Free-market baby making

Gregory Pence has been teaching bioethics at the medical school at the University of Alabama in Birmingham for 33 years.

Thirty years ago Friday, Louise Brown came into the world amid alarmist predictions that her birth would end sex. Jeremiahs such as writer Jeremy Rifkin wailed that in-vitro (“under glass”) fertilization would harm the future Louise. Bioethicist Leon Kass then warned that in-vitro fertilization (IVF), by sundering the bonds between the act of sex and conception, would damage families.

Because of such fears, when Louise’s parents walked down the streets of their English town in 1978, their neighbors fled, expecting something scaly or monstrous to be in the baby carriage. When they saw a normal baby, their fears disappeared. “IVF is just helping nature along a bit,” Louise’s father told them, correctly.

Since then, assisted reproduction has helped along hundreds of thousands of American babies. According to 2005 data from the Centers for Disease Control and Prevention, assisted reproduction helped create more than 50,000 American babies that year alone.


The Vatican perversely persists in condemning IVF, but it is hard to see the wisdom -- or any sense of compassion -- behind that thinking. Perhaps no children in history have been so wanted.

Of course, things aren’t perfect. Children conceived through IVF have a slightly elevated rate of rare birth defects. It is still not clear why; it could be because of the older age of the eggs and sperm of the parents. But 99% of IVF kids, just like Louise Brown, are born healthy.

Although infertility clinics advertise great rates of success, real figures often disappoint. Few states require insurance companies to cover IVF, and the costs run about $8,000 or more for each attempt. Most couples try two or three times but end in failure. In fact, CDC statistics show that only about 25% to 30% of couples using IVF take home a baby, and if the woman is older than 35, the likelihood is worse.

So physicians have looked for new approaches. The next best tool is using eggs of young women. Such eggs, fertilized by sperm from the older man, create an embryo that can be gestated by the older woman and has a genetic connection to the father. For women over 40, this procedure dramatically increases their chances.

New medical -- especially fertility -- techniques are often reported in sky-is-falling prose. In 1969, Warren Kornberg, editor of Science News, wrote that ethical questions about assisted reproduction, cloning and human genetics outweighed ethical questions raised by atomic bombs. Whether it is with sperm donations from geniuses, egg donation, babies from thawed eggs, babies from frozen embryos or a baby from a medically twinned embryo, alarmists always predict that the next new technique will take us down the dreaded slippery slope.

Looking back, the alarmism cloaked the real issues, which concerned money. The first involved deception, fraud and greed. Throughout the 1980s, Dr. Cecil Jacobson of Fairfax, Va., used his own sperm instead of the intended fathers’ to create as many as 75 embryos. He went to jail for it in 1992. In the mid-'90s, Dr. Ricardo Asch at UC Irvine was caught switching donor eggs without women’s consent. Asch fled the country to avoid prosecution. The U.S. legal system expunged these fraudulent physicians; further laws wouldn’t protect consumers.

There is another issue about money here. Deeply affecting research in assisted reproduction, Congress in 1974 banned the use of federal money in research involving human embryos, a ban that continues.

For such research to occur, then, it had to be done in private clinics that accepted no federal grants but instead got all of their money from client fees. Early on, critics doubted that couples would pay for IVF, especially if their chances of creating a baby were low. The last three decades proved the critics very wrong.

A primal human desire may exist to create a child of one’s own. In 1978, most insurance companies resisted paying for IVF as too expensive or frivolous, and critics thought that would halt the practice altogether. Fortunately, couples enjoy the freedom to spend their money as they choose to buy reproductive help. So, in trying to conceive a child with IVF, some couples drove 15-year-old cars, rented apartments rather than bought houses or went without vacations.

Wholly unintentionally, the U.S. ban on federal funding jump-started innovation in assisted reproduction. One byproduct of the ban was that the National Institutes of Health and ethics committees had no mechanism for regulating research in these private clinics. In Europe, assisted reproduction has always been subject to strict government oversight, and as a result, few innovations occur there. Those in the U.S. opposed to assisted reproduction miscalculated -- and wound up creating one of the fastest-growing areas of American medicine fueled, in part, by competing private clinics.

The experience of 30 years teaches us two things: first, discount alarmism about assisted reproduction and embrace (don’t fear) new ways of making babies. Second, let the market, not government, regulate baby making. One final note. Last year, Louise Brown had her own baby, without assisted reproduction, proving yet again how natural she is.