Modern Families and the Messes We Make
by Jennifer Lahl
This article was first published at thepublicdiscourse.com on November 1, 2013.
Assistive reproductive technologies such as in vitro fertilization not only involve serious medical risks, they also disrupt family life and commodify human beings.
It almost always starts with an emotional story: an infertile couple trying desperately to conceive; a woman diagnosed with cancer, worried that she may lose her fertility when she undergoes chemotherapy or radiation treatment; a couple with a dreaded inheritable genetic disease that they do not want to pass on to their children; a sick child in need of a transplant from a "savior sibling." And now added to the list is the same-sex couple or the single-by-choice person who wants to conceive a biologically related child. Even post-menopausal women can now—with the help of modern technology—experience the joys of motherhood.
With the birth of Louise Brown in 1978, the world's first "test-tube baby," the solution to infertility was seemingly found in reproductive technologies. The beginnings of life moved from the womb to the laboratory, in the petri dish.
As a result, we find ourselves in a world in which a global multi-billion-dollar per year fertility industry feeds reproductive tourism. Women old enough to be grandmothers become first-time mothers, and litter births like the Octumom's (I prefer Octu vs. Octo, as she gave birth to octuplets, and she isn't an octopus) are distressingly common. Pre-implantation genetic screening, which is in reality a "search and destroy" mission, has become the modern face of eugenics. Grandmothers are carrying their daughters' babies (their own grandchildren) to term. Doctors are now creating three-parent embryos using DNA from two women and one man. Single-by-choice mothers and fathers, same-sex parents, and parenting partnerships between non-romantically involved couples have become "The New Normal."
Stanford law professor Hank Greely, in a talk titled "The End of Sex," made the bold assertion that within the next fifty years the majority of babies in developed countries will be made in the lab because no one will want to leave their children's lives to nature's chance.
Indeed, we see a shift away from helping infertile couples have a child to helping adults produce the types of children they desire. The child is no longer a good end in and of itself, but a consumer product to be designed—made not begotten—and discarded if imperfect. This is a shift away from a medical model of trying to treat, heal, and restore natural fertility, and toward the manufacturing of babies. In the United States alone, we are fast approaching the million mark of frozen babies in the laboratory—so-called "surplus" embryos.
But the veneer is coming off, and the realities of these modern solutions to help people have a baby are being exposed.
First, there are the hard data, which continue to show how many fertility treatments fail. The most recent data we have are from 2010; the Centers for Disease Control and Prevention annual reports show that 100,824 IVF cycles were performed in the United States using non-donor eggs. Only 19 percent of those cycles resulted in a live birth, meaning that over 80,000 of the IVF cycles failed. These figures have not changed significantly over the last five years.
This high failure rate shifts the problem to healthy young women who are courted with large sums of money to "donate" their eggs to help make babies. The first recorded birth using donor eggs was in 1983, just five years after the birth of Louise Brown. What follows is scandalous.
No central registry tracking egg donors and their health over their lifetime exists, even though there is precedent for such a registry in how we track living organ donors and organ recipients. No long-term safety studies have been done to show how many egg donors go on to have complications with their own fertility or to develop cancers that are known risks for women taking the drugs involved. There is no tracking of the children created from donor eggs. And there seem to be no ethical qualms about paying women thousands of dollars to "donate" their eggs, even though we know how coercive money can be, and how it works against making truly informed choices.
The harms and dangers of egg donation are slowly emerging. Much of my work over the past several years has been gathering and telling the stories of women harmed. Young women, struggling financially, see an ad asking them to "be an angel," "make a difference," or to "help make dreams come true." As one egg donor asked, "Who doesn't want to see themselves like this?" Sadly, she went on to suffer a torsioned ovary a few days after her eggs were harvested. Losing an ovary compromised her fertility. A few years later, she developed breast cancer in both breasts, as a young woman with no previous medical history of cancer. All for a few thousand dollars to help another.
My work with egg donors has brought me face to face with the recklessness of the fertility industry, its work to suppress the risks and dangers of egg donation, and its refusal to do any research that might not support its claims that egg donation is safe. The truth is, egg donation is risky, and in some rare cases can even lead to death.
A few studies have come out touting the successes of egg donation. But when you get past the headlines, what you find is that these successes refer to pregnancy outcomes, not to the health of the woman who "donates" her eggs. A recent issue of the Journal of the American Medical Association devotes space to a new study on egg donation, but it is in the editorial where the truth is found: "data regarding outcomes on oocyte donation cycles have an important limitation—no data on health outcome in donors."
The practice of surrogacy is becoming more prevalent and more widely accepted as a solution to helping people have a child. In 2007, Time magazine listed "The 10 Best Chores to Outsource." While you would expect to find lawn mowing or housecleaning on such a list, the number one chore to outsource —number one—was pregnancy. Factors driving the rise in the use of surrogacy include the high failure rate of many of the assisted reproductive technologies and the rise of same-sex parenting, which, in the case of two male parents, requires both donor eggs and a surrogate womb. Surrogacy—either "traditional" or "gestational" —intentionally sets up a negative environment. Instead of encouraging women to bond with their child in utero, for the benefit of both mother and child, surrogacy demands that the mother not bond with her child.
Like egg donation, surrogacy is harmful to both the woman who carries the child and to the child. The health risks to the woman, who must take powerful synthetic hormones to prepare her body to accept an embryo, are real and serious. Most surrogacy contracts require that the surrogate mother already have children as proof that she is able to carry a child to term. However, no one has done any studies on these existing children who observe their mothers keeping some babies and giving others away. The message surrogacy sends to these children seems both clear and dangerous: mommy keeps some of her babies, and mommy gives some of her babies away to nice people who can't have babies of their own. And often mommy is paid to do this.
Women who decide to become surrogates are often motivated by the financial gains they are offered. Even the promise of "just" living expenses can be an enticement for a woman of low income with children in the home. Make no mistake: it will not be wealthy women who line up to make themselves available to gestate babies. It will, however, be wealthy individuals or couples who seek to buy such services. Surrogacy takes something as natural as a pregnant woman nurturing her unborn child and turns it into a contractual, commercialized endeavor. And it opens the door for all sorts of exploitation.
What about the children? Are the kids really all right, as Hollywood tells us? The verdict is not yet in. This is an unfolding social experiment. But, again, the veneer has begun to crack. More and more studies are coming out on the risks to children created via assisted reproductive technologies. These risks include higher rates of cancer and of genetic and heart problems. More stories (and more research) are surfacing that mothers and fathers are indeed good for children. Family and kinship are real—biology matters, and genetics are important.
I often tell egg donors: you didn't help a woman have a baby; you helped a woman have your baby. Even Sir Elton John, who with his partner David Furnish used a woman who sold her eggs and another who rented her womb, has lamented that he is worried about his children growing up without a mother.
While modern reproductive technologies began as what seemed to be good ways to help people who struggle with infertility, from where I sit, we've made a real mess. The biggest losers are the poor and vulnerable women who are exploited, as they say in India, for "selling their motherhood." And, of course, the children are losers too.
One story sticks in my head. A surrogate mother for a gay couple, right after she gave birth, realized she couldn't surrender the child—so she went to court to get shared custody. The daughter, being raised by the gay couple and the surrogate mother, one day asked her surrogate mother a very poignant question: since she looked like her biological mother, why is it that her mommy gave her away? The little girl simply could not understand how her mother would do this. The surrogate mother's response? "I didn't know what to tell her."
I wouldn't know what to tell that little girl either. Maybe we should just stop making such messes.
Jennifer Lahl is the Founder and President of the Center for Bioethics and Culture and producer of the documentary films Eggsploitation, Anonymous Father's Day, and the forthcoming Breeders: A Subclass of Women?