EVERYTHING CONCEIVABLE: HOW ASSISTED REPRODUCTION IS CHANGING MEN, WOMEN AND THE WORLD By Liza Mundy Alfred A. Knopf, 416 pages, $24.95

Reviewed by LAURA LLOYD

A newspaper in late 2007 featured a photo of 12 women in saris wearing surgical masks. They are surrogate mothers in an Indian hospital that is set up to take care of them, offering the best foods and the most comforts as they progress toward parturition. They are the very valuable carriers of fertilized eggs of infertile American women. They will be handsomely paid for their trouble, much more than if they worked in the call centers of U.S. companies. These women may be the ultimate in outsourcing: Third-World bodies that can perform the elemental functions of human life, housing First-World babies that require the ultimate in technological intervention to come into being.

This news story describes just one of the many types of mediated reproduction described in Everything Conceivable, How Assisted Reproduction is Changing Men, Women and the World by Liza Mundy, Washington Post feature writer. She shows how American women will often put up with a huge array of medical tests and expense to have the joy of a child, no matter what it takes. In clear, readable prose, using vivid anecdotes and descriptions, Ms. Mundy lays out her basic thesis: Our complex civilization has made hefty demands on Mother Nature in the realm of reproduction. The price is greater and there is more scientific intervention in what should be an eminently natural process, having a baby.

Ms. Mundy notes that the Catholic church is opposed to IVF and its attendant practice of selective reduction, where multiple eggs are implanted in offering polemic support for a particular moral perspective, and she performs a useful service by describing a moral universe that has taken shape seemingly while we slept. She shows how the genie of assisted reproductive technology (ART) is already out of the bottle and what is likely to happen because of that. She notes that the reproductive drive, however altered by technology, is so strong that couples are likely to avail themselves of whatever options are available as long as they are legal.

What are some of these reproductive choices? Most informed readers will have at least a passing familiarity with the best known of these: egg donation, lesbian motherhood through artificial insemination, fertility hormones, surrogate motherhood, gay fatherhood through surrogacy, IVF. These are the main foci of her discussion. She notes that it is not yet possible to genetically enhance a fetus: The designer baby remains a fantasy of the future. She discusses issues such as children who are never told who their genetic mother or father is, families in which fetuses are “deleted” in order for the mother to be able to carry only twins or triplets.

And she talks about the steep price in the health of babies born very early, often as part of multiple births engendered by IVF and other fertility techniques.

Despite Ms. Mundy’s dispassionate approach, there is much in this book to nag the consciences of thoughtful individuals.

She adds some titillating information about the likely technology involved in the epidemic of middle-aged Hollywood mothers of twins (in vitro fertilization) and other public figures who have become mothers in late middle age. One of her bottom-line facts is that maternal age is the absolute enemy of female fertility and that women are getting married later and trying to conceive later than ever before. Most women can conceive relatively easy before 35 years of age. After that, the incidence of viable pregnancies begins to slip. By their early 40s, women desiring to have babies may well have to resort to the high-tech aid that presents moral, financial and medical dilemmas, she says. Still older women must definitely rely on egg donation because the numbers of viable eggs that they carry has slipped to a small quantity.

The question of what to do with all the frozen embryos that have accumulated as a result of in-vitro fertilization is one issue that Ms. Mundy spends quite a few pages discussing. She says that it won’t be long before one million such embryos are stored in fertility clinics. Her book is not totally up-to-date on embryonic stem-cell research; recent advances that obviate the need for embryos means, if nothing else, that there is no secondary purpose for the forgotten embryos. A few are adopted, Ms. Mundy writes, but, for the most part, they live in a scientific limbo, nagging the consciences of more than a few thoughtful individuals.

Everything Conceivable makes the science of fertility easily accessible. Ms. Mundy presents the problematic moral dimensions of assisted fertility in clear terms. She shows compassion for the mothers and fathers who submit to multiple tests, spend large sums of money and sometimes only have a tenuous genetic link to their unborn children. She notes that, like it or not, the definition of the American family is expanding and thinks it inevitable that women, enjoying equal rights, will decide to conceive at different ages, sometimes necessitating help from hormones or other interventions. Yet when evaluating all the births that can’t happen on their own, there is a sense that our complex, advanced world has made a mess of conception, something that is supposed to be even a bit too easy.

Laura Lloyd is a freelance writer and the mother of three daughters.

National Catholic Reporter, February 8, 2008