Book One Hundred and Eight: Everything Conceivable

Please be warned that if you get all riled up about infertility issues, you may not want to read this post. And if you decide to read it anyway and you get all riled up, don’t blame me, because I warned you.

I picked this book up at the library as a personal challenge to myself, because it’s about a topic which I find repulsive, yet morbidly fascinating: fertility treatment. I noticed it on the new and noteworthy shelf, and I thought it might be interesting to read a scholarly work on how fertility treatment is changing society and morality. I also thought that since I have such issues with the whole fertility treatment deal, it would be an engaging personal challenge to force myself to read about it, and to try and put myself in the shoes of people who struggle with fertility issues.

I should stress that I do not have a problem with people who struggle with infertility; obviously, it’s not their fault. And while I am not interested in children, nor do I have any, I can understand, on some level, the desire to have children. I am just disgusted by the fertility industry, and to some extent the people who buy into it, primarily because I don’t understand it, and I was hoping that this book might provide some interesting insights, but I don’t mean to sound like I am personally attacking anyone here. “To each their own,” as they say, and it’s not my place to tell anyone what to do, or to act like I understand complex situations I am not involved it.

This book certainly provided insight and some thought-provoking material, along with more ammunition for hating the fertility industrial complex, as it were.

But let’s start with why I take issue with the whole fertility treatment thing, because on the off chance that one of you lazy people does decide to comment for once, I figure that’s a question that might get asked. My main reasoning for disliking it isn’t that it’s unnatural (although it is), but that I think it’s wasteful and vain. I believe that as long as there are children without homes in the world, people shouldn’t be spending tens (or hundreds!) of thousands of dollars on having children that are “theirs,” with their own genetic material.

I realize that infertility is probably immensely lame, and I am not even going to pretend to understand what people with infertility are going through, because I can’t. I can understand the desire to have children, but where I get lost is when people are willing to have their own children, by any means possible. It just seems ludicrous to me, when the money wasted on cycle after cycle of IVF could be saved to create a college fund for an adopted child. And it obviously causes a lot of angst and heartbreak, which makes me wonder how worth it fertility treatment is, if you destroy a partnership over it.

I learned a lot reading this book, and that’s one of my primary criteria in deciding whether or not I like a book. I think the author really did her research, and it really shows, and for the most part, I found the book both interesting and balanced, although the author made a few one-off comments that I found kind of irritating and offensive. But, overall, the book was quite good.

A great deal of the information in this book was new and surprising to me, and maybe it’s not to you, but I’m going to go ahead and talk about what surprised me anyway. For example, apparently the rate of adoptable infants in the United States is actually on the decline, and especially white adoptable infants, which have always been the majority. (African American and Hispanic women are statistically less likely to give their kids up for adoption.) One ramification of this, of course, is that it’s hard to adopt children with an American cultural background, and as this book pointed out, some parents have strong reasons for not wanting to adopt internationally: for example, if you adopt a kid from China, you automatically cut the child off from his or her cultural heritage, and that’s a choice some parents aren’t willing to make.

This certainly assails my position that as long as there are children without homes, people should not be doing fertility treatment, and it also got me thinking about the difference between foster care and adoption. The fact of the matter is that there are a lot of kids in the United States who really, really need homes, but many of them are severely damaged and they come with baggage, unlike fresh, new-born infants. So if you’re sticking to infants, and cultural background and a sense of belonging is an issue to you, fertility treatments start to seem more…defensible. Hey, this is not to say that international adoptions shouldn’t be done; I know several people with children from international backgrounds, and those kids seem happy and healthy. Their ethnicity might be foreign while their culture is American, and I have no doubt that this is weird for them, but they seem to be doing well. I would love to see more serious studies on this, personally.

Another interesting titbit I learned is that in situations where women do IVF treatments after age 42, the chance of success with their own eggs is, uhm, basically nil. So all those actresses in their 40s with kids who did IVF? Those are donor eggs. Without exception. When older eggs aren’t viable, they just aren’t, although it is possible to conceive naturally after 42 in some cases.

One of the big issues that the book talked about was the moral and social implications of egg and sperm donation. Mundy talked about adoption, and all of the shifts there, from traditional closed adoption to open adoption to coparenting, and the book really got me thinking about children of egg and sperm donors, and their rights, and how we deal with them as a society.

Do egg and sperm donors deserve to know where they came from? I argue yes, because I think it’s crucial to know one’s health history, and because I don’t like secrets, as a general rule. Coming from donated eggs or sperm doesn’t make a child any less wanted or loved (in fact I would say he or she is almost more wanted and loved, given the lengths his or her parents went to), but it helps to explain why someone might not look like the rest of the family, or why someone might be more prone to certain health problems.

Of course, a lot of egg and sperm donation is anonymous and virtually impossible to trace, and some donors prefer to keep it that way. They don’t want to be responsible later in life for the kid, or they don’t want to deal with meeting the child, or whatever, and I understand these feelings. (If I was in a position to sell my eggs, I would probably do it anonymously.) So do we set up a system where the medical records of donors are available, along with basic biographical information, but not their names? Or allow people to send letters through a third party? What happens when one donor donates enough material for sixty children to be born, and the kids meet each other, don’t know it, and get married? (I know, I know, unlikely, but I think it’s something which bears considering.) What do you do with extra eggs and sperm, anyway, let alone leftover embryos?

Do parents always know what’s right for their children? I would argue no, especially when your children are adults, and concealing origins could be dangerous, humiliating, or just shameful. I think that the desire to conceal adoptions came from shame, and the desire to conceal the use of fertility treatments comes from shame. (And no wonder, with people like me running our mouths off about how repugnant we find it.) Maybe being more frank about these things would dispel the shame.

Furthermore, the book really underlined the differences between fertility treatments like drugs to stimulate ovulation, and the use of IVF and other treatments which I will, for lack of a better word, term “artificial.” I’m still pretty opposed to fertility drugs, because they elevate the risk of multiple birth significantly, and that carries a lot of medical and social issues, as I learned. I was dimly aware that multiple pregnancy is dangerous, but I wasn’t aware of how dangerous it was; even twins are risky, let alone “high order multiple births” like sextuplets. It isn’t just dangerous for the mother, either; the children are also at risk of a range of health problems.

And, as Mundy pointed out, low-income households are more likely to use fertility drugs, and to be unable to cope with the explosion of spawn that ensues. In IVF, there’s a little more control over how many kids you have, depending on how many embryos you put in the uterus, but with fertility drugs, there’s no control. And low-income people can’t afford seven children, several of whom might have severe developmental disabilities. Aside from that, multiples are highly stressful for their parents, and Mundy interviewed several parents who expressed regret, and anger at not being made more aware of the risks.

IVF isn’t without risks either; American doctors are apparently keen on popping as many fertilized eggs in the uterus as possible, resulting in the need for “selective reduction” (killing of unwanted embryos), or the risk of carrying multiples. And what do you do when you go through IVF and the embryos are implanted in a surrogate, who might have her own personal issues about selective reduction, or concern about carrying multiples?

The author also touched upon the reasons for infertility, and she raised a number of interesting points. Thanks to fertility treatments like IVF, parents can now pass infertility on to their children, along with some potentially dangerous birth defects. Maybe there’s a reason infertility happens, Mundy suggests, and it has to do with the welfare of the species. Are we weakening the human race by developing technology to overcome infertility?

She also talked about the way that fertility treatments are reshaping the structure of the family, and that was interesting to read about. Thanks to advances in infertility treatment, for example, gay and lesbian couples can have kids, which I think is awesome (my one exception to generalized loathing of fertility treatments). And more complicated situations are arising, like a kid with two parents in addition to a birth mother (surrogate) and a donor mother and/or father. Thanks to some open-minded donors and families, contact between children and donors isn’t impossible, and in fact sometimes complex relationships evolve, which is kind of, well, for lack of a better word, neat. It’s neat to see how humans adapt to new and formerly unknown situations.

Everything Conceivable really illustrated, for me, the complex ethical and social issues involved in fertility treatment. I really cannot recommend it enough, no matter what your stance on the issues covered might be, because it was worth reading. I can’t say that my opinion on fertility treatments has changed, but I certainly feel better informed, and being better informed is pretty much always a good thing.

Demographics:

Everything Conceivable, by Liza Mundy. Published 2007, 406 pages. Science.