When First We Practice to Conceive

Baby-Making: What the New Reproductive Treatments Mean for Families and Society

  • Bart Fauser and Paul Devroey
  • Oxford University Press, 2011; 292 pages, $29.95

What does it mean to “make” a child? The title of this book is presumably a nod to the euphemistic meaning of the term, but with the twist that it invokes the idea of “manufacturing.” That association is intentional because Baby-Making is an introduction to the booming industry of “assisted” reproduction, another euphemism—along with “reproductive treatments”—that softens the cold reality of engineering human procreation apart from the conjugal act. The authors are fertility experts from the Netherlands and Belgium, respectively. The focus of their professional practices—in-vitro fertilization (IVF)—is the main subject of the book. Thus, artificial insemination and surrogacy receive relatively little attention.

The idea of a commercial industry dedicated to “manufacturing” babies (and, of course, the attendant possibility that “customers” could presumably specify just what kind of product they are buying) raises a host of moral, ethical, social, and philosophical questions. The subtitle alludes to these reservations but the text itself gives only glancing notice to such concerns. It is not as though the questions, and their pressing practical implications, are not in plain sight. For instance, the ongoing debate over sex-selection abortions in the United States and Canada has brought to light an IVF clinic in Washington State that advertises in Canadian newspapers: “Create the family you want. Boy or girl.” The clinic uses preimplantation genetic diagnosis (PGD), a technique Fauser and Devroey spotlight, to ensure that they implant only embryos that fit parents’ preferences for the sex of a child.

A story out of London describes a same-sex couple who are “devastated” that a child they created by IVF was genetically unrelated to their first child (also created in vitro) because of a mix-up at the clinic. The Daily Mail also reports that since the British government removed a requirement that children conceived via IVF have either a father or father substitute, the number of single women using IVF has increased 448 percent and the number of lesbian couples using the procedure has more than doubled. The same newspaper ran a disturbing expose about women in India kept by a private company in a home where they serve as surrogates for wealthy Western couples, carrying babies created through IVF. In an interesting touch, the reporter disclosed he was “urged not to tell the surrogates I met that they might be carrying babies for same-sex parents.”

Also, a recent article in the journal Fertility and Sterility reported that children created by IVF and another common assisted-reproduction technique have a 37 percent higher risk of having a birth defect than children conceived the natural way without technological intervention.

This is not to suggest that the book has no value. Indeed, the authors note that the global market for IVF is much larger than imagined, with estimates of the number of children conceived by IVF reaching close to 5 million. The authors also provide helpful data quantifying the increased risk of multiple pregnancies and other health risks associated with in-vitro fertilization. They claim these risks are declining everywhere but in the U.S., where the industry is almost entirely unregulated and “more than 50 percent of all children born from IVF in the US are from multiple pregnancies.”

The authors are at their best in exposing the nature of the global “infertility epidemic.” They note that “more than half the total patients at some of Europe’s main fertility centres [are] over the age of 35” and conclude that “it’s fair to say that the leading cause of infertility is simply related to female age.” They diagnose the “epidemic” in these frank terms:

This growing reluctance to have children, or at least the trend to defer the birth of a first child, has been apparent in our fertility clinics since the early 1990s, with around one in three of all IVF cycles now performed in women aged 35-39, and more than one in 10 in women over 40. Thus, what we seem to be seeing as demand for IVF continues to grow and fertility rates remain at their lowest, is a fertility epidemic determined principally (though not exclusively) by the deferment of a first pregnancy attempt, a medical complication related more to age than to any disease or physiological problem.

In other words, the “epidemic” is really a “social trend” fueled by “women in their mid-thirties who suddenly find that their fertility is not as buoyant as anticipated, and who, without much warning, have become yet another statistic in Europe’s growing infertility epidemic.”

The chapter on the use of assisted reproduction by the biologically fertile is also eye opening. These clients use IVF for purposes of trait selection, for the production of “saviour siblings” who can produce organs for a child already in existence, for sex selection, and for post-mortem fertility (a growing legal issue resulting in a U.S. Supreme Court decision this year). These cases expose the specter of “designer babies” produced by an industry that looks disturbingly like any other manufacturing enterprise. Also driving demand for IVF, according to the two specialists, are clients who might be called socially infertile, meaning they could physiologically have children but do not want, or allegedly cannot find, a spouse with whom they could naturally have a child. Requests for IVF under such circumstances are no problem for the authors, who assert rather stoically that “concerns about the child’s need for a father are misplaced.” Such concerns would obviously impact the Belgian practice of Devroey, who admits to treating “some 300 single women and lesbians a year, the majority of them from France.”

The authors do not totally ignore ethical concerns related to the use of these alternative means of reproduction. But they take a dim view of critics who insist that certain lines need to be drawn, dismissing their views because they “are largely determined by religion and its associated cultural opinions.” Thus, in a postscript, Devroey suggests IVF restrictions in Italy are an artifact of Catholic influence while similar laws in Germany are “inspired by cultural historical events,” a quaint way of describing the very understandable, and indeed laudable, remembrance of Nazi atrocities caused by attitudes about the human person that echo in eerie ways in some of the expansive promises of assisted reproduction’s boosters. Nonetheless, Fauser and Devroey fear no resurgence of eugenics because screening technology “is about individuals and their own choices, eugenics is not. In our view OGD and the avoidance of multiple pregnancies are justified as applied technologies in the welfare of the children born and the parents’ freedom of choice once they are in full possession of the facts.” They do disapprove of some practices, like the strawman of intentionally creating a deaf child, an option few clients would choose, and express some reservations about sex selection, yet their caveat has done little to persuade their colleagues to change their practices. Moreover, it is hard to imagine the authors and their fellow fertility specialists objecting too strenuously to clients’ demands given their accepted narrative about “freedom of choice.”

Overlooking the Impact on Children

Equally troubling is the authors’ indifference to family structure. It is no coincidence that the book’s subtitle references the impact of reproductive technology “on families and society”—not on children. Nowhere do the authors acknowledge that most of the children that their industry “makes” do not enjoy their rights to being conceived by the act that expresses the love of their parents and being raised by, or even knowing, their biological mother and father. A cynical observer could be justified in concluding that, to this growing industry, clients are clients. Indeed, the Ethics Committee of the American Society for Reproductive Medicine concluded a few years ago, “There is no sound basis for denying to single persons and gays and lesbians the right to reproduce that other individuals enjoy.” This is a dog-bites-man story: it would be hard to imagine that the Committee would decide that their market niche—possibly a very small portion of the general population but a disproportionately large group of potential clients—should not be able to avail itself of in-vitro services. The likelihood of the Committee reaching such a decision is especially low because of its members’ vulnerability to the cultural poison of “rights inflation.” Yet on what grounds can an individual claim a “right” to reproduce, especially in the absence of the sexual relationship that nature requires for that very activity to take place?

These developments confirm that reproductive technologies have come a long way from the days when the focus may have been on the needs of genuinely infertile married couples. Indeed, the book’s glowing embrace of artificial and nonsexual means of procreating makes it clear that their use is now primarily driven by troubling social and demographic changes, including delayed marriage and fertility and the increasing acceptance of alternative family forms that deny children what they need most of all. Moreover, the commercial technology shows no signs whatsoever of being reined in for ethical or moral reasons—or even informed by the needs of children. And don’t think the impact of the industry is limited to its clients, as its influence on social attitudes about children and family is disproportionate to its use in the general population.

For all these reasons, Americans need to step back from the so-called wonders of science and reflect seriously about the implications of IVF and other reproductive schemes, including their role in turning children into commodities. It may seem all right, perhaps even laudable, to allow some married men and women to overcome medical limitations in order to bear children. But these limited situations are not what reproductive interventions—and the specialists that make a good living pushing them—are primarily responding to. The public may be assured that the desire of adults to have children should be honored and facilitated. The assumption is that children will be fine because the very intentionality of parenting signals a deep wanted-ness for a child, a factor that the public might assume will bode well for the child’s prospects. Intention, however, cuts both ways. It may signal not so much wanted-ness as wantonness, a wantonness that deprives a child of at least one parent or of daily interaction with one half of the human species “on purpose.” At its extreme, intention facilitates the denial of life to a child, as when an embryo is produced but then discarded for being the “wrong” sex or having traits or disabilities not desired by the fertility-industry client.

Likewise, the use of terms like donor, which provides a philanthropic gloss to the industry, is deeply misleading. Those who provide the sperm and egg for the children they have no intention of raising or even contributing to are donating only in the sense that the grocery store is donating a gallon of milk to a customer after he pays the cashier $3.29. In reality, this language cloaks the disconcerting practice of encouraging—even insisting—that one class of parents repudiates parental obligations for the sake of lifestyle choices of another class of parents.

At its core, the danger of widespread acceptance of out-of-the-body reproduction is not that science will fail to meet desires regarding offspring but that it will encourage adults to subordinate children to their own ends, as an exercise in the fulfillment of their desires. Whatever particular individuals have intended, these contrived means of reproduction have contributed to a significant cultural shift in our view of children, especially as the law has failed to draw needed lines in the sand. Increasingly, children are no longer valued as gifts of God with inherent value, as offspring begotten in the private conjugal act, but as products of our will and items of commerce bought and sold in the public marketplace. A similar shift has occurred in the way we view other human “components” in the industry, such as “donors” and surrogates.

To adapt Samuel Johnson’s trenchant observation about colonial Americans who accepted the abhorrent practice of slavery, we may have become too accepting of voices braying for self-fulfillment while denying children their rightful identity and dignity.

Mr. Duncan, a frequent contributor to The Family in America, is the executive director of the Marriage Law Foundation, a public-interest law firm in Lehi, Utah.