If there ever was a case for a colossal lawsuit, against the greatest social experiment of our time, one need look no further than Liza Mundy’s, Everything Conceivable: How assisted reproduction is changing men, women, and the world. Looking back over the last 25 plus years, since the birth of Louise Brown, Mundy’s behemoth account of the infertility industry and the customers it serves leaves me wondering, Where do we begin cleaning up the mess? How does one close Pandora’s Box?

There is certainly enough blame to go around, starting first with the reproductive endocrine fertility doctors. Throughout the book we learn such things as, “Doctors were making up the rules as they went along,” and what few rules they did have, quickly were relaxed. Early on, no physician would consider helping a woman over 40 conceive and then the “new normal” was a fifty-one-year-old mother of twins. Now women in their 60’s, well past menopause, are giving birth! And the guidelines over how many embryos can be safely implanted in a woman’s womb are meaningless and by in large ignored. Mark Evans, the physician known for his technique for selective reduction (where he injects potassium chloride into the beating hearts of the fetuses targeted to be killed), recalls an ultrasound of one mother with twelve fetuses! He adds that this mother’s physician only told her about six of the babies. Robert Nachtigall, a San Francisco Fertility doctor said, “Let’s face it: donor gametes is an experimentナThis is a huge social experiment mediated by technology. Who the hell knows how it’s going to turn out?” Geoff Sher, an IVF doctor says that the scientific approach to embryo transfer is to “throw a bunch of spaghetti against the wall and see what sticks.” The fertility industry is often referred to as the “Wild West”-and the doctors act like wild cowboys for sure.

Mundy does a bang-up job of describing the new ways we have babies and the new faces of the reproductive, technological, nuclear family: Single women becoming mothers “by choice,”; sometimes co-parenting with other heterosexual single women; older women who waited (way) too long; lesbians and gays having babies; the infertile man now able to sire a child; and the egg, sperm, and womb donors/sellers who make this all possible. Of course, the train wrecks abound and the endings are not always suitable for a Hallmark card. Multiple births are at epidemic proportions which are putting babies and mothers at risk like never before. Low birth weight, failure to thrive, blindness, cerebral palsy and other birth defects, and of course fetal demise are left in the wake of reproductive choice, rights, and autonomy. Let’s not forget too, that many customers go away unsatisfied since only about 1/3 of all IVF practices are successful. Parents and individuals, motivated by desperation and the high costs of fertility treatments, are making some pretty reckless decisions and putting many people at risk. One gay couple who had contracted with a surrogate were faced with “this horrible intersection of morals and money” when they had to decide how many of the four embryos to implant into their surrogate. They had already spent $60,000 and decided to implant all four. Two of the embryos died in utero and two went on to be born, but the surrogate almost hemorrhaged to death and ultimately had to have her uterus removed to stop the bleeding. Bioethicist, Barbara Katz Rothman said, “Any man with a checkbook can buy a baby.” Of course, Mundy’s book makes the case that any man or woman with a checkbook can buy a baby.

Mundy falls short in her chapter on assisted reproduction and the rights of the child. Outlining the arguments for and against disclosing to children the way in which they were conceived, she forgets some important rights of the child. What about the right not to be born as part of a huge social experiment? What about the right not to be conceived by technology that inherently puts them in harm’s way? For example, ICSI, or intracytoplasmic sperm injection, is a technology which now allows sterile men to become fathers. Even a man with low sperm count and slow swimming sperm will have one sperm which can be used to fertilize an egg. With ICSI, we have found that we may pass on the father’s infertility to the male offspring. Does the male child have the right not to be born sterile? We haven’t begun to understand the impact of these technologies on the children we have made.

While Mundy is loathe to offer criticism or draw any ethical lines, such as “we shouldn’t do this” or “this is bad medical practice,” she does show her cards every now and again. For example, she states categorically that women should be paid for their eggs, even after setting her endorsement up by listing the realities that face the egg donor: possible increased risk of ovarian cancer, 1 in 100 chance of infection, and Dr. Nachtigall stating, “One of them (egg donors) is going to die one day.” Gerald Schatten, the infamous U.S. partner of South Korea’s Dr. Hwang, says he is very terrified of financial reimbursement to young women egg donors and that ovarian hyperstimulation syndrome is a life threatening risk. Schatten cautions, “If California moves superfast in stimulating thousands of women, when the first woman dies (note-not if, but when) for the sake of cells in a plastic dish, this is going to be a nightmare. And I am seriously, seriously worried.” Very odd that Mundy offers no thumbs down for the surrogate woman who almost died delivering twins, or the mother who had multiple babies born with multiple birth defects, whose marriage ended in divorce, who gets through the day with the help of Prozac, but Mundy is happy to say she agrees that egg donors ought to be paid for their efforts so as to be consistent (with sperm and blood paid donations) and not to be patronizing to women!? Perhaps the medical profession and scientific community needs to be more paternalistic in order to safeguard women’s lives.

I know the anything goes, reproductive-medicine-gone-wild approach has got to end and I will be endorsing new practices like single-embryo transfer, and natural cycle/minimal stimulation IVF, if only for the sake of the children, who are minimally represented in books like Everything Conceivable.