ART is the artless little acronym for “assisted reproduction technology”. Before 1978 technology and reproduction were not concepts that would have been put together. In that year a British scientist, Robert Edwards, together with a gynaecological surgeon, Patrick Steptoe, enabled the birth of the first child – Louise Brown – by in vitro fertilisation (IVF). For the first time in history conception had taken place outside a woman’s body. In practice this means that sperm and egg are brought together in a Petri dish; the resulting embryos are grown in a laboratory and then transferred to the womb of the mother.
The two men who made this possible hoped that it would be of use to married couples who had problems conceiving. But inevitably they had opened a Pandora’s box, out of which in the ensuing years flew, fast and furious, any and every experiment that greed, medical ingenuity and unappeasable yearning could devise.
This, then, is the theme of Liza Mundy’s book. A Princeton graduate, she is a feature writer on the Washington Post Magazine, and has done her research conscientiously, if selectively. Interspersed with her investigations into the reproductive industry are many human stories which tug at the heart. To want a baby is the most natural thing in the world, as many Bible stories testify. So how did this natural longing become caught up in so much scientific malpractice (my question, not Ms Mundy’s)?
She lays out the “new reproductive landscape” for the reader: one in seven adults in the US is infertile; 4% of Finnish babies result from IVF treatment; childbearing in the West has massively shifted to later ages, with inevitable consequences for fertility; the fastest-growing group of patients is now single mothers by choice, lesbians and homosexual men; eggs and sperm are routinely bartered, bought and sold over the internet. There is also intense competition between fertility clinics, leading one specialist, David Keefe, to comment that “ART is a business, not science.” Indeed the author, who has an entirely secular if concerned outlook, describes fertility medicine as the new “Wild West.”
Her book reflects both her uneasiness with some of the issues – “what happens when the rights of the child conflict with the rights of the parents?” (answer: the parents win) – and her unreflective endorsement of ART as a testament to “what we women, we men, will do to have the children we love and long for.” After all, human embryos are only “multi-celled clumps of tissue” which, “unlike hamburgers, say, can be frozen and thawed and frozen and thawed again, and used…”
If this is truly the case, why is there so much heart-searching among many of those involved in ART, both doctors and patients? One doctor is quoted as saying, “This is a huge social experiment, mediated by technology.” There is also increasing awareness that some male and female infertility exists for a reason: to prevent genetic problems from being passed on. Ironically, infertility can now be passed from father to son. Parents also agonise about what they should do with their surplus frozen embryos. Sell them? Destroy them? Donate them to science for further experimentation? One mother, speaking of her frozen embryos in implicit recognition of their human status, said simply, “They call to me.” Tellingly, the author calls this chapter of her book “Souls on ice”.
Then there is the question of multiple births, when several embryos are implanted in the womb in the haphazard hope that one, two or more might “take”. This last problem has created its own macabre solution: selective “reduction” or “deletion” (as if they were unwanted emails, maybe) of embryos. Even Mundy draws breath at this point in her narrative, as she describes the injecting of potassium chloride into the heart of the selected victim: “the fetus, which had been undulating and waving, went still…” Doctors involved swiftly guide the mothers away from potential grief by instantly talking of twins, rather than triplets or quads. When multiple births occur, because parents are naturally reluctant to “reduce”, the result is often death, disability, or several disabilities, not to speak of the social problems for parents who are overwhelmed by what nature did not intend. A perinatologist, Alfred Khoury, who struggles to save the lives of tiny, very premature babies, comments that those involved in reproductive endocrinology “have a special place in hell”.
What of the children produced by this technology? Mundy tries to be optimistic about the issues involved; indeed, she generally ignores moral issues altogether. Of same-sex parenting she says “Dads are the new mothers”; of motherhood itself, she breezily replaces it with the concept of “the mothering process”: this involves the egg donor, possibly a surrogate womb, and the “adoptive” mother who actually raises the child thus conceived and gestated. Actually, adoption is the wrong word here; none of those involved see it as remotely similar to traditional adoption.
Mundy ruefully notes that there is minimal screening of egg and sperm recipients, compared with the exhaustive home studies required for adoption proper. Patients are prepared to pay anything and undergo any treatment, however invasive and humiliating, to have a baby; the principle behind fertility treatment is the right of the paying consumer to reproductive freedom.
Yet the author acknowledges that for children conceived under coercive laboratory conditions there is often a sense of loss, frustration, anger and confusion over their identity; in a word, genetic bewilderment. Their parents, in these uncharted and murky waters, agonise over what to tell them of their conception and when to tell it, if indeed they don’t decide to conceal it entirely. They also have related problems, in particular a concern about the number of offspring produced by an egg or sperm donor. There is now a Donor Sibling Registry in the US, where children can search for half-brothers and sisters; these can number ten, 20 or 30 upwards. Some parents, understandably, struggle with the problems raised. Nonetheless, “This is the way we have babies now, many of us.”
Mundy herself is careful to try to avoid taking a moral line. In raising her misgivings she avoids providing answers that might identify her as part of “the small but vocal body of conservative researchers” or a “right-wing opponent of gay marriage.” God forbid that she should come down from her enlightened and open-minded perch. Unlike “some Christian leaders” who take a “hard-line pro-life stance” and believe that embryos should have a father and a mother, she gamely opines that the “need for a family” trumps the need for parents of the opposite sex. She suggests that lesbians and single mothers could well produce “brave new boys” and even goes so far as to speculate that “we could get away from gender entirely.” Doubtless, given sufficient dollars, scientists will manage this, too.
What is lamentably absent from this energetically researched book, for all its author’s sympathy for those caught up in the suffering of infertility, is any sense that there is valid criticism of the repugnant practices she details so eloquently. I looked in vain for any discussion of what constitutes human dignity, any suggestion that conception outside the womb might be tampering with a fundamental, even sacred, process, one which debases and cheapens the mystery at the start of life.
When the scientists she interviews speak in their portentous fashion of “playing God” they really mean that “God” is meaningless and that they can both do what the market demands and what they damn well please. The reverence for the science of genetics, as evinced by the late Professor Jerome Lejeune, is entirely lacking in this book, as is the notion of acceptance of infertility. The late King Baudoin of Belgium spoke movingly of his painful acceptance that he and his wife, Queen Fabiola, could not have children. He was led, gradually, to see that their parental love had to be a spiritual one, embracing all children.
On a personal note: I join others in a monthly pro-life prayer vigil outside our local hospital, where abortions take place. Our placards proclaim “Life is a Gift” and “Have Mercy on the Unborn”. While hoping to address all those who destroy life within the womb, it struck me that the messages also appeal to those who would try to manipulate the material of life outside the womb. From the advent of the Pill, followed by Roe v Wade – the huge efforts made to avoid or destroy new life – to the equally vociferous demand for babies made to order, it seems that society in the main has forgotten both the notion of “gift” and the notion of “mercy”.
Mundy would dismiss this as hard-line conservatism. She is, predictably, critical of opposition to embryo stem cell research, despite serious misgivings by others. Indeed, as I write this on August 1, I note a letter to the Editor in today’s edition of The Daily Telegraph by two MPs, one Labour and the other Conservative. It is worth quoting in full as it raises acute concerns that Mundy brushes aside. The MPs, David Burrowes and Geraldine Smith, write:
“As members of the Parliamentary Joint Committee on the Draft Human Tissues and Embryos Bill, we have grave concerns about the Bill. Sanctioning the creation of animal-human hybrid embryos, the Bill permits what is banned in many other countries. We are very concerned that, by facilitating ‘hybrid’ experiments, the Bill will inevitably have the effect of further diverting money away from adult stem-cell research – which has given rise to more than 70 successful patient therapies – to embryonic research, which has produced no therapies whatsoever. It is a shame that the committee did not have the opportunity to take evidence from adult stem-cell scientists with misgivings about hybrid experiments.
“We are also profoundly concerned about the implications of the draft Bill regarding fathers, especially the clause that makes provision for deliberately bringing children into the world who will be prevented, by law, from having any legal father. The Bill’s fathers’ provisions prioritise the interests of adults over children whose parenting needs are best met by the presence of both a mother and a father.
“On July 11, the Prime Minister told Parliament that there was an emerging consensus on the Bill. Our committee had no consensus on these key issues, which will probably reflect the position of an informed public.”
As Hilaire Belloc wrote: “Oh! Let us never, never doubt / What nobody is sure about!”
Francis Phillips writes from Bucks in the UK.