Test Tube Families

reviewed by Barbara Kate Repa

Even before The Octomom, formerly known as Nadya Suleman, overplanted and gave assisted reproductive technology (ART) a questionable name, Test Tube Families, while defending the industry, was lamenting its lack of regulation.

Author Naomi Cahn knows of what she writes. She teaches family law at George Washington University Law School and is a self-described "player in the fertility game," whose first of two daughters was born with the help of ART.

Cahn first points out the reasons the field is unregulated, the biggest being that most of those involved?donors, parents, gamete banks, fertility clinics, and doctors?have little reason to lobby for laws controlling a multibillion-dollar business that is thriving without such controls.

More subtle forces may be at work too. The question of how and when to regulate the industry has undeniably become mired in politics and privilege, with surprising twists. Cahn asserts that feminists often trip over the issue of infertility, which reinforces both "the importance of motherhood in women's lives" and "the difficulty of women's 'having it all.' " Add to that the sheer touchiness of discussing the weaknesses of ovaries Of A Certain Age. And as a look at the costs of diagnosing and treating infertility reveal, the full range of treatments is largely reserved for the rich?mostly wealthy white women fortunate enough to have some insurance coverage for infertility services.

Indeed, as much as many contemporary dads attempt to revolutionize fatherhood by dropping the little ones off at taiko drumming practice and toting them to the office on Take Your Child to Work Day, men are largely left out of battles over ART issues. Also left on the sidelines are same-sex couples, whose sometimes-murky status as parents makes them arguably most affected by the resolution of such matters.

Cahn offers even more surprises concerning ART. While the book necessarily presents but a snapshot of a rapidly evolving field, the greatest instruction and intrigue is delivered in the facts and figures peppered about the tome's pages. These include:

0: Number of published cases involving children seeking the identity of a donor parent

1: Number of states that expressly prohibit gays and lesbians from becoming adoptive parents (Florida) [Editor's note: Arkansas now makes the total 2.]

3: Number of states in which employee health care plans must cover infertility and reproductive services (Illinois, Maryland, Massachusetts)

5: Number of years a person can be imprisoned in California for intentionally using sperm, eggs, and embryos contrary to the provider's consent (Cal. Penal Code § 367g)

10: Estimated percentage of Americans who have fertility problems

90: Percentage of prospective donors rejected by sperm banks

92: Percentage of physicians who, as recently as 1979, chose the sperm donor exclusively, without input from the recipient

295: Cost in dollars in 2006 of the least expensive vial of sperm available from the Sperm Bank of California, located in Berkeley

190: Added cost in dollars for shipping that vial

1785: Year of the first recorded artificial insemination of a woman, by Dr. John Hunter in London

1983: Year of the first documented egg donation

5,000: Number of children one U.S. sperm donor estimates he could have "fathered"

20,000 to 30,000: Cost in dollars of one cycle of egg-donation treatment

Beyond its shock value, and viewed in its least positive light, there can be something a bit queasy-making about ART. At the very least, it raises questions perhaps too disturbing or confusing to be legislated and regulated out of mind. Among them: Is a sperm donor a father? Does a child born due to the interaction of three women?the genetic mother who is the egg donor, the gestational mother who carries the fetus, and the intending mother who wants to raise the child?actually have three mothers? Do embryos deemed "excess" in the in vitro process have the legal status of people, property, or quasi-property? Does the reproductive control that ART fosters raise the specter of creating a nation of only smart and beautiful people? And that most nettlesome question: Who should provide the answers?

In the end, Test Tube Families proposes sweeping legal reforms that would empower the federal government to mandate ART procedures that protect donors against exploitation, assure fair deals for recipients, and promote an ethical fertility market.

Last May, The Octomom inked a deal with European production company Eyeworks to advance a television show featuring her plus her brood of 14. Whether or not you agree with Cahn's proposals, you might be cheered by the hope that regulating the ART industry might at least help prevent more such reality TV shows.

Barbara Kate Repa is a lawyer, writer, and editor in San Francisco who frequently writes about women's issues.

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