Reviewed by Debora L. Spar
Sunday, May 13, 2007
How Assisted Reproduction Is Changing Men, Women, and the World
By Liza Mundy
Knopf. 406 pp. $26.95
How do you baptize three small boys who sprang from two different mothers? What ritual can anoint their genetic mother, a young flight attendant who "donated" her eggs? In Everything Conceivable, this complicated dilemma is resolved by a thoughtful minister, who solemnly blesses the egg donor as an "angel" who by Jesus's "abiding grace helped to place them in the arms of their parents." After the ceremony, the flustered flight attendant is bustled off to a post-baptismal Mexican lunch, where she meets the extended family, bounces the other woman's babies on her knee and then flies home to Denver, wondering whether she might someday use the couple's leftover embryos for herself.
Welcome to the wild new world of reproduction, where traditional players in the nuclear family are tossed about like so many cards in a deck. In this well-researched and vividly detailed book, Liza Mundy follows dozens of topsy-turvy tales from the reproductive edge. There is, for example, the story of Doug Okun and Eric Ethington, two gay men determined to conceive and raise a child. They visit a swank surrogacy agency, compile a marketing profile of themselves and eventually discover Ann Nelson, a mother of four from West Virginia, who agrees to carry their child. Then they start searching for another woman to provide the eggs, reasoning, as Mundy tells us, that "of course she would have to be fabulous, your basic Ivy League supermodel."
When these eggs don't take, Okun and Ethington start again, becoming even pickier in the process: "The thing that became very, very important to me," Ethington recalls, "was music. Music and sports, as an indicator of well-roundedness." They finally find their perfect woman, fertilize her eggs with a mixture of their sperm, fly Nelson back to California, and then watch as four embryos are transferred to her womb. Thirty-five weeks later, she delivers Elizabeth Ruby and Sophia Rose, biological twins and genetic half-sisters born of two mothers and raised by two dads.
Although there is not much in Everything Conceivable that is truly new, Mundy, a reporter for The Washington Post, tells her tales in a fresh voice and with a keen eye for detail. People reveal all sorts of intimacies to her, and she plays them back for us to see. The result is a largely uplifting read, full of joyful parents, gorgeous babies and embryos that generally survive.
Yet the sum of all this happiness is oddly disquieting. For while Mundy does not hesitate to give us the gory details, she seems resolutely determined not to draw any broader conclusions from them. Instead, agonizing decisions and life-threatening situations are treated almost literally parenthetically, as with the three boys conceived by donor eggs: "After the birth of the triplets," Mundy reports matter-of-factly, "which was horrific and nearly fatal -- Laura hemorrhaged badly after the triple C-section, losing an enormous amount of blood -- Laura emailed Kendra photos of the newborns. Kendra put the pictures up in her townhouse. She e-mailed them to friends." Now, it's nice to learn that the egg donor delighted in her far-off progeny and that she and the birth mother have become friends. But somehow the material inside the dashes seems more deserving of our regard. A young woman had three embryos transferred to her womb. She hemorrhaged during delivery and nearly died. Yet these details are bundled oddly away.
An equally frightening subplot runs through the story of Okun, Ethington and Nelson. While the two men are dashing across the country to attend their daughters' birth, Nelson starts hemorrhaging. Doctors race to stop the bleeding and ultimately perform an emergency hysterectomy to save her life. An unfortunate accident? Perhaps. But Nelson, we learn, was overweight. She had delivered her own children by Caesarean section and was at increased risk for uterine rupture. Yet the doctors and prospective fathers still agreed to transfer four embryos to her, creating a predictably dangerous pregnancy.
It is in not dwelling on these accidents-in-waiting that Mundy's book falls short. She seems so enchanted by her subjects and so sympathetic to their plights that she refuses to touch more than briefly on the questions that their stories raise. Should any woman -- and particularly a paid surrogate -- have four embryos transferred to her womb? Should fertility doctors be allowed to create such high-risk pregnancies, passing the potential dangers to the obstetricians who eventually treat these patients? And what about the plight of others dragged along in the harrowing quest for high-tech babies?
For this reader, the most poignant stories of Everything Conceivable concerned the peripheral players: David Nelson, Ann's husband, who stood photographing Okun and Ethington's newborn daughters while his wife lay nearly dying from their birth; and in another case reported by Mundy, Megan, a little girl whose mother gave birth to premature triplets. Two years after their arrival, Mundy reports, the triplets are doing well. But Megan is not. Her parents are getting divorced and she is in therapy, trying to cope with the sibling abundance that has been thrust upon her.
Even as reproductive technologies advance at warp speed, discussions of reproduction slip easily into timeworn patterns. We want babies to be born healthy. We want families to cherish their offspring. And we want to conclude, as Mundy does, that the critical element of the baby-making equation, regardless of the technology involved, is love. The problem with love, though, in parenthood and elsewhere, is that it is too often blind. Parents are entranced by their offspring and unwilling to question the mechanism of their conception. In some deep pocket of their souls, they need to believe that the particular child they have acquired is precisely the child they were destined to have: the only magical mixing of egg and sperm that could ever have made sense. Yet when science intrudes so heavily into the realm of nature, an impartial observer should be moved to feel not only compassion for others' offspring but also some sense of excess.
How many babies are too many for a family to handle? When is a mother too old or sick to conceive? And how much choice should parents have in determining their offspring's traits? Everything Conceivable pushes us toward these questions, but leaves us tantalizingly short of answers. ·
Debora L. Spar is a professor at Harvard Business School and the author of "The Baby Business: How Money, Science, and Politics Drive the Commerce of Conception."