Book review: Everything Conceivable (or not an Advent post)

Everything Conceivable: How the Science of Assisted Reproduction Is Changing Our World

This book by Liza Mundy is a fascinating look at infertility treatment and artificial reproduction today. It gives a very thorough look at all the different ways people can have babies today: IVF, ICSI, IUI, surrogacy, donor eggs, donor sperm, adopting embryos, etc. I thought I understood what was available fairly well before reading this book, but I was wrong. There’s a whole lot in the infertility world I had no idea about.

Mundy does a good job of juxtaposing  scientific explanations of the treatments with stories about real couples who are going through treatment. It makes the technical become personal and makes for a good read. She also talks about the history of how these techniques have developed and evolved.

She does less of a good job in exploring the ethics surrounding these issues. She seems to want to be neutral and just tell the stories without making judgments. However, she clearly is writing from a pro-choice position and portrays those who are pro-life as being on the fringes of society. So for example, the chapter on “selective reduction” deals with when it’s ok to “reduce” an embryo. For gender? For genetic diseases? 3 down to 2? 2 down to 1? But she comes at it with the assumption that “selective reduction” itself is ethically fine.

Mundy does point out that different groups within the pro-choice and women’s rights communities are at odds over infertility treatment and ethics.  Some want to emphasize choice above all, no restrictions ever on reproductive rights. Ever. At all. Get your hands off my uterus. But Mundy points out this brings up questions like can a woman choose to have as many embryos as she wants implanted at once, despite the risk to the babies? Do children born from egg donation or sperm donation have the right to know about the details of their conception? To have the opportunity to meet the donor? As Mundy says, “What happens when the rights of the child conflict with the rights of the parent? Whose reproductive freedom is it?”

As someone who is pro-life I come at the issues from a different perspective than Mundy. I have always had some real concerns with fertility treatments. I believe in medicine and science and I believe God gives us medicine as a gift. I don’t have a problem with medicine or science helping with infertility. I don’t see it as “playing God”. However, I do think the infertility  industry (and it is a huge commercial industry) has been allowed to develop in a culture where there are no limits. Or at least very few. The prevailing ethic seems to be that of choice above all other considerations. Mundy sums up the problem like this:

There were moments when it seemed to me that two modern ways of thinking about parenthood – an absolute commitment to reproductive liberty under all circumstances, and a trend toward compulsive micromanagement of every aspect of our children’s lives- sometimes persuade would-be parents that they are entitled to pursue any avenue of reproductive technology and to determine every aspect of the outcome.
And the ironic thing is- for me, this was a key revelation- determining the outcome is exactly what can not be done. Assisted reproduction is, often, the least controlled form of reproduction imaginable. That’s what we should be taking away. Situations never turn out the way patients expect them to.

Mundy does a good job of pointing out that this ethic of choice above all is problematic, to say the least.

The ethical issues in this book aren’t easy and aren’t black and white. But they are here to stay. If you are interested in bioethics I would definitely recommend it. Even if you aren’t that interested, I’d recommend it. A warning though, if you are pro-life and very sensitive this is NOT the book for you. There are some graphic descriptions of certain procedures that may upset you. ( Mom, that means you,  do NOT read this book.)

I was acutely aware while reading this book while nursing my third child who is not yet three months that I really have no idea what the women and couples in this book have gone through. I’ve never experienced infertility and I can only  imagine the pain and heartache that goes along with it. It’s easy for me to think in my head where I might draw the line ethically if I was in their shoes, but the reality is I have never been nor ever will be in their shoes. That was a good lesson for me and in itself worth the time spent.

6 thoughts on “Book review: Everything Conceivable (or not an Advent post)

  1. Interesting review. This is such a thorny issue! We have the ability now to do so much that [I believe] we shouldn’t, and the temptation can be so huge and also so understandable… I met a mom at preschool last year who learned to her enormous shock, after the birth of her healthy first child, that she and her husband were both carriers of…cerebral palsy? cystic fibrosis? maybe something else–but in any case it was a major disorder and all their children would have a 75% chance of having (not carrying) whatever it was. Consequently, she and her husband decided to use some sort of genetic screening before trying to conceive again and eventually had twin boys. The only way I know of that that screening could work would be to fertilize several eggs and do genetic testing on the embryos and only implant the–I guess it should have been 25%ish–ones that were not affected with the disease. Is there any other way? To me that’s such a sad thought…and yet, I can so understand her desire for more children, and see how hard it would be to pass up an opportunity to have them without the looming probability of their inheriing a life-altering and -shortening disorder. I don’t think it’s the right choice, but it could be very tempting. Your thoughts?

    • Totally agree. You are right in how they do it, create embryos by IVF and then do genetic testing by removing a cell from each embryo and testing it. I agree that it’s not a procedure I agree with, although I have great sympathy for why someone would want to use it. The book brings up an interesting twist on this procedure in that it’s now possible to do genetic testing for a lot of conditions, some of which are not lethal and some of which might not even effect the person until adulthood. For example, breast cancer. Or blindness. The author of the book talks about how even amongst those who have no problem selecting embryos to avoid a lethal disease, many have real problems with selecting to avoid something like breast cancer (that won’t occur until adulthood and is treatable). But there aren’t real guidelines in place. So once again we’re stuck with the question of whose choice is it and where should the line be drawn if at all. The major issue I have with all this is that the more a procedure is allowed to exist without guidelines, the more the envelope gets stretched and the harder it is to draw those guidelines.

  2. Pingback: Saturday Review of Books: December 5, 2009 : Semicolon

  3. I find this post so interesting as a doctor’s wife, a pro-life Christian, a woman who has experienced the grief of infertility (including an adoption attempt), and now the mother of IVF twins. Thank you for your kind treatment of the topic. It is an awful, often unrecognized grief. We were thankful to have a Christian doctor (although we didn’t know he was a Christian at the time!). We hadn’t planned to do IVF because of moral concerns. When nothing else worked, our doctor carefully walked us through the issues so that we understood how we could do IVF without compromising our beliefs. God was very clearly in our journey. I worry, too, about the lack of limits – and so does our doctor! There are some reproductive endocrinologists out there trying to establish guidelines for self-regulation within the specialty. Pray for them!

    • Good points. Reproductive endocrinology is one of those fields that is definitely not for me, but that I’m so glad there are good caring ethical people involved in.

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