A new book questions the effect of assisted reproduction on the world but the book fails to deliver. Deirdre Veldonreports
Not so long ago, forming an opinion on reproductive choice meant deciding how you felt about abortion. Now, it means selecting from one of the myriad options engineered by technology to have a baby. And what a choice there is.
In the book, Everything Conceivable: How Assisted Reproduction is Changing Men, Women and the World, US reporter Liza Mundy follows people who have made some of those choices, which now cater to the entire range of human social experience. Its scope takes in helping "traditional" couples experiencing fertility issues, through to the boom in lesbian parenting thanks to sperm banks, ever later childbearing, surrogacy, egg donation and an explosion in the numbers of gay fathers.
In recounting these stories, Mundy discovers a kaleidoscope of experiences, backgrounds and motives. Consider Kendra, the young egg donor who finds herself as guest of honour at the baptism of triplet boys, her genetic offspring. She's even more non-plussed to be invited to the celebration afterwards, where she bounces the boys on her knee, makes her excuses and escapes back to her life as a single flight attendant.
All the same, she can't help mulling over the possibility of some day using the embryos frozen by the triplets' parents, should she not be in a position to conceive herself at the time. Kendra, it appears, has all the choices.
At the other end of the scale, Laura, the triplets' mother, probably felt she didn't have too many options remaining when she accepted Kendra's eggs. And she was one of the lucky ones. Mundy doesn't dwell on it, but for many, particularly women who may have postponed childbearing to develop their careers, assisted reproduction is not so much a choice as a last resort.
As one friend pregnant with IVF twins reflects over lunch with Mundy: "Life isn't a restaurant where things are served in courses, it's more like a deli, where they're throwing plates out and you just have to catch them when they fly out of the kitchen."
In contrast, Doug Okun and Eric Ethington, now the proud gay fathers of twin girls, exercised all of their choices to the hilt. They contracted a surrogate through a carefully selected agency for gay dads. Then, they chose the perfect egg donor from a selection screened for looks, family health history, SAT scores or college entry exams in the US.
Of course, they were looking for "your basic, Ivy League supermodel". They fertilised the donor's eggs with a mixture of their sperm and, hey presto, 35 weeks later the surrogate delivered Elizabeth and Sophia, biological twins and, as happy co-incidence, individual offspring of each father.
Mundy steers away from any less-than-ideal outcomes, preferring to focus instead on breathless happy baby stories and diluting her argument somewhat in doing so. If she has seriously set out to explore the proposition that assisted reproductive technology has changed the way we think about human life, a selection of joyful anecdotes from the reproductive fringes, how ever well researched, is not going to cut it.
At times, she is almost cavalier about the risks faced by some of her subjects. That Laura, the triplets' mother, haemorrhaged badly and almost died after the delivery of the triplets merits barely an aside. It seems incidental that the surrogate for Doug and Eric's children, who was overweight and had already had four Caesarean sections before being implanted with four embryos, had to undergo an emergency hysterectomy to save her life while having the twins.
Similarly, there is little reference to some of the more challenging issues in reproductive science. Does it suffice to mention, for instance, that male infertility may be nature's attempt to preserve the survival of the species, by ensuring that genetic diseases are not passed on from father to son? Or to claim that IVF babies are different from the children of parents with no fertility problems, full stop?
If Mundy hoped to find answers from the world's pre-eminent embryologist Robert Edwards, she will have been disappointed. In 1978, Edwards and his partner, Patrick Steptoe, fertilised the first human egg outside the body, resulting in the birth of Louise Brown. Could they have imagined the pandora's box of possibilities they were opening? Edwards in the present day is sanguine, but non-expansive: "Eye hoop they all have babies," he proclaims to Mundy in what she describes as his north of England "working man's burr".
Where Mundy mines a little deeper into her subject, her book benefits. She manages to shake off the anecdotal elation long enough to have a clear-eyed look at the impact of multiple births.
As she says, "Who doesn't have twins these days?" In the US, the number of twins has climbed by 75 per cent in the past 25 years. This trend - described by some doctors as a twinning "epidemic" - is fuelled by two factors. As women age, they are more likely to ovulate erratically and conceive twins naturally. In addition, women undergoing IVF are usually implanted with multiple embryos, as not all may take. A recent research paper showed that more than half of all IVF patients want twins.
Multiple births carry more risks for mothers and babies. It is more likely that multiple babies will be born prematurely and suffer from developmental delay or other respiratory, brain or nerve disorders.
Among twins, infant mortality rates are four to five times higher than that of singletons; for triplets, it is higher again. Multiples increase the rates of low birth weight infants.
"Women are less likely than ever to smoke or drink alcohol during pregnancy; yet a twins pregnancy hardly draws a second glance and in some cases is actively courted," Mundy says.
So while bioethicists are wondering about whether assisted reproductive technology will allow parents to "optimise" their offspring, they might be better employed to worry about whether children born as a result of IVF will suffer any disadvantage.
This is just one of a plethora of questions that arise, such as: how old is too old to bear a child? Should multiple births be deliberately cultivated? Does the use of frozen embryos need massive state regulation? Should gender selection be allowed?
In her research, Mundy hits on lots of questions, but precious few answers emerge.
As San Francisco fertility doctor Robert Nachticgall remarks: "This is a huge social experiment mediated by technology. Who the hell knows how it's going to turn out?"
Everything Conceivable: How Assisted Reproduction is Changing Men, Women and the World by Liza Mundy. Allen Lane (Penguin) £20.