Because of the work I do in the area of third-party assisted reproductive medicine, I have Google alerts set for “egg donation,” “sperm donation,” and “surrogacy.” Often the daily digest reads like the lineup for a week of reality-TV programming. Stories break with headlines that boggle the mind: “Mother tells of giving birth to her gay son’s baby,” or the recent court decision that a “dead reservist’s parents may use his [frozen] sperm, against widow’s wishes” so they can have grandchildren. Or this dreadful decision from Australia’s foreign minister, who said “Department of Foreign Affairs correct to allow couple to abandon unwanted Indian surrogacy twin” because the couple claims they cannot afford to keep both of the babies.
More recently, news broke of 65-year-old Annegret Raunigk, who lives in Berlin and is pregnant with quadruplets via egg and sperm donation. Because egg donation is illegal in Germany, Raunigk left the country to conceive the babies. If the pregnancy is successful — that is, if it results in live births — she will be the oldest woman to give birth to quadruplets. The current holder of this claim to fame is Merryl Fudel of San Diego, who was a five-time divorcee and 55 years old at the time she gave birth to quadruplets in 1998.
Ms. Raunigk is already the mother of 13 children by five different fathers, and she has seven grandchildren. Her oldest child is 44, and she said she wanted to have more children because her youngest daughter wanted a younger sibling. This latest episode in the saga of reproductive technology gone mad has set off a firestorm of comments and opinions.
The debates that follow stories like this typically divide into discussions about competing rights and issues of equality. It’s not fair that a man can father a child in his 60s! What’s wrong with a woman becoming a mother in her 60s? Fifty is the new 40. Why shouldn’t grieving parents have the right to their son’s frozen sperm? As the judge decreed,
even though his sperm was not bequeathable, any use of it should be based on the deceased’s desire as expressed while he was still living. He had wanted children, not necessarily from his widow, and his parents represented his wishes. [The judge] described his parents as loving, devoted people with much to give to their future grandchild, and added that while being fatherless from birth was not an optimal situation, it would not necessarily do the child harm.
These stories demonstrate that there seem to be no legal or moral limits on assisted reproductive technology (ART). They also serve to highlight how strong the view that people have a right to a child, and thus may demand a child through ART, has become. What has happened to medicine when all that is required is a paying customer who wants a baby? But most important is just how little concern there seems to be for the children created through these technologies. Their best interests are rarely considered when adults pursue what they need, want, or feel entitled to.
Assisted reproduction fails a lot of the time and costs a lot of money. Fertility treatments pose real risks to women as well as to the children created via these modern methods. In fact, experts are starting to challenge the narrative that ART is the solution, with reports like “Are We Overusing IVF?,” which was published in the British Medical Journal in 2014: “Concern has also been raised about the long term health of children born via IVF.” Also in 2014, an important article was published in the Journal of Perinatology, “Impact of ART on pregnancies in California: An analysis of maternity outcomes and insights into the added burden of neonatal intensive care.” The authors found that “among ART/AI pregnancies, there was a 4–5 fold increase in stillbirths…#more cesarean sections (fourfold) and a near fourfold increase in the rate of preterm deliveries.” This of course led to increased hospitalization for women and children, and dramatically increased hospital charges.
There are other facts we’ve known for a long time. Maternal age matters. This isn’t about age discrimination, but about human reproductive biology. The older a woman is, the more risk her pregnancy presents for her and for the child or children she is carrying. The use of donor eggs in pregnancy puts a woman at additional health risks, which may compromise the pregnancy and the child.
This is where today’s landscape finds us. A global, unregulated, multibillion-dollar-a-year industry exploits the poor over the rich and treats children as products to be designed, bought, and sold. When the product does not meet the design requirements, too often it — literally, he or she — is abandoned.
This is not medicine. It is human trafficking under the guise of family building.