Assisted Reproductive Technologies

More on the Curious Lives of Surrogates

April 18, 2008

Still more on the "curious lives of surrogates." From the NY Daily News:

[I]n real life, surrogacy is hardly a comedy, says Melissa Brisman, a New Jersey attorney who has helped more than a thousand couples through the process.

"Somebody who thinks it's a good way to make money would probably drop out when they see how much work is involved" says Brisman.

Before a woman is hired as a gestational carrier, she is subject to home visits to assess her suitability. After she is hired, she undergoes more than 90 injections to prime her uterus for in vitro fertilization.

Former surrogate and blogger Tina discusses the hard choices intended parents and surrogates must make.

Surrogacy is a hot topic in Japan, too:

A young woman cradles her baby boy, born from a surrogate mother, and describes how she stuffed fabric in her clothes to fake pregnancy so her neighbours would not know, a sign of the stigma surrounding surrogacy in Japan.

The woman’s own mother bore the baby for her daughter, who was unable to bear children of her own because she had no uterus.

“The doctors said she should train for a profession, be a career woman and not think about marriage,” the woman’s mother, her face hidden, tells a TV programme on surrogacy.

posted by Cheryl Miller | 1:39 pm
File As: Assisted Reproductive Technologies, Surrogacy

Infertility and E-patients

April 16, 2008

Susannah Fox at has a brief interview with Melissa of Stirrup Queens. (Full disclosure: I am mentioned, because of my "Blogging Infertility" article.) I was taken by this question in particular:

SF: In Miller's article, she writes about how infertility was a "silent disorder" and went on to talk about how this generation is no longer silent – do you agree? Has the internet had an impact on this "coming out" process? Related to that, have you taken inspiration or learned techniques from other formerly "silent" communities?

If you had asked me this question 2 years ago, I would have said that our generation is far from silent. But now, 2 years down the road, I can see the huge difference between speaking about it online and speaking about it face-to-face. The Internet makes discussion easy and it can be a misleading barometer of how open people are in the face-to-face world.

I think my generation is more "out"--that there are simply more of us that are willing to speak about it frankly and openly vs. my parent's generation. Which is not to say that everyone is open or that it is no longer a silent community. I think we're doing a good job connecting within the community and talking within the community and building in-roads within the community. And that is the first step. The next step is taking it outside the community, tearing down the stereotypes that are often presented in the media, having frank discussions in the same way we now do about other diseases that were whispered about years ago.

This conflict between privacy and exposure was something that fascinated me while interviewing the bloggers. When I first went in, I was a little skeptical about all the talk of raising awareness from these (mostly) anonymous bloggers. Many hadn't even told their families or friends. If you can’t even talk openly with the people closest to you, I thought, how are you going to educate the public at large? 

After talking with bloggers, I changed my mind. For one thing, my interviews made clear how difficult it is to be "out" 24/7 about your infertility. Who — and what — to tell is a question the infertile have to struggle with on a daily basis. Do you use every awkward exchange as a “teachable moment,” an opportunity to educate others about the 6.1 million people struggling with infertility? And who is appropriate to "educate": relatives you see once a year, co-workers, neighbors, total strangers who just happened to ask an innocent, but painful, question? During an interview, Gabrielle Sedor of Fertility Notes told me about how she was teased by co-workers who were unaware of her infertility. “Do you go into the whole story right there in the break room?” she asked me. “Or do you just let it slide?” And then there's the fact, as Melissa put it, that “infertility is about your sex life, and no one wants to hear about your sex life.”

Aside from that, I also began to see blogging more as an intermediary step in the way Melissa describes above. Blogging's appeal, I think, is much like that of the “Common Thread” bracelet: It’s discreet and public at the same time. Only those in the know will understand the bracelet’s meaning, and, only they — or at least that’s the common assumption — will be reading your posts about just how obnoxious your pregnant sister-in-law is. (A few of the bloggers even assumed I was infertile since they couldn't figure out how else I would have found them.)

Yet, many of the bloggers had started their sites as a way of building a movement and raising awareness. They weren't ready to tell just anyone about their infertility, but they still wanted to make a public contribution, to help educate. Blogging gives people a way of participating without necessarily becoming the "poster child" for a disease. It's a compromise of sorts. Also, there might be less need to "come out" since there are now so many public faces of infertility: Peggy Orenstein, Beth Kohl, Brenda Strong, and many others.

posted by Cheryl Miller | 4:47 pm
File As: Assisted Reproductive Technologies, In Vitro Fertilization

The Globalization of Baby-Making

April 15, 2008

Ellen Goodman has a fascinating column in the Boston Globe about the international surrogacy business. She writes:

[T]here is — and there should be — something uncomfortable about a free-market approach to baby-making. It's easier to accept surrogacy when it's a gift from one woman to another. But we rarely see a rich woman become a surrogate for a poor family. Indeed, in Third World countries, some women sign these contracts with a fingerprint because they are illiterate.

For that matter, we have not yet had stories about the contract workers for whom pregnancy was a dangerous occupation, but we will. What obligation does a family that simply contracted for a child have to its birth mother? What control do — should — contractors have over their "employee's" lives while incubating "their" children? What will we tell the offspring of this international trade?

I've been wrestling with this column for a few days now. On the one hand, I share Goodman's uneasiness. Maybe it's just the "yuck" reflex, but something seems wrong about paying a desperately poor woman to carry your child, espcially in "social surrogacy" cases. The entire thing just feels a little too much like The Handmaid's Tale to me.

On the other hand, my uneasiness about international surrogacy seems a little...luxurious, in a way that reminds me of the moral handwringing over Third-World sweatshops. Most of the protests over these factories did very little to improve the lives of the people working in them, and served in many cases to actually make them worse off — all so some well-off Westerners don't feel uneasy. (Needless to say, my inner libertarian is not happy with me.) One Indian surrogate used the money for her son's heart operation. Another explained her decision thus: "This is not exploitation. Crushing glass for 15 hours a day is exploitation. The baby's parents have given me a chance to make good marriages for my daughters." Who am I to decide crushing glass is somehow less "degrading" or "exploitative" than carry another woman's child? (For a similar argument, see Kerry Howley's post about egg donation.)

Yet, I'm not wholly satisfied with the libertarian argument. Goodman says that we have not had any stories of a surrogacy pregnancy gone wrong, and she is right that the media hasn't yet reported on any international cases that resulted in the death or near-death of a surrogate. But surrogacy can be a dangerous occupation, and too often women are not properly informed of the risks involved — as these two disquieting stories from Liza Mundy's Everything Conceivable attests. In one case, the intended parents wanted twins so they asked their surrogate, Ann Nelson, to transfer four embryos. Only two of the embryos "took," yet the twin pregancy put Nelson at increased risk for uterine rupture. She was also overweight and her prior pregnancies had been delivered by C-section. Despite these red flags, her doctor (independent of the agency) had cleared her to carry triplets. Nelson nearly hemorrhaged to death during labor, and her doctors had to perform an emergency hysterectomy to save her life. No one had informed the intended parents that this pregnancy might be risky, and even Nelson hadn't realized she might die as a result.

A good agency (and an attorney!), of course, will help to navigate many of these pitfalls, but even in a situation, like Nelson's, where no one was acting improperly, things can go wrong. My fear is that if American surrogates are often unaware of the risks involved, how can we ensure that women who are illiterate and desperately poor understand what they are getting into (and are not taken advantage of, as happened with these young Romanian women)? Which brings me right back where I started from...

RELATED: Stuart Rennie on "ready to consent" populations in Africa and India.

posted by Cheryl Miller | 11:06 am
File As: Bioethics and Medicine, Assisted Reproductive Technologies, Surrogacy

On Other Blogs

This Edition: pregnant men and male birth control, the ethics of egg donation, art and infertility
April 14, 2008

Tyler Cowen and Megan McArdle think the male birth control pill won’t be so popular.

William Saletan congratulates Pulitzer Prize winner Amy Harmon of the New York Times. Check out her coverage, "The DNA Age," here.

Infertility blogger Melissa (and one of my recent subjects) is named a top mommy blogger by the Wall Street Journal.

Art critic Laura Cumming on art and infertility (via Gabrielle).

Bioethicist Linda MacDonald Glenn asks how far reproductive autonomy goes.

Wesley Smith thinks the "pregnant man" story is no big deal.

Egg donation: Jennifer Lahl and Michele Clark say it's all about the money.

Reason's Kerry Howley: I too am a victim of human trafficking.

Maurice Bernstein looks at the risks and challenges involved in getting eggs for stem cell research.

posted by Cheryl Miller | 10:20 am
File As: Assisted Reproductive Technologies

Blogging Infertility

April 10, 2008

I have an article in the current issue of TNA about “infertility bloggers,” men and women who keep online journals about their struggles trying to conceive (or as they call it “ttc”):

As it has for people suffering from cancer or other illnesses, the blogosphere offers the infertile a place to chronicle their personal stories, create community, seek support, and raise awareness about their condition. “One of the great things about technology today is its democratization,” blogger “Bea,” of “Infertile Fantasies,” says. “You don’t have to be a professional writer or film school graduate to tell your story online—anyone can do it, and even if it’s of interest to only a small percentage of people in the world, they can find you.” (Throughout this essay, bloggers will be identified by their noms de blog—whether their real names or pseudonyms.) These blogs offer a unique perspective on the lives of infertile men and women, revealing the many ways the infertile are tackling the tricky questions reproductive technology poses: What does it mean to be infertile? If treatment succeeds, what, if anything, do you tell your family, your friends, and the children you have conceived? When, if ever, should one give up on fertility treatment? And, perhaps most importantly, how do these technologies transform our understanding of what it means to be a family?

The intersection of medicine and the Internet has been getting a lot of attention lately; interested readers might take a look at a recent article in the New York Times Magazine, “Practicing Patients,” about the website I focused more on the emotional support side to patient blogging than the medical, which I found less problematic than the author of the NYT piece. (Although, I must say cyberchondria is my new favorite word.) Most of the bloggers I interviewed had tried some things that were probably not medically sound—mostly herbal medicine and other “natural” remedies—on the basis of an ecstatic blog testimonial or two. But no one used the blogs or other infertility-related sites to replace their doctor and his/her advice. The Web served more as a supplement, particularly about things a doctor might not think about: e.g., How do I give an injection and not leave an ugly bruise? How can I best pack my meds for an overseas trip?

That said, participatory medicine does have a downside. Not everyone is as responsible (or as reasonable) as the bloggers I interviewed—as the ongoing blog debate over mandatory vaccinations and autism has amply demonstrated. Doing "yoga for fertility" or drinking Chinese herbs might not help you get pregnant, but it certainly won't harm you (well, maybe just your bank account) or anyone else. Encouraging people not vaccinate their children (I'm not linking since these people don't need any encouragement) leads to things like the mumps outbreak in Iowa last year that infected 219 people.

RELATED: I am interviewed here about infertility bloggers by TNA’s own Adam Keiper.

posted by Cheryl Miller | 8:52 am
File As: Assisted Reproductive Technologies, Autism