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Assisted Reproductive Technologies: Blessing? Curse? Both?

(Image: Pregnant woman via Shutterstock)

The 11-year-old Calabasas, California, business is called Planet Hospital. Billing itself as a “medical tourism” company, its website informs readers that its purpose is to “send patients to affordable surgery destinations around the world.”

“Instead of a destination, you choose a procedure,” it advises. “Instead of a hotel, you choose a surgeon and ultimately a hospital.”

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Should your quest be for a baby, rather than a new kidney or lung, Planet Hospital tells shoppers that for a fee ranging between $23,000 and $36,000 – less than half of what it would cost in the US – they’ll find you a surrogate. “The surrogate acts as a rented womb, and none of her genetics transfer to the child,” the site continues. Indeed, as long as the would-be-parents – Planet Hospital’s reproductive services are mainly marketed to heterosexual couples – can provide their own egg and sperm, the company emphasizes that the baby will be genetically theirs, unmarked by the nine-month gestational way-station they used.

The countries providing these “rented wombs”? The top sellers are India, Mexico, Panama and Thailand. And business is booming: ABC News estimates that international surrogacy is a $500 million-a-year enterprise.

But not everyone is jubilant over the growth of this burgeoning industry. Diane Tober, associate executive director of the Center for Genetics and Society, calls it reproductive colonialism. “These arrangements commodify women’s bodies as producers of reproductive services for a privileged market,” she said. What’s more, Tober reports that surrogates often are required to deliver by Caesarian section – making it possible for the purchaser to select a precise birthdate – which puts the laboring woman at heightened risk of infection and complications in places where quality aftercare is often difficult to access.

It’s hard to escape the fact that people with economic privilege will go to extremes to get what they want – in this case, biological children. Indeed, as US infertility rates – defined by the Centers for Disease Control [CDC] as the inability to conceive after 12 continuous months of trying – continue to grow, business at domestic and international clinics specializing in Assisted Reproductive Technologies [usually called ART and defined by the CDC as any treatment that involves the handling of both egg and sperm] is growing by leaps and bounds, from 30 US clinics in 1986 to nearly 500 today. Already, the CDC estimates that 11 percent of American women between the ages of 15 and 44 – a total of 7.3 million – have trouble getting or staying pregnant in large part because of physical problems or age. According to the agency, women older than 35 not only have a decreased chance of bearing a child, they also have an increased chance of miscarriage and delivering a child with a genetic abnormality.

At the same time, a study reported in an academic journal called Fertility and Sterility in March 2013 revealed that the majority of women, regardless of age, do, in fact, eventually become pregnant; 84 percent of 20- to 34-year-olds and 78 percent of 35- to 40-year-olds conceived within a year or two of trying. Despite these positive numbers, baby panic – fear that it will be impossible to have a family without assistance – has sent countless women into the waiting arms of the ART industry. This anxiety has social roots. While teen moms and dads are routinely berated by mainstream media for being too young to parent, by the time women are in their mid- to late 30s, the social imperative to reproduce typically has them scrambling to get pregnant. What’s more, the idea that offspring are the greatest gift one generation can give to the next is hardwired into most of us, making us feel deficient if we fail to conform. The pull is so strong that some 20-somethings have begun freezing their eggs, assuming that 10-15 years down the line, when they are more established, they’ll be able to unfreeze them and have a child. Others assume that if they need help, In Vitro Fertilization (IVF), which relies on ovulation-stimulation drugs to increase the number of mature eggs that can be surgically retrieved and readied for embryo transfer into a woman’s uterus, or Intrauterine Insemination (IUI), also called artificial insemination, which involves washing the sperm and injecting them with a tool similar to a turkey baster, will do the trick.

Truth be told, they may: More than 3 million babies have been born through these methods since 1978, when the technology became available.

The flip side, however, is that ART is neither a panacea nor a guarantee of pregnancy. The CDC reports that in 2011, 163,038 ART cycles resulted in just 47,849 live births, meaning that two of every three efforts failed. Even more stunning is the fact that IVF, one of the most popular ART techniques – and one costing an average of $12,500 a pop – is successful for only 6 percent to 10 percent of women over the age of 40. Younger women don’t fare much better. The success rate is 25 percent to 30 percent in women under 35; 25 percent in women age 35-37; and 15 percent to 20 percent for those 38-40. Egg freezing is less reliable: The Wall Street Journal reported in 2008 that only between two and four percent of inseminations with frozen eggs result in live births. Not surprisingly, clinics rarely, if ever, mention this, instead focusing on their successes.

Susan Wefald, a New York City foundation director, is one of them. Wefald was 41 when she began using ART to get pregnant in 1997. “I had had a Dalkon Shield, which caused scarring on my fallopian tubes and led to problems getting pregnant,” she said. “I had surgery to remove the scarring but still could not conceive.” Wefald adds that given her age and medical history, her doctor recommended she go straight to IVF. “He estimated that I had a 28 percent chance of getting pregnant and a 22 percent chance of carrying to term. I figured I’d give myself one chance to have a biological child. If the IVF did not work, I would adopt. My mom is from China, and I would try to get a child from there. It was a big gamble, and I told myself I would roll the dice once and see what happened.”

Cost was a huge concern. While Wefald’s insurance covered the $4,000 price of the drugs needed to increase egg production, the remaining $11,000 came from her parents and brother.

Another concern was where to obtain sperm. “A month before I started the process, I broke up with my partner, so I went to the California Cryobank and looked for an anonymous donor. Because I’m biracial – Asian and white – I looked for a biracial, Asian-Caucasian, donor. The Cryobank had a handful of them, and I looked at their written profiles. I then listened to two or three of them on audio. They were asked if there was anything they wanted to say to a child or to the woman buying their sperm. One guy told a story about a family friend who had trouble getting pregnant and how much joy there was when she finally succeeded. I chose him because I felt a connection to him.”

“I hit the jackpot,” Wefald said. After weeks of injecting herself with drugs, the doctor was able to retrieve 12 eggs; nine were fertilized. “They then wait a few days. Five of the zygotes seemed healthy, and all five were transferred. A few weeks later, I found out I was pregnant,” she said. “When I had a sonogram, I learned I was having twins.”

British resident Emilia T. was not as lucky. When it became clear that sexual intercourse was not going to result in pregnancy, she and her spouse decided to give IVF a try. “We understood that it was a long shot – I was 41, and my husband was 45 – and if it worked, great. If not, we’d move on with our lives.” The clinic she used was in London, and she says she was initially shocked by how crowded it was. “They treated us well,” she said. “but sometimes I felt a bit like cattle, because there were so many peoplee. And it had a bit of a conveyor-belt feeling.”

“What was most difficult was the uncertainty,” she said. First, each time a menstrual cycle started, I’d get a blood test. Were the numbers high enough to start treatment? No, then wait. We had to put our lives on hold for a good while. When the treatments did start, the early-morning blood tests and the various injections were a slavery. The injections – one was painful, and the other wasn’t – bruised my belly and were unpleasant. Having to wait for the daily phone call after the blood test to tell me what injections to carry out each day and at what time was also a slavery and kept me in constant anxiety mode. I sort of knew it was going to be like this, but I really didn’t fully know what it was going to entail.”

After one failed IVF cycle, Emilia and her partner called it quits. “We’re happy now, just the two of us, and we’ll enjoy our lives as they are,” she said.

Others, like Rebecca C. and Deirdre Fischel, were not as quickly deterred.

“I’m usually immune from magical thinking,” Rebecca, a Maryland college professor, confesses. “But I thought I’d have no trouble getting pregnant. I was 30 when the I-want-to-have-a-baby hormone kicked in, but I did not act until I was 37. It took two years of trying – 12 rounds and about $40,000 – for me to get pregnant.”

Rebecca’s first foray into ART brought her to a New York City clinic that she describes as “crowded, smirky and cold.” Later, after attending meetings for would-be-parents at Manhattan’s Lesbian and Gay Community Center, she learned of a two-woman medical practice that better met her needs. “My now-wife was living in New York, and I was working at a Catholic College five hours south of the City. I had health insurance, but none of the processes I needed were covered. I was using IUI, and the drugs cost $1,100 to $1,300 a month. I started with the lowest level of hormones, and it got ratcheted up over time. My partner, Leigh, injected me, and you have to have the timing exactly right. You then have to coordinate getting fresh sperm.”

Like Wefald, Rebecca and Leigh chose the California Cryobank. “I’m Jewish, and Leigh is Korean,” she said. “We knew the kid would have my last name and wanted Leigh’s Korean-ness to be linked to the baby, so we looked for someone Korean who was also reasonably intelligent, sane and honest.”

Rebecca had difficulties from the start, suffering horrible side effects from the medications, but she says she brushed them off because she so desperately wanted to have a biological child. After five or six failed tries, she had surgery to wash out her fallopian tubes. “It was a painful, yucky, in-hospital procedure,” she said. She then began IVF but developed an allergy to Lupron, the drug she needed to inject. A few months later, she had another round of IUI. “Everything that could go wrong went wrong. The sperm went to the wrong address, the doctor had to leave early because her dad was ill – and I had to race from Maryland to New York and then head back immediately, but this was the time I got pregnant. Our daughter, Natalia, was born in the summer of 2007.”

It took Brooklyn filmmaker Deirdre Fischel six tries over eight months to get pregnant through IUI. Although she had no problem tolerating the drugs, she hated the clinic’s hospital environment. “There were long lines, and the waiting room was insane,” she recalls. “It was a huge room full of anxiety and panic. I saw a different doctor each time I visited, and everything was couple-oriented. I was shocked that they did not acknowledge that not everyone is straight or paired- up. The staff answered questions, but there was not a lot of loving, personal attention; once I became pregnant, they were done with me.”

Fischel’s twin daughters were born in 2004. “I was lucky in that I had purchased a house 25 years earlier,” she said. “And I was able to take out a $200,000 mortgage. I used the money to buy 60 hours of child care a week. I essentially bought a wife. She was fantastic and was with us for five years.”

Nonetheless, she, Rebecca, Susan and Emilia admit that the process – whether successful or not – was emotionally difficult. Indeed, Kris Bevilacqua, a clinical psychologist who specializes in reproductive health issues, said women undergoing ART – whether coupled, single, gay or straight – typically have psychological issues to grapple with. “I always start by exploring the woman’s expectations. We talk about all kinds of things. If she’s single, we address whether she feels shame at not having a partner. Regardless of her social situation, she may feel defective if she can’t get pregnant. People need to talk about this. If they’re alone, I make sure they understand what it means to be the only one to get up in the middle of the night and stress the need to develop a support committee. Over time, I help them evolve into parents.”

Bevilacqua acknowledges that there are ethical practitioners, people eager to help those hell-bent on reproducing, and shady ones, people whose only interest is profiting from the desire to procreate.

Cindy Pearson, executive director of the National Women’s Health Network (NWHN), notes that it is easy to take advantage of people when they are in a frenzy to reproduce, which is why she and other feminist activists have long pushed for truth in advertising. “We tried to get regulations requiring fertility clinics to use standardized success rates, so women would have better information, but the clinics dodged our efforts,” she told Truthout. “This often leaves women adrift, not able to find reliable information” about a particular clinic’s track record.

The organization also cautions users about the possible side effects of hormonal interventions, information that clinics may minimize. Lupron, for example, is one of the most commonly used medications and can cause amnesia, breathing difficulties, depression, headaches, hypertension, itching, nausea, severe joint pain, tingling and vision changes. [ technology] Rebecca, the Maryland college professor, discovered this shortly after injecting the drug. “I developed red bumps, like hives, all over my body, my tongue swelled, and I was unable to think until it left my system,” she said.

The NWHN further warns that Interacytoplasmic Sperm Injection (ICSI), a process that involves thrusting a single sperm directly into an egg rather than fertilizing it in a petri dish, has been linked to developmental delays and autism.

Even egg retrieval is fraught with uncertainties, because little is known about the long-term health consequences for women who undergo the procedure – either when extracting their own eggs for IVF or using another woman’s donor eggs for implantation. Another concern: It is students and low-income women who most often sell their eggs – going rates vary from $2,500 in Louisiana to $8,000 in New York City for six weeks of work – an offer that can seem appealing to those making minimum wage or who need quick cash, risks notwithstanding. Internationally, the lure is even more blatant, as a full one-third of Indian women, for example, live in poverty.

Similarly, the going rate of payment for a surrogate living in the US is $27,000 for a single fetus and $32,000 for twins. International surrogacy arrangements – Planet Hospital is just one of several outfits crafting these matches – pay the woman between $7,500 and $9,000.

There are other health concerns as well. According to Our Bodies Ourselves, one quarter of women who inject fertility drugs – a necessary part of ART treatment – experience Ovarian Hyperstimulation Syndrome which causes the ovaries to temporarily swell and become painful.

OBOS and NWHN activists want to be sure that women contemplating using an Assisted Reproductive Technology know about these potential dangers so that they can give true informed consent. Users, they argue, should understand the benefits as well as the risks from each treatment modality.

More than 100 years ago, Sigmund Freud declared that “anatomy is destiny.” ART has helped turn this notion on its head by helping millions of women – some of them older than 35 and others with health problems that would have precluded pregnancy in earlier eras – have children. At the same time, moral concerns and medical questions abound. Should women of means have access to “rented wombs”? Is it OK for women to sell their eggs for profit? And why has no one studied the long-term impact of fertility drugs to ascertain if they put users at elevated risk of cancer or other ailments? Like many matters of reproductive justice, assisted reproduction involves highly individual situations and intensely personal decisions.