer burn. Unlike, say, hamburgers, human embryos can be frozen, and thawed, and frozen, and thawed again, and used. There are about a half-million frozen embryos in storage in the United States alone. These embryos present terrible moral difficulties for patients, and for doctors, who for fear of lawsuits are reluctant to destroy or thaw frozen embryos, even when patients divorce or move or disappear or otherwise fail to pay "storage fees." Enter ReproTech: standing by one display was a man named Russell Bierbaum, who operates a company that for a fee will take over a practice's frozen embryos, and also is willing, collection-agency style, to track down delinquent patients and persuade them to make what has come to be known as the "disposition decision."

"There are ways of getting people to respond," said the affable Bierbaum, who declined, for proprietary reasons, to reveal how he locates patients and encourages them to decide what to do with their frozen embryos. He did not seem to recognize the menacing significance of any phrase beginning "There are ways." Keeping things upbeat, Bierbaum would say only that "the Internet is a wonderful tool for finding people." Also nearby was the National Embryo Donation Center, one of a number of brokerages that help one couple "donate" surplus human embryos to another. Really good quality embryo batches are sometimes passed among three or four families before they get all used up, or born, or both.

Standing in yet another cubicle was—could it be true?—Professor Robert Edwards, the Bob Edwards, the British scientist who with his partner, the gynecological surgeon Patrick Steptoe, enabled the birth of the first IVF child in Oldham, England, in 1978. The very man who set this elaborate reproductive machinery into motion. Edwards was wearing a tan suit jacket, pale gray slacks that did not match the coat, and beige slip-on shoes. He was grayer but otherwise little changed from the photos that show him and Steptoe celebrating the birth of the infant Louise Joy Brown almost three decades ago. There was the same voluminous, side-parted haircut, the same big rectangular glasses, the same stout and genial look, more like a satisfied fly fisherman, or a Rotarian, than the scientific visionary he is.

Robert Edwards, who is probably the most knowledgeable embryologist in the world, now edits a Web publication called Reproductive BioMedicine Online, a British-based journal that publishes scientific papers and essays on the many ethical issues raised by the field he helped create. He was standing in the RBM Online cubicle for the purpose of saying hello to a long line of visitors, and, when possible, to sign them up as subscribers. Edwards was also, it emerged, brooding. I stood in line with the vague hope of asking whether back in 1978 he had had any idea of the array of services and situations that would arise from his work. I knew the answer in part: Edwards has a reputation for having been remarkably prescient. He had an early fascination with genetics and is widely credited with having foreseen that science someday would be able not only to produce embryos but to diagnose their genetic makeup before placing them in the womb.

Still, it would be interesting to hear what the man himself had to say.

As it turned out, the man had a lot to say and not much time to say it: Edwards, who was raised in the north of England, speaks in a wonderfully non-establishment, workingman's burr. He had been standing in the RBM Online cubicle for two days and needed to leave to catch a plane. An assistant was meaningfully clasping a rolling suitcase. Nevertheless, almost before I had finished my question Edwards began by commenting on a speech given by a prominent stem-cell scientist. "Did you hear the talk this morning?" he wanted to know, smoldering over an assertion that embryonic stem-cell research—one of the most promising, and controversial, realms of modern medicine—was an unforeseen consequence of IVF.

Unforeseen? Edwards wanted to correct the record here. Well before Louise Brown was perking along in her dish, he had indeed envisioned that the cells of the human embryo might be coaxed into making a medical therapy. And so many other things! Babies, period! Millions of babies! "Four percent of the babies in Finland are from IVF!" pointed out Edwards with a kind of defensive glee. It seemed that he, Bob Edwards, had seen coming much of what surrounded us, and found it, for the most part, good. Not just babies but delighted parents, of all stripes and varieties and ages. "Eye hoop they all have babies!" Edwards called out as he was being pulled away by his assistant, leaving behind a line of disappointed pilgrims who had hoped to shake his hand. "What coood be better than a baby?"

"Cancer Patients Aren't as Motivated as Infertility Patients"

What indeed? Through the displays wandered doctors, male and female, young and old, many of whom find it hard to believe that Steptoe and Edwards never received a Nobel Prize for what they did. What they did, after all, was conceive human life—human life—outside the womb. What they did was create a situation in which millions of human beings would be born who otherwise never would have existed. What they did was find the first effective treatment for infertility, an ancient affliction as old as humankind itself, and for most of history one of the most dreaded and untreatable; if you don't believe that, why are fertility totems found among the earliest human artifacts? According to more than one doctor, what Steptoe and Edwards accomplished in 1978 was one of the medical breakthroughs of the twentieth century, ranking with the discovery of penicillin and Christiaan Barnard's first human heart transplant.

What People are Saying About This

Ann Hulbert
Making babies has become a big business in the United States, and Liza Mundy is there at the bedside, monitoring the rise of assisted reproductive technology. Mundy expertly tracks the fascinating scientific developments. But the real marvel of her book is her empathetic scrutiny of the human dramas and dilemmas those advances have brought with them. Everything Conceivable is a pioneering portrait of an industry that has, for better and for worse, altered our ideas of biology, family, destiny. (Ann Hulbert, author of Raising America)
Margaret Talbot
Beautifully written, unfailingly smart, Everything Conceivable is a marvelous book. Mundy’s empathy for people struggling to have children is palpable, but so is her keen astonishment at some of the brave new ways science has devised of helping them. This is a book full of unforgettable stories about human beings facing personal, ethical, and moral dilemmas we could scarcely have imagined a generation ago.
David Plotz
Everything Conceivable is an enthralling tour through Fertility World. . . . Liza Mundy is the ideal tour guide to this remarkable land. She's curious, funny, incisive, and deeply sympathetic to the terribly difficult decisions that would-be parents face. All that you want to know about modern baby-making-from scientific gambles to wild-west law to gripping human drama-you will find in Everything Conceivable. (David Plotz, author of The Genius Factory)

Meet the Author

Liza Mundy received her A.B. degree from Princeton University and an M.A. at the University of Virginia. She is a feature writer at The Washington Post Magazine and her work was selected by Oliver Sacks for inclusion in The Best American Science Writing 2003. She has won awards from the Sunday Magazine Editors Association, among others. She lives in Arlington, Virginia, with her husband and two children.

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Everything Conceivable: How Assisted Reproduction Is Changing Men, Women, and the World 5 out of 5 based on 0 ratings. 1 reviews.
Guest More than 1 year ago
Current developments in Artificial Reproduction Technology are making a fundamental change in the situation of humanity. It is no longer necessary for there to be sexual and ideally loving relations between 'man' and 'woman' to have children. This is is a revolutionary change in the human situation. What began as an effort to help infertile married couples have much desired offspring has become a three - billion dollar business in which there is very often disconnection between at least one of the genetic parents, and the child 'produced'. The new technology thus has in sociological terms one very questionable consequence. It has multiplied the numbers of what were once considered dysfunctional families, families without a father at home. There is increasing demand for the technology on the part of single women, and same- sex couples. The result is the proliferation of new kinds of families of a kind mankind has never known before. There are other problems created by the new technology. There has been produced a vast surplus estimated at close to five- hundred thousand frozen embryos. And the 'parents' have to decide whether to 'make use of them' to donate them to another 'infertile couple' to let them remain frozen, or to let them thaw and be disposed. Against the negatives and the problems there are the cases amply documented here of happy parents who at last have had their dream come true. But then there are too the questions of the kinds of 'identity problems' many of the offspring have especially when there has been no connection with genetic parents. The unregulated exploitative attitude of some of the service- provider businesses suggests much greater government regulation is in order. There is it seems to me a real question of whether the overall communal situation of the United States would not be benefited by scaling back some of this activity. After all in the United States one out of every three children, unrelated to ART is born out of wedlock. Does it make much sense to produce more children who may face psychological and social problems of a severe kind? This book is a very realistic picture of what is happening in the world of Artificial Reproduction. Players from all sides were interviewed, and have their points-of- view expressed. This is a vital book on a vital subject.