Thursday, December 30, 2010

Their Bodies, My Babies

Melanie Thernstrom and her husband, Michael, set out to make a baby.

What they created instead was a complex and unconventional family.

As she writes in this weekend’s New York Times Magazine, it took five adults to bring two little children, Violet and Kieran, into the world.

Melanie calls her babies “twiblings.” It’s a word more usually used to describe siblings who are extremely close in age, which, until very recently, could only mean children born nine months to a year apart. But, using an egg donor (who she calls the Fairy Goddonor), two gestational surrogates (Melissa and Fie) and Michael’s sperm, Melanie’s son was born five days before her daughter. A Google search shows that she might well be the first one to use the term quite this way. And her new twist on the word is just one more reflection of how we continue to find previously unthinkable ways to use reproductive technology to change the mix and meaning of parenting.

As Melanie writes:

For many couples, the most crushing aspect of fertility treatment is not all the early morning blood-draws but the haunting feeling that the universe is telling them that their union is not — in a spiritual, as well as a biological, sense — fruitful. But I knew Michael and I were a great couple — I had pined so long for the elusive feeling of rightness, and now that I finally had it, I was damned if I was going to let biology unbless us. And I knew if we let biology become Mother Nature, we actually would be damned.

We forged ahead. I wanted to find carriers who would be like female relatives — women with whom it was fun to shop for baby things and who would give us advice on actually caring for the babies and make it all seem doable. While this desire seemed natural to me, I was surprised by how differently other people saw it.

“You won’t have anything in common with the carriers,” a director of a Los Angeles agency (which we decided not to work with) insisted dismissively. The gestational carriers at their agency were mainly white, working-class women, often evangelical Christians — “the kind of girls you went to high school with,” he said, managing to give “high school” an ominous intonation. He waved his hand. “You may think you want to stay in touch now, but trust me, once you have your baby, you’re barely going to remember her name. I call it surrogacy amnesia.”

Many intended parents do feel uneasy at the idea of too much intimacy with their carriers and are willing to pay the hefty agency fees to “manage” the surrogacy and maintain distance between them. But for us, the idea of not being close to the carriers seemed much more alarming, like something from “The Handmaid’s Tale.” Moreover, the only true safety in surrogacy lies in trust. What real remedy could there be if, for example, your baby was born with fetal alcohol syndrome?

Readers might remember that this is not the first time gestational surrogacy has been the subject of a cover story in the magazine. Two years ago, Alex Kuczynski wrote about the birth of her son using her own egg, her husband’s sperm and the womb of a stranger named Cathy. The article caused a firestorm, mostly because readers saw Alex as distancing herself from Cathy, viewing her as a vessel whose services were purchased. As Alex wrote of her relationship with her surrogate:


I searched the literature for a way to understand our relationship, one that is unprecedented in the history of human association. No writer or psychiatrist or medical ethicist offered an easy answer for how to behave. When Cathy told me that she considered the couple for whom she gave birth a year earlier as close as extended family, I wondered: Do we all have to have Thanksgiving together? If so, for how many years? And which husband carves the turkey?
Jeff Riedel for The New York TimesThe surrogates, Fie (left) and Melissa (right), with Kieran and Violet.

Melanie’s story shows that there is no one way to navigate these new emotional waters. (The addition of the surrogates’ voices — literally — to the article this time around is but one hint of that.) All parents are different; all families reflect those differences; throw reproductive technology into the mix and everything is amplified. Taken together, the two articles show that there are endless ways to blend love and science.

As Melanie writes:

I ONCE FELT a prick of an unpleasant emotion. It was the week the Fairy Goddonor came to Portland for the egg retrieval. Over tapas one night, I watched her and Michael laughing and suddenly felt unhappy. I poured myself more wine, but instead of dispelling the feelings, it made me feel more alone. “You were so quiet at dinner,” Michael said as we got into the car. He turned to look at me. “Are you not feeling well?”

“Is it weird that you’re having babies with her instead of me?”

“I’m not having babies with her. I’m having babies with Melissa and Fie.”

The conversation dissolved into laughter. That was the thing about our conception: there were too many players to be jealous of any one. And once we made the decision to have children this way, and put away regret, I felt happier embracing it than just tolerating it. There was even something I liked about the idea of a family created by many hands, like one of those community quilt projects, pietra dura, or a mosaic whose beauty arises from broken shards. If it takes a village to raise a child, why not begin with conception? When I tried to think about why I don’t want to have donor-and-surrogacy amnesia, it isn’t that it seems unfair to them (although it is), but that it erases our own experience of how our children came to be. At a basic level, the fact that our children originated through the good will of strangers feels like an auspicious beginning.

Oddly, the very aspects of third-party reproduction that others found threatening, I found reassuring. I wanted to avoid what I think of as the claustrophobia of the nuclear family. I wanted my children to have as many other influences as possible — to have other people teach them how to set up camp or shoot a basketball, as Melissa might; or how to say, “Thanks for the food; can I be excused from the table?” in Danish, as Fie insists her children do. I don’t know what the future will hold, and perhaps we will lose touch with them — we all agreed anyone can close the door at any point. But I hope not. If you consider third-party reproduction to be simply a production detail in the creation of a conventional nuclear family — a service performed and forgotten — then acknowledging the importance of outsiders could make it all seem like a house of cards. But if you conceive of the experience as creating a kind of extended family, in which you have chosen to be related to these people through your children, it feels very rich. At the twiblings’ first birthday party, there were lots of people who cared about them, but Melissa and Fie and their families were the guests of honor. And although the Fairy Goddonor was not there, we thought of her and sent her an antique gold charm of an angel hovering over a crib.

Melanie has responded to the overwhelming number of comments. You can read her response, and comment further, here.


Friday, December 3, 2010

Did the Pill Cause an Infertility Epidemic?

This week New York Magazine ran a cover story with the very sensational title “Fifty Years Ago, the Pill Ushered in a New Era of Sexual Freedom. It Might Have Created a Fertility Crisis.” And the accompanying cover photo shows a young woman sticking her tongue out, with a little white pill resting in the middle. Hard to miss. But for those of you who haven’t read it, the article claims that since the Pill was introduced in 1960, it made women so crazy with their sexual freedom that they somehow “forgot” to have children, until in many cases it was too late. In other words, the Pill may be responsible for the rising rate of infertility and the burden of expensive, high-tech fertility treatments. (Reminds me of those funny retro postcards with captions like, “Oh no, I forgot to have children!”)

I’m sorry, but I don’t buy it. For the last six years I’ve edited Conceive (a sister magazine to Parenting), a publication devoted to giving women the information and support they need to get pregnant when the time is right for them. The Pill doesn’t turn women into crazed sex maniacs or childless spinsters. It doesn’t do anything but give women more control over their lives, their careers, and their relationships by letting them plan their families. Is the article implying that it was better when women got pregnant accidentally at younger ages? True, there was less need for infertility treatment then—and fewer options available for those who needed it—but there were also a lot of women whose educations and careers were derailed by an inconveniently timed pregnancy .

No, the Pill doesn’t slow the so-called biological clock. But if women are waiting until their thirties—or later—when it’s more difficult (or too late) to get pregnant, it’s not the Pill’s fault. Rather, it’s due to a lack of widely disseminated information about general reproductive health, age, and fertility. I hope that schools are doing a good job of teaching teens how not to get pregnant, but I wish they also taught girls more about their reproductive system and how it changes over time so they’d understand better how to get pregnant when the time is right.

Authorities used to try to scare young women into celibacy by telling them that if they have sex they’ll get pregnant. The Pill took some of that away (although not the threat of STDs). But flipping that message to its reverse—if you don’t get pregnant when you’re young you won’t be able to when you want to—isn’t really the answer, either.

How about giving women reliable contraception and protection against sexually transmitted diseases AND accurate information about reproductive health, age and fertility? And then treating us like the smart adults we are and letting us make the decisions that are right for us and our families?

I am so grateful I had the tools I needed to avoid pregnancy before I was ready, and to conceive my son when my husband and I decided we wanted to be parents. I can’t imagine how my life would have been different if that control were taken away from me.

What do you think? Did you take the Pill? Do you think it influenced how long you waited to have children?

Wednesday, December 1, 2010

In-vitro UK pioneer Edwards wins medicine Nobel

STOCKHOLM — Robert Edwards of Britain won the 2010 Nobel Prize in medicine on Monday for developing in-vitro fertilization, a controversial breakthrough that ignited sharp criticism from religious leaders but helped millions of infertile couples in the last three decades have children.

Edwards, an 85-year-old professor emeritus at the University of Cambridge, started working on IVF as early as the 1950s. He developed the technique — in which egg cells are removed from a woman, fertilized outside her body and then implanted into the womb — together with British gynecologist surgeon Patrick Steptoe, who died in 1988.

On July 25, 1978, Louise Brown in Britain became the first baby born through the groundbreaking procedure, marking a revolution in fertility treatment.

"(Edwards') achievements have made it possible to treat infertility, a medical condition afflicting a large proportion of humanity, including more than 10 percent of all couples worldwide," the medicine prize committee in Stockholm said in its citation.

"Approximately 4 million individuals have been born thanks to IVF," the citation said. "Today, Robert Edwards' vision is a reality and brings joy to infertile people all over the world."

Steptoe and Edwards developed IVF from the early beginning experiments into a practical course of medicine and founded the first IVF clinic at Bourn Hall in Cambridge in 1980.

Today, the probability that an infertile couple will take home a baby after a cycle of IVF is 1 in 5, about the same odds that healthy couples have of conceiving naturally.

Prize committee secretary Goran Hansson said Edwards was not in good health Monday when the committee tried to reach him. Bourn Hall said Edwards was too ill to give interviews.

"I spoke to his wife and she was delighted and she was sure he would be delighted too," Hansson told reporters in Stockholm after announcing the 10 million kronor ($1.5 million) award.

"Louise's birth signified so much," Edwards said at Brown's 25th birthday celebration in 2003. "We had to fight a lot of opposition but we had concepts that we thought would work and they worked."

Brown, now 32, reportedly is a postal worker in the English coastal city of Bristol. In 2007 she gave birth to her first child — a boy named Cameron. She said the child was conceived naturally.

"Its fantastic news, me and mum are so glad that one of the pioneers of IVF has been given the recognition he deserves. We hold Bob in great affection and are delighted to send our personal congratulations," Brown said in a statement released by Bourn Hall.

The work by Edwards and Steptoe stirred a "lively ethical debate," the Nobel citation said, with the Vatican, other religious leaders and some scientists demanding the project be stopped. When the British Medical Research Council declined funding for Steptoe and Edwards, a private donation allowed them to continue their research.

The Vatican is opposed to IVF because it involves separating conception from the "conjugal act" — sexual intercourse between a husband and wife — and often results in the destruction of human embryos that are taken from a woman but not used.

There was no immediate comment from the Vatican's top bioethics officials Monday to word of the Nobel.

In a statement, Bourn Hall said one of Edwards' proudest moments was discovering that 1,000 IVF babies had been born at the clinic since Brown, and relaying that information to a seriously ill Steptoe shortly before his death in 1988.

"I'll never forget the look of joy in his eyes," Edwards said.

William Ledger, head of reproductive and developmental medicine at Sheffield University, called the award "an appropriate recognition" for Edwards.

"The only sadness is that Patrick Steptoe has not lived to see this day because it was always a joint team effort between the two of them," Ledger said.

Steptoe was not honored with a prize because Nobel rules were amended in 1974 to prohibit posthumous prizes.

Other experts criticized Britain for not honoring Edwards earlier with a knighthood.

"It's a shame Britain hasn't recognized him in a more explicit fashion," said Francoise Shenfield, infertility expert with the European Society of Human Reproduction and lecturer in medical ethics at University College London.

In an interview with The Times of London in 2003, Edwards said he was "not terribly bothered" about not getting a knighthood.

"I'm a very left-wing socialist and I won't shed a tear. But if you can organize a Nobel, please go ahead," he joked.

Aleksander Giwercman, head of reproduction research at the University of Lund in Sweden, said Edwards' achievements also provided tools for other areas of research, including cancer and stem cells.

"Many of the illnesses that develop when we are adults have their origin early on in life, during conception," Giwercman said.

The controversy over in-vitro technology has not dimmed despite its popularity. In the last few years, the increasing use of IVF has also raised discussions about what age it's appropriate to become a mother. In 2006, a 67-year-old Spanish woman became a mother after she used IVF technology to conceive twins, only to die herself two years later.

For more information, please visit: http://nobelprize.org/nobel_prizes/medicine/laureates/2010/press.html