This Is Not About Surrogate Mothers

The tale of the South African grandmother pregnant with her daughter's triplets surfaced in the middle of the Fifth World Congress on In Vitro Fertilization and Embryo Transfer. But it created hardly a ripple among the scientists and clinicians gathered last month in blossom-time Norfolk, Virginia. They included all the big names of IVF as well as many who nurse big-name dreams, and they were intent on taking stock of where they are and where they're going. So intent, in fact, that news from the outside world seemed not to penetrate—let me succumb to an irresistible metaphor—the concrete zona pellucida of the convention center's appropriately round main hail. Not even relevant news, apparently. For, unlike poor pitiful Baby M, conceived through the comparatively hoary technology of artificial insemination, the South African Three are IVF products. The laboratory-generated embryos resulted from bringing together the mother's eggs with her spouse's sperm. They were transferred into a surrogate mother who was also the mother's mother, if you follow—proving once again that truth really is stranger than the National Enquirer. The South African stunt is the sort that gives IVF a bad name. It proclaims that some people who do 1VF are more interested in notoriety than in helping infertile couples achieve much-desired families. It also helps reinforce the roadblocks in the way of important research on early development of the human embryo. Of course, media attention has, on the whole, probably been more helpful than harmful to IVF—perhaps almost too helpful. Those who do IVF know that, and they have cleverly turned it to their own purposes on occasion. Front-page photos of joyous moms triumphantly holding aloft their hard-won infants served as wordless but highly effective rebuttals to opponents of IVF. Ignoring analysts who worry about where it will all lead, infertile couples vote with their feet. 1VF clinics have long waiting lists. New clinics, often with little experience and no track record, have sprung up to meet the demand. The resulting exploitation of some desperate would-be parents has become a source of concern to many in the field. Despite mostly favorable PR, the public policy questions about IVF are troubling enough so that researchers have had difficulty raising money, particularly public money. In the United States about a decade ago, for example, a government task force decided that there was nothing morally wrong with using IVF to help an infertile couple. But the National Institutes of Health decided it had other priorities and enough headaches without putting money into this politically prickly work. As a result, U.S. IVF clinics rely mostly on their clients for funds. Although IVF seems now like a standard clinical practice, and is financed like one, in fact it has always been research, and still is. It took a few hundred test-tube babies—experimental subjects, really—to provide reassurance on the question of whether laboratory manipulation of an embryo would cause birth defects. Even now some uncertainty remains; there was talk in Norfolk, for example, about recent reports of low birth weights. Today, in vitro fertilizers are experimenting with injecting a single sperm into the egg; the immediate goal is to give men with low sperm counts improved chances for fatherhood. Tomorrow, they hope to start testing germ cells and embryos for chromosome abnormalities and genetic disorders. The worriers will point out, however, that success in these areas, whatever their laudable immediate clinical applications, will be steps toward highly selective baby-making, in which sperm and egg can be brought together on the basis of their genes, not their owners' marital status. Behind IVF has always lurked the specter of human genetic engineering. Partly as a result, IVF research is already operating under some restrictions. In the United States, absence of public money is a factor, and so is a vocal right-to-life movement that opposes all embryo research. The Australian stars of IVF are constrained by a recent law that provides criminal penalties for some kinds of work on human embryos. They are lobbying hard and speak optimistically about getting the law changed. But the fact that such restrictions were enacted in what has become the glamorous world capital of frontier IVF is further indication that IVF research, despite its overall positive image, continues to take place in a public-policy minefield. The Vatican's recent pronouncements condemning artificial human reproduction should have surprised nobody. But Rome has acknowledged that it hopes to shape, not just the behavior of its flock, but public policy as well. The moral and policy issues are also professional issues. There is a clear line between most IVF and wretched excesses such as the South African circus. Scientists need to draw it, for the public and for themselves. Intraprofessional pressure would help curb the essential lack of seriousness such incidents display. And if they hope to move forward with IVF, sooner or later researchers are also going to have to address systematically the legitimate concerns about where IVF is headed. Powledge is Editor of The Scientist.

This Is Not About Surrogate Mothers

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