Everything Conceivable: How Assisted Reproduction Is Changing Our World - Hardcover

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.

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 o...