By Sheryl Gay Stolberg
There is perhaps no more unsettling noise in medicine than the sound of infertility specialists tinkering with the biological clock. Witness the ethical uproar over their latest technological triumph, the apparent reversal of menopause in a 30-year-old ballerina who suffered from ovarian cysts. Doctors removed her remaining ovary, froze the tissue, and, two years later, reimplanted it. Now, they say, she is producing eggs again.
The ballerina story follows the same plot line as every other tale of modern baby-making, a genre that began in 1978 with the birth of the first test-tube baby, Louise Brown. The drama typically unfolds as follows: Whiz-bang scientists develop new technique (in vitro fertilization, donated eggs, frozen eggs, frozen ovaries) that makes it possible for childless woman (subtext: old childless woman) to conceive. Media circus ensues. Ethicists ponder potential abuse. Media circus subsides. Family life goes on.
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Indeed, the most remarkable thing about the supposed end of the biological clock may be just how unrevolutionary the reproductive revolution has been. It has, of course, created legal and ethical quandaries King Solomon could never have envisioned, like who gets custody of the frozen embryos when the couple gets divorced? And it's true that parents' night at some preschools are beginning to resemble grandparents' night. But as Barbara Katz Rothman, a sociologist at City University of New York, says, babies still wet their diapers. "Kids still need help with their math homework. And the social order has not particularly changed."
Far more people have babies the old-fashioned way. In 1997, the most recent year for which statistics are available, 24,582 babies were born in the United States as a result of in vitro fertilization, which accounts for most births through assisted reproductive technology. That is six-tenths of one percent of the nearly 3.9 million babies born that year. Among 45 to 49-year-olds, according to the National Center for Health Statistics, the birth rate was 4 babies for every 10,000 women. That is less than the rate in 1970, when it was 5 babies per 10,000.
Why then, does the technology provoke such a visceral reaction? Scientists who stave off death are cheered on, but decried when they try to create new life.
Certainly, the new technology raises the prospect of redefining sacrosanct notions of motherhood, work and family, and redrawing old images of fertility and youth. It also raises a double standard; the idea of older mothers seems much more problematic than the reality of older fathers, perhaps because older fatherhood doesn't necessarily require tinkering with nature.
The biological clock has always been predicated on the cold, scientific fact that a woman's eggs deteriorate as she ages. Science has not yet put the clock out of business, but it could, and that's what gets some people nervous. A LREADY, egg donation, in which a patient conceives with another woman's eggs, has made it possible for women -- at least those who can afford the steep fees -- to spend more time building a career, or looking for the right mate, before having children. It has also made fatherhood possible for gay men, using egg donors and surrogate mothers, to have families. The promise of egg freezing is even more sweeping. Imagine an 18-year-old girl banking her eggs. She could finish college, medical school, train in a specialty and start a practice before settling down to have a family with her own, younger and presumably healthier eggs.
"We are developing the potential to redefine some of the most basic elements of human life," said Kevin Wildes, who teaches medical ethics at Georgetown University. "All kinds of couples who could not have children before can have them now. We just have no way to think about this stuff."
And so it is over-analyzed, and science-fictionalized. Last week, 3,700 doctors and researchers attended the annual meeting of the American Society for Reproductive Medicine in Toronto. More than 1,000 papers were presented. Only the ovary story, about an Arizona woman, made news.
Never mind that, at 30, the patient is five years younger than the current cutoff for "advanced maternal age" or that she is not pregnant. Never mind that the procedure is meant to preserve ovarian function in cancer patients who face infertility as a side effect of chemotherapy, and that transplanting ovaries from one woman to another probably isn't feasible now because of organ rejection. The mere flicker of the idea that lost fertility might someday be restored was enough.
"We get the old backlash of 'This is God's will that this couple is infertile,' " said Pamela Madsen, the mother of two boys by in vitro fertilization and head of the American Infertility Association, a New York advocacy group. "We don't say this about any other disease. No one says to a woman with breast cancer that this is God's will. We say, 'Let me find you the best doctor in the world. I heard about this new technique; it's experimental. Let's try it.' "
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| Science is poised to recast the old image of motherhood. |
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Infertility doctors also invoke the metaphor of disease.
"We try to facilitate nature and to correct what is abnormal," said Dr. Zev Rosenwaks of Cornell University. "It is no different than the doctor who treats diabetes with insulin."
Yet some doctors are conflicted. As they push back the age at which women can conceive, some worry they are sending a dangerous message to would-be mothers: that they can wait to have children because technology will be there to save them when they are ready.
"I call it my 'Connie Chung campaign,' " said Dr. Maria Bustillo, referring to the newscaster's much publicized 1990 announcement that, at age 44, she was cutting back on work to pursue "a very aggressive approach to having a baby." In the United States, said Dr. Bustillo, 2.4 million couples experience infertility that has nothing to do with eggs that deteriorate because of age. "We should be using this technology to help the truly infertile," she said, "not just people who are infertile because they are 45." And the truth is that treating infertility is indeed different than treating diabetes. When a doctor treats a diabetic, the treatment ends with the patient, says Paul Root Wolpe, a fellow at the University of Pennsylvania's Center for Bioethics. When a doctor treats an infertile woman, he said, the treatment "will affect future generations, and that is what evokes the greatest fears."
Tinkering with reproduction, of course, is not entirely new. The first successful artificial insemination was reported in 1790, according to the reproductive society, although it did not become common until the 1960's, when doctors learned how to freeze sperm. There was little outcry at that time, Dr. Wolpe said, in contrast to the current furor over egg donation, where questions have been raised about everything from what to tell the children to whether the donors are being overpaid. This gender gap has long characterized the public discussion over babies conceived in the lab. Two years ago, when a 63-year-old woman gave birth through egg donation, people expressed shock, and complained it was unfair to the child. When the actor Tony Randall became a father at age 77, most people looked on with bemused appreciation.
It is easy to envision the ways that infertility research might operate as a great technological force for women's liberation. But some argue that scientific baby-making can be as much of a trap for women as it is a path to reproductive freedom. When there was little recourse for infertility, women were forced to mourn that loss and then make other choices, whether adoption or childlessness. Now, modern medicine, with its boundless opportunity, makes what the psychologists call "closure" virtually impossible. As infertility specialists continue to refine their techniques, some patients feel pressure to keep trying, no matter how slim the odds.
"There is always another specialist, another procedure, another technique," said Hilary Hanafin, a psychologist at the Center for Surrogate Parenting and Egg Donation in Beverly Hills, Calif. "I had a woman come in the other day, she's 53. She spent 10 years and $100,000 on things that did not work."
The real challenge for women may be one that Betty Friedan, the feminist author, posed last year. On the one hand, Ms. Friedan said, it's wonderful that science has offered women the flexibility to alter the seasons of their lives. "On the other hand," she mused, "somehow I don't think it's cutting edge. It still assumes that the major defining value for women is the having of children. If we are going to have, as the statistics indicate, a good 80-year-life span, is the only thing to do with those new years of life the things you did when you were younger?"