The Business of Making Babies: How Much Hype and How Much Hope?

Miriam Zoll’s  Cracked Open:  Liberty, Fertility and the Pursuit of High Tech Babies   is in part a moving memoir, in part a troubling expose of yet another  unregulated corner of our healthcare system. In this case it is  an industry that offers women everything from in-vitro fertilization (IVF)  to another women’s eggs-for-sale.

Zoll titles her first chapter “One Egg, Please and Make it Easy.”

If only it were that simple.

Zoll begins by acknowledging how naïve she was:

“I am an official member of the Late Boomer Generation. We grew up . . . . in the 1970s and ‘80s, watching with wide eyes while millions of American women—some with children and some not—infiltrated formerly closed-to-females professions like medicine, law, and politics. This exodus from the kitchen into the boardroom created a thrilling, radical shift in home and office politics, in the economy, and in relations between the sexes.

“‘Shoot for the stars,’” some of the more thoughtful women advised us, “’but don’t forget about the kids.’”

Zoll herself became one of the trailblazers. She is the founding co-producer of the original “Take Our Daughters to Work” Day, and on the board of “Our Bodies Ourselves.” In 2005, she became a Research Fellow at MIT’s Center for International Studies. There, her widely –published research addressed gender inequity and poverty in HIV/AIDS-affected households in sub-Saharan Africa.

At 35, Zoll married. At 40 she reports, she looked in the mirror, and decided:  “It’s time to have a baby.” Finally, she felt confident that she would be a good mother.  It didn’t occur to her that she might have trouble conceiving.

“We are the generation that . . .  came of age at a time of burgeoning reproductive technologies,” she explains. “We grew up with dazzling front-page stories heralding the marvels of test-tube babies, frozen sperm, surrogates and egg donors; stories that helped paint the illusion that we could forget about our biological clocks and have a happy family life after—not necessarily before or during—the workplace promotions.”

Zoll goes on to chronicle her own long trek through our multi-billion-dollar fertility industry. At the beginning, she and he husband were as innocent as most couples who believe what the media had told them: “Science and technology have finally outsmarted Mother Nature.”  Just because you’re over 40, this does not mean that you can’t conceive.

That final line is absolutely true.  Each year in-vitro fertilization and other forms of Assisted Reproductive Technology (ART) produce miracles.  The extraordinary joy that parents who thought that they could never have a child feel when holding their baby should never be discounted.  When the right patient receives the right therapy at the right time, these technologies can heal broken hearts.

                                             The Odds 

Neverthless, although 15 states mandate that insurers cover in vitro fertilization  the Affordable Care Act does not list IVF as an “essential benefit” that insurers must provide.

ART is still a medical experiment. Or, as Zoll puts it “ART is a crap shoot.”  In many cases, physicians don’t know why some couple succeed and others do not.  No one keeps tabs on who wins and who loses.  We have a National Joint Replacement Registry, a database of information that surgeons can consult as they learn why certain procedures work for certain patients while others go awry. But there is no official registry for in vitro fertilization—despite the fact it is an infant science shot through with uncertainties.

As Minnesota law professor Michele Goodwin and Judy Norsigian, Executive Director of Our Bodies Ourselves, warn in the Foreword to Cracked Open: “While the ‘better’ fertility centers now claim live birth rates of 50 percent or more, the national average remains at about one-third. It is easy to misinterpret pregnancy rates—which are high but often end in miscarriage—as live birth rates, which are much lower in comparison.”

Here are the facts: the most recent data from the Centers for Disease Control and Prevention reveal  I.V.F. failure rates as high as 68 to 78 percent in women ages 35 to 40, and 88 to 95 percent among women 40 to 44.
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