Reproductive technology, though still nascent and geared toward infertile couples, is moving rapidly into an era of wider commercialization.
Sperm is routinely bought for $35 and frozen, then sold and shipped by overnight courier across the country.
Human eggs now can be ”donated” anonymously, for a $1,200 fee paid to the mother through the hospital where the process occurs, and fertilized eggs or embryos can be transferred from womb to womb as a commercial babymaking service.
Researchers expect to discover soon a method of freezing eggs for long-term storage. If that works as well as frozen sperm, women building a professional career could pay to store their own eggs and need not worry about the ”biological clock” that limits fertility. They could mother a child when it became convenient to do so.
A Los Angeles area woman, Melia Josephson, gave birth last month to a child conceived in a glass petri dish with a stranger`s sperm and another woman`s egg and then implanted in her womb. After nine months, she handed over the 7-pound, 3-ounce baby girl to the woman who supplied the egg, and she is using her $10,000 surrogate fee for a down payment on a backyard swimming pool.
The debate over reproduction is drawing zigzag patterns across moral, ethical and legal lines, but there is one shared concern: How commercial will babymaking become in this society?
The new biology remains limited, but there is increasing pressure to expand and market medical procedures and human baby material.
”We were in a way caught offguard,” says Susan Wolf, who specializes in reproductive issues and the law at The Hasting Center, a bioethical think tank in Briarcliff, N. Y. ”Almost all this technology has developed in the private sphere . . . so now we have to ask how can we control the fees so children do not become commodities.”
The prospect of businesses and promoters dealing in eggs, sperm and embryos, or scheduling the use of available wombs, is alarming to those who prefer the mystery or romance of the bedroom and the magic of conception in the body. But, medical ethicists also recognize, this is a society that reveres technology almost as much as it does free market enterprise.
The primary focus of this marketing is infertile couples and single women, so far.
At present, only a fractional number of births, little more than 100 a year, comes from a new contractual relationship society calls surrogate motherhood. A more significant number, about 30,000, resulted from clinical procedures to inseminate a woman with sperm either from her husband or from an anonymous donor.
The overwhelming majority of the 3.7 million babies born in the United States last year were the result of romantic love, or at least sexual union between a man and a woman.
Louisiana is the only state so far to have banned surrogacy, though more than 25 other states are considering bills to ban or to regulate it. Otherwise, there has been no significant new legislation to limit
commercialization.
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While the birthrights of the next several generations may be radically altered by the ethics and economics of the new technology, these are the current costs:
— Sperm costs between $50 and $85 a sample. The seller, or ”donor,”
receives from $25-$35. There are more than 100 million sperm in each donation, enough for 5 or more inseminations. There are 27 commercial sperm banks in the U.S., but hundreds, if not thousands, of doctor`s offices and hospitals have tanks of liquid nitrogen to freeze sperm.
— Women who donate eggs under a new program at the Cleveland Clinic will receive $1,200 for their time and inconvenience during the procedure of hyperovulation and extraction, which could take up to 12 days.
— The price of surrogacy has remained fairly constant at about $10,000. It has not changed in this decade, despite inflation, though fees for lawyers and doctors have increased. There are an estimated 25 professional surrogate brokers in the nation, though Noel Keane, a lawyer from Dearborn, Mich., who also has offices in New York City, is the undisputed leader in the field.
Considering that surrogacy is a nine-month job, the fee works out to below minimum wage, about $1.54 an hour, for the gestating female.
— Adoption fees range from nominal payments to public agencies to as much as $50,000 for a healthy white baby. Despite laws against baby-selling, there are networks of lawyers and doctors who spot pregnant women who do not want to keep their babies.
— Fees for the physicians and hospital care and surgical procedures using new babymaking technology can be costly: In-vitro fertilization (IVF), or the uniting of egg and sperm in a glass petri dish in the laboratory, costs between $3,000-$7,000 for each attempt. It is rarely successful on the first try. The gamete intra-fallopian transfer (GIFT), the surrogate embryo transfer (SET), and artificial insemination all have their own price schedules, from $500 for the simplest procedure to more than $5,000.
— In the sperm marketplace, there are prices for ”sperm swim-ups” to select the hardiest or ”best” sperm ($75), and sales of over-the-counter
”gender kits” ($20) or more sophisticated sex-selection tests ($150)
available only in the laboratories to pick out the male or female chromosones. (The ability to select sex is hotly disputed. While some claim up to 70 percent success in picking sperm with male chromosones, the chances of having either a boy or girl are still 50-50.)
The more sophisticated laboratories ship sperm packed in dry ice via overnight delivery for home insemination. Both the California Cryobank and Idant Laboratories in New York, a company once called the Chase Manhattan of sperm banks, ship their sperm to Canada, Europe and South America.
Much of the technology has been directed at upper middle-class couples and single women who yearn for a child from their own genes.
Marketing forces are at work, however, and doctors at the Burlington, Vt., University Health Center last month cut back prices to $3,000, down from $7,000, for one treatment for in-vitro fertilization and to $3,000, from the original $4,500, for the GIFT treatment.
The 1-year-old infertility program had tried to help 20 women conceive and had failed. They claimed the program was hampered by the small number of people who can afford to participate, so they were lowering prices to get more clients–and therefore more experience.
There also have been efforts to patent medical procedures dealing with infertility, such as methods of operating that are uniquely suited to retrieving eggs. Most of those procedures, however, are ”on the fringes of medicine,” said Gary Ellis of the congressional Office of Technology Assessment.
One commercial venture was begun by two Chicago brothers, Dr. Randolph Seed and Richard Seed, and they called their company, Fertility and Genetics Research Inc. The Seeds` idea, called the ”non-surgical ovum transfer,” was to remove fertilized eggs from a fertile donor and introduce them to an infertile woman. The company holds a patent on a special catheter needed to recover the fertilized egg, and it has three patent applications submitted for the process itself.
In March, however, the company announced to shareholders that the new GIFT procedure may be preferable to its own, especially because it doesn`t require artificial insemination. Company chairman Lawrence Sucsy said they would not try to establish free-standing ovum transfer centers, as they had previously announced, but would continue to license the procedure to clinics and hospitals.
The history of reproductive technology, indeed all technology, is filled with hope and failure.
”But you can also sell false hope,” said Ellis, a reproductive biologist who is directing an 18-month study of in-vitro fertilization for Congress.”What else do you call it when an IVF clinic that hasn`t delivered a baby will continue to take in 30 new infertile couples a year?”
”A lot of this gets muddied by the money issue,” suggested Dr. Selwyn Oskowitz, a Boston fertility specialist who uses the GIFT method. ”If you used the same technique and had the same results without the transaction of large sums of money, we would look at it differently.
”But you have to look at the financial and commercial aspects,”
insisted the doctor. ”It`s the same with sex; it`s a beautiful thing, but as soon as there is an exchange of money for it, it becomes different and maybe illegal.”
Much of the public criticism of the new techniques was prompted this year by the Baby M case. In that controversial court decision, Mary Beth Whitehead, the surrogate mother, lost custody of the baby she had agreed to bear in exchange for $10,000, before she changed her mind.
Whitehead, who last week announced she was separating from her husband, is appealing the decision, and the New Jersey Supreme Court will review the case next month. Catholic bishops, feminist leaders and Resolve, the nationwide support group for the infertile, among others, have filed motions with the court as interested parties.
Most surrogate arrangements, however, do not end in such a melodramatic and bitter court battle.
”I know well 15 to 20 surrogate arrangements, and they are happy children who had happy surrogate mothers,” said Dr. Cappy Rothman, a fertility specialist and director of the California Cryobank in Los Angeles.
He recalled this scene to illustrate his point: ”One man came to me to have a second child, and he wanted the same surrogate mother. So I got them together again and when he came into the office, he asked me if he should show the picture of the first child to the surrogate. I said yes, why not?
”So the man pulled out his wallet, took out picture and asked the surrogate to `take a look at our new son.`
”The surrogate mother looked, and then from her purse she took out her wallet and a photo and said, `Take a look at our new house.`
”So, you see, it was a blessing for all parties.”
Not everyone takes such a sanguine view.
”The brokers should be tightly regulated,” said Priscilla Alexander, a member of the panel discussing surrogate motherhood at a recent convention of the National Organization for Women. ”The brokers, who make money off of contracts, are, in a sense, pimps, just like in prostitution.”
That is a theme often heard among feminists.
”It is effectively creating a whole new traffic in women,” said Janice Raymond, a University of Massachusetts professor and member of the 700-member Feminist International Network Against the New Reproductive Technologies.
Gena Corea, author of ”The Mother Machine,” condemns the commercialization, drawing a parallel with the worldwide marketing of baby formula that created disaster in some Third World countries by replacing available mother`s milk with an expensive and hard-to-obtain product.
”There`s a strong motivation to expand the markets,” said Corea, ”so if there are not enough infertile women, then expand the definition of what is an unhealthy egg.”
She worries that businesses will one day tout services to select only the best eggs or sperm and try to lure couples who are not even infertile in order to create more business.
A related concern for those in the right-to-life movement is the increasing use and sale of fetal tissue for experimentation on diabetes and for transplant surgery to relieve symptoms of Parkinson`s disease.
Though legal, the experiments are controversial, and some researchers in Chicago and elsewhere in the U.S. have had difficulty in obtaining the tissue from aborted fetuses. The major research so far in Parkinson`s disease, especially using fetal pancreatic tissue, has been in Sweden and Mexico.
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There are some voices trying to strike a middle position in dealing with the new reproductive technology.
Dr. Wendy Chavkin, director of the New York City Health Department`s bureau of Maternity Service and Family Planning, suggested to a congressional panel that ”if we disallow fees for eggs, sperm, uterus use, babies and brokers, we reduce opportunities for economic exploitation while keeping the door open for medical innovation.”
”Commercialism is a problem; that`s why we`re not involved in surrogate arrangements,” said Dr. Antonio Scommegna, a nationally recognized fertility specialist and director of Obstetrics and Gynecology at Michael Reese Hospital in Chicago.
Though it has not yet been fully accepted, Scommegna has suggested that the partners of infertile persons contribute to a nationwide egg and sperm donor network.
”They are the most motivated,” he said.
The National Council of Churches promoted a policy supporting ”genetic science for human benefit,” but it warned against relationships such as surrogacy and some reproductive techniques that might have a negative effect on family life and values.
The American College of Obstetricians and Gynecologists took its own stand on commercialization of surrogacy and recommended that the physician should receive only the usual fees for his medical service, and not any referral fees, and also ”should not participate in a surrogate program where the financial arrangements are likely to exploit any of the parties.”
Far from exploitation, Dr. Rothman believes the technology is actively helping society better itself.
”We practice negative eugenics; we try to eliminate defects,” said Rothman. ”The so-called Nobel Sperm bank set everything back, it created such uproar, but that was about positive eugenics.”
Eugenics is a controversial concept to improve the race by selective mating. Rothman was referring to the Repository for Germinal Choice, in Escondido, Calif., founded in 1980 by Robert Graham, who looked for donors among Nobel Prize laureates and later included athletes among his donors.
”A nonprofit system for gamete (a mature female egg or male sperm)
collection and distribution in the United States would be ethically preferable to the current system,” the College of Obstetrics and Gynecology suggested last year.
The professional group said such a system ”would reduce the incentive for gamete providers to withhold information in giving their medical histories, and it would reduce the likelihood that commercial banks will make extravagant claims for their products.”
Rothman said his sperm bank, with its more than 30,000 specimens, is more modest.
”We`re not being demagogic, or trying to create a new race,” he said.
”We`re not dealing with Frankenstein here.”
Jeremy Rifkin, a liberal public interest lawyer in Washington who is opposed to much of the biotechnology and genetic engineering experiments, sees it differently: ”We would not allow people to sell their corneas and kidneys. We don`t allow people to sell body parts just for profit. It`s exploitative, inhumane and barbarous.
”We`re establishing a commercial eugenics, not a social eugenics; we buy and sell genetic traits in the marketplace. We want healthy babies, perfect babies. There`s no evil intention here, our desire is predictability, our desire is for perfection,”said Rifkin.
George Annas, a Boston University ethicist, testified before a congressional committee last month that ”Congress has indicated its willingness to ban the purchase and sale of human body parts, and could certainly ban the interstate sale of human embryos (and sperm and ova as well) . . . ”
Annas said federal legislation already covers selling organs for transplant operations.
”Congress should amend this statute to include human embryos among the items it is unlawful to sell. The purpose would be to protect children by preventing them from being viewed as, and treated as, commodities,” he said. Other nations have already addressed the new technology and what is acceptable to their societies. The Warnock Committee in Great Britain, for instance, said that commercial surrogacy should be outlawed, though not voluntary surrogacy.
Surrogacy was banned in Great Britain in 1985, but, as one report speculated, it was perhaps less because of the scientific commission than because of the controversy over ”Baby Cotton,” a child born to a surrogate mother who carried it in her womb for an American couple, who then had the baby sent to the U.S.
Lori Andrews, a Chicago attorney with the American Bar Foundation, and her co-author, J.L. Hendricks, wrote a paper on the legal and moral status of in-vitro fertilization and embryo transfer. They cited three reasons why the sale of sperm and eggs, or payment to a surrogate, may be considered immoral and serve as a base for legislation to forbid such payments:
”First, such payments may allows a means of coercing poor persons to give up their genetic materials, or to sacrifice themselves physically or emotionally for a reproductive service . . . Secondly . . . it may allow persons to replace a biological and emotional investment in parenthood with a financial one, and this may adversely affect the child . . . ”
The third reason, ”perhaps the most compelling,” Andrews wrote, is
”that such commercialization reduces the value of human life to that of a commodity, and therefore violates a widely shared and deeply felt conviction that human beings should not be treated merely as objects or man-made goods.” Monday: The right to privacy.