Too many women know the heartbreak of infertility.  Too many women don’t know that their infertility relates to menopause, not disease.

Last week was National Infertility Awareness Week.  From the organization’s website:

National Infertility Awareness Week (NIAW) is a movement that began in 1989.  The goal of NIAW is to raise awareness about the disease of infertility and encourage the public to understand their reproductive health.  RESOLVE: The National Infertility Association founded this movement and continues to work with the professional family building community, corporate partners and the media to:

1. Ensure that people trying to conceive know the guidelines for seeing a specialist when they are trying to conceive.

2. Enhance public understanding that infertility is a disease that needs and deserves attention.

3. Educate legislators about the disease of infertility and how it impacts people in their state.

In 2010 National Infertility Awareness Week became a federally recognized health observance by the Department of Health and Human Services.

While I am quite sympathetic to diseases which cause infertility, and the need for proper medical intervention to attempt to cure or treat the underlying cause of the infertility, in reality, many consumers of reproductive services have no disease whatsoever.

Take for example, a same-sex couple who uses these technologies to have a baby.  No disease.  No infertility.  Or consider the “single-mother-by-choice”.  No disease.  No infertility.

Or what about the growing number of women who have just waited too long to have their children?  These women are certainly not infertile; they are in (or entering) the period of menopause.  Menopause is a natural and normal event which occurs in a woman’s life, it is not a disease which needs to be treated. The biological clock is real and as women, we must re-educate ourselves to this fact and educate our daughters to this fact.  While women are living longer and healthier lives, this has no bearing on our fertility.  Women still experience a dramatic decline of their fertility in their early 30s.  If we want to have children, we need to have them when we are young.  We risk closing the door on natural childbirth if we postpone pregnancy.

The Mayo Clinic  reported that a woman’s fertility peaks between age 20 and age 24. The fertility rate remains relatively constant (at about 15–20% below maximum) through age 35. From 40 to 45, though, the decrease is a dramatic 50–95%. This translates as follows: a healthy 30-year-old woman has about a 20% chance per month to get pregnant. By age 40, however, her chance is only about 5% per month.

The following graph comes from the Centers for Disease Control and Prevention (CDC) – the only government body which gathers data (incomplete in my assessment) on the use of assisted reproductive technologies in the United States.    

Note the dramatic “percentage” rise in the use of “donor” eggs as maternal “age” increases.  The use of eggs from another woman reflects the simple biological reality that, as an older woman’s fertility declines, she must turn to younger women to provide her eggs in order to conceive, bear and birth a baby.

The older birth mother is, in fact, having the younger woman’s baby – and exposing the younger woman to the detrimental health and fertility risks associated with egg harvesting procedures.

But conception is only part of an older woman’s challenge to bearing children as her fertility wanes.  Advanced maternal age also heightens the risk of “fetal loss” – meaning the older mother’s age alone increases the likelihood that she simply cannot carry a baby to term.  One important study noted this stark conclusion:

There is an increasing risk of fetal loss with increasing maternal age in women aged more than 30 years. Fetal loss is high in women in their late 30s or older, irrespective of reproductive history.  This should be taken into consideration in pregnancy planning and counseling.

I do understand and acknowledge the heartbreak when that strong desire of women have to bear children is frustrated by age and declining fertility.  But I do think National Infertility Awareness Week should focus its resources on the diseases which affect our fertility and develop a model that recognizes biological realties and practical things we can do to promote fertility.

In my next post, I will share some steps and precautions you can take in practice to safeguard and protect the gift of female fertility.

What chores do you outsource?  I read a list once in Time Magazine: The “Ten Best Chores to Outsource.”  Expecting to see housecleaning, landscaping, pool cleaning, you know, actual chores, I was shocked and saddened by the “number one” best chore to outsource: pregnancy.

As the Time Magazine article put it:

Outsourcing brings to mind big factories and call centers.  But entrepreneurs around the globe now offer services—from tutoring to sculpting a bust of your grandpa—to regular folks for a fraction of the cost in the West.  Thought the world was flat before?  Well, now you can hire someone in India to carry your child.

Outsourcing “pregnancy” has become big business, transforming having a child into a “bits and pieces” brokered industry:  sperm from a handsome Scandinavian stud, eggs from a smart, beautiful Ivy League woman, a womb-for-rent from a poor woman in India trying to provide food and education for her children, and brokers in the middle helping set up the legal transactions to build a better baby the 21st century way.

Entrepreneurs like Rudy Rupak, CEO of PlanetHospital, make their living converting conception and pregnancy into a commercial business.  Rudy’s brokering business offers what his company calls the India Bundle.  This “affordable” package deal offers would-be parents an egg donor, four surrogates for four embryo transfers, room and board for the surrogate during the pregnancy, and transportation services when the parents arrive in India to pick up the baby.  Costs escalate from there depending on services rendered.  Gay couples wanting to do egg-sharing so that they can each offer sperm to fertilize the egg drives up the price.  All the various preimplantation genetic diagnostic tests also drive costs upward.

This is what a consumer model of baby-making looks like.

Twins cost more, of course, which brings me to the latest craziness: twiblings.  Parents Michael and Melanie chronicled their infertility story, which is not atypical, in the New York Times Magazine article, “Meet the Twiblings.”  After what Melanie describes as many failed relationships, she finally met Mr. Right, but maternal age had hindered her ability to get pregnant, so they were off to the fertility doctor for five failed in vitro fertilization (IVF) cycles.  Always wanting twins, they decided to hire not one, but two surrogates, enlisted the help of an egg donor, and “gave birth” to a boy and a girl five days apart.  Since the babies were from the same egg donor and they used Michael’s sperm, they are siblings.  Being that they were created in the lab at the same time, they are fraternal twins.  But, given that they were carried in separate surrogate wombs, they have been dubbed twiblings.

Meanwhile cases like those of an Australian couple who aborted their twin boys because they wanted a girl, and Olivia Pratten’s battle for the right to have access to her biological father’s identity (she was born in Canada some 20-plus years ago via anonymous egg donation), make their way through the courts.  These are uncharted global waters we are swimming in, woefully unregulated, with, at best, some ad hoc international law.  What is even more disheartening is the lack of a faithful witness (with the exception of Catholic teaching) in response to infertility.  From the New York Times Magazine “twiblings” piece, a director of a Los Angeles agency for surrogate searches stated that many of their gestational carriers were “white, working-class women, often evangelical Christians—the kind of girls you went to high school with.”  Or Sunday school perhaps?

The basics are well established within Christian orthodoxy.  Children are a blessing and a gift, not a right, and certainly not a product to be designed and manufactured.  They should be begotten, not made. Artificial reproductive technology – ART – is the manufacturing of children, often by design and often using third parties, a violation of the ethical principle of the two flesh becoming one.  In the garden, husband and wife are a complete family.  This was declared very good, without children yet being part of the story.  While infertility is a sad and difficult occurrence for those who want children, it has been made even more difficult because of a lack of Protestant thinking on the matter.  

Infertility is not a death sentence.   Children are not products to be made.  Our reproductive bodies are not to be blithely parceled and sold to someone else.  And pregnancy is not a chore to be outsourced.  It’s time for some serious corrective thinking lest our reproductive illness creates unleashed madness among us, and those who stood by silently be morally complicit in the exploitation of some lives for the commercial manufacture of another.

What does it say about a society which permits, no, which condones the use of medicine and technology for the sole purpose of creating human life just to destroy it? It says we are a culture that has morally lost its way.

My Sister’s Keeper, Jodi Picoult’s novel turned film takes on an important and real-life issue known as “savior sibling.”

A “savior sibling” refers to the creation of a genetically matched human being, in order to be the savior of a sick child in need of a donor. This requires creating human embryos in vitro, then, using pre-implantation technology, the embryos are tested, and the one deemed genetically compatible is implanted into the mother’s womb. Once that baby is delivered, the cord blood is collected because it provides a perfect match for the sick sibling. Later on, bone marrow, blood, or even organs, can also be taken and used for transplantation for the sick sibling.

Savior siblings are already a reality, and the use of such practices in the United States is not prohibited. Adam Nash is a well-known savior sibling in the U.S. Adam was born in 2000 to rescue his sister Mollie, who was diagnosed with Fanconi’s anemia. Mollie would have otherwise succumbed to death if not for a matched donor. The Nashes created 30 embryos and went through four rounds of in vitro fertilization (IVF) to finally produce Adam. Of course, the ethics of the disposition of the 29 other embryos is quite problematic. Adam was chosen, 29 other human lives were not, simply because their DNA was not able to rescue Mollie from a deadly diagnosis.

In Picoult’s story, the film opens with a voice-over narration of Anna Fitzgerald, the savior sibling. Anna describes herself as a “designer baby.” Note to self: Beware of euphemisms. Euphemisms are rampant in the world of IVF. Selective reduction refers to a situation in which many embryos are transferred into a mother’s womb, and then if too many of them implant, the physician, (with the parents’ consent), removes the “extra” embryos. Family balancing, social sex-selection and gender selection are terms used to discuss the use of these technologies to intentionally select your children based on their sex and your preference for a boy or a girl. The practice of social sex-selection is banned in Canada, so Canadians who wish to order the sex of their children come to the U.S. Surely these are symptoms of a culture in decline!

Anna Fitzgerald, the self-described designer baby — designer not as in Prada, or Gucci — was designed for the purpose of being the donor for her sick sister, Kate. Anna suggests that the doctors took the best part of her mom’s DNA and the best part of her dad’s DNA and voila — the perfect match was made. If we as a society are going to be able to have an earnest conversation on the ethics of creating savior siblings, we must be intellectually honest with the facts. Embryos — as in multiple embryos, were created, and then tested, and only the one that would provide the genetic match was brought to term. The other embryos were discarded.

And here is the heart of the ethical matter. Technology, apart from any ethics, has progressed to the point where, for the first time in history, we are able to intentionally create human life and allow it to fully develop solely because we need that life to save another. And perhaps even more worrisome is the reality that other lives were created and destroyed because they did not meet the need of another. In our desire to relieve suffering, seek healing, and avoid death, we have crossed a bright ethical line by seeking to use one human life for the good of another.

Whether we look for moral guidance from our religious texts or to secular historical documents, it is important that we as a society remain rooted in the belief in the inherent dignity of all persons. The U.N. Declaration on Human Rights warns that wherever there is “disregard and contempt for human rights,” “barbarous acts” are sure to follow. Surely, the rights of the savior sibling have been denied when from their first breath they are being used as a means to an end.

Early in the film, Anna hires an attorney and announces, “I want to sue my parents for the rights to my own body.” From the moment of birth, she has been denied the full rights to her own body, and to willingly and freely be her sister’s keeper.

OR . . . why do women faint when I show Eggsploitation?

The first time I screened Eggsploitation on a university campus was at Harvard Law School. During the screening, a young female student walked out of the auditorium and proceeded to faint.  I happened to be outside the auditorium meeting with a colleague (I’ve seen the film many times, so I typically step outside while the film plays). As a nurse, I immediately saw the warning signs – woozy, white as a sheet, things just didn’t look all right with this woman from my quick assessment.  I intervened:  Pulse, check.  Breathing, check.  When she came to, I asked her all the basic questions.  Are you sick? No. Do you have any medical history? No.  Did you eat today? Yes.  Why do you think you fainted?  I don’t know . . .

Then I received an email from a professor who ordered a copy of the film to show in her class.  She emailed me to say she had to stop the film halfway through because two women in her entire class of female students had fainted.  She wanted me to know of this reaction so I could warn others. She chalked it up to the fact that the week before, she had shown the film “The Coat Hanger Project” and felt this was a carryover response from that traumatic film.

Next stop: Yale Law School, where a bright, energetic female student who then headed up Women’s Law at Yale had really pulled together a phenomenal, standing room only showing.  I prepped her that “women have been known to faint,” but she assured me, “This is Yale Law School, and we are tough here.”  So, I’m outside the room, talking with my colleague from NOW, who does many screenings with me, when two women walk out of the room and proceed to go down in a heap on the floor.  Not one, but two “tough” Yale law students.  They are fine, and we get them on their feet and send them on their way.  Neither ventures back in to finish the film.

Same thing happens at University of Virginia Law School.  Two women leave the auditorium to go outside and sit down on the floor.  The nurse in me instructs them to put their heads down between their knees.  Drink some water.  Pale pasty white faces begin to regain color, and I send them on their way, back to their dorms.

Then just this past week, I was premiering my latest film, Anonymous Father’s Day, at the SoHo Gallery for Digital Art in New York City, but was also doing many showings throughout the week of Eggsploitation, too.   While I was upstairs in the gallery, the film was being shown in the theatre downstairs, and a young woman came up the stairs, looking white as a sheet.  I took one look at her and knew she was having a strong reaction to the film.  The gallery curator and staff came quickly and, fortunately, caught her before she landed hard on the floor.

So, as a nurse, my observations are these:  Young women faint.  Older women don’t faint.  Men don’t faint.  The exact women who are being targeted to “donate” their eggs faint.  And they faint because they most closely identify with the women in the film.  They need money, and they think they are helping someone while getting money that they feel they desperately need (it’s rare that I meet an altruistic egg ‘donor’). They identify with the women in the film who get so sick and feel alone.  And they are really bothered by the needles, the drugs, and the outcomes of these women’s lives.

I was happy to receive Marjorie Campbell’s kind invitation to join her team here at New Feminism. Marjorie and I have been meeting, thinking, and discussing many things as it relates to our bodies, our ability to procreate, and the impact that feminism has had in shaping the landscape for where we find ourselves today. Our conversations have been very helpful to me as we have some shared experiences in our past; old guard feminists looking to rethink the statement ‘you’ve come along way baby’, spiritual wanderers (rebels) who have found rest again in our faith, feeling we are at a time in our life when we were ready to spread our wings and embrace a new season in life, a new calling if you will. So, in this spirit of camaraderie, I will be writing here, mainly addressing things around infertility and reproductive ethics and technologies, although I have many interests in the whole field of bioethics, as I have my master’s degree in bioethics.

My personal interest in matters on infertility, assisted reproductive technologies, and modern day baby-making, has been shaped by many and my voice comes from many rich experiences in my life. I am first a woman with a keen interest in our bodies and health. I am a wife and a mother, so my thoughts have been impacted by what I have tried to live and teach at home. I spent 25 years working as a nurse, and am committed to patient advocacy; informed consent, evidenced-based medicine and medical ethics rooted in the ancient Hippocratic tradition—first, do no harm. The Georgetown mantra of beneficence, non-maleficence, autonomy and justice have no meaning if not rooted in a principle that recognizes the dignity and worth of every individual.

I came into the area of reproductive technologies through a sort of backdoor way. Living and working in California, I found myself entering the field of bioethics at the height of the embryonic stem cell and human cloning wars. How was it that we came to be debating over a half a million surplus frozen embryos in the United States? Why and when did the human embryo become such a prize to the stem cell researcher? It was through digging into these questions that I really uncovered the fertility industry and how uncritically we had accepted these technologies which allowed Louise Brown, the first “test-tube” baby, to be born, in order to help Mr. and Mrs. Brown have a baby. Through my writing and speaking, people began to find me – thanks to the internet and Facebook. They told me their stories which led me to make films. Three at this point and counting! First, I made Lines That Divide: The Great Stem Cell Debate. Then I made Eggsploitation, which won best documentary in the California Independent Film Festival in 2011 and in December of 2011, I released Anonymous Father’s Day which tells the stories of children, now adults, who were created via anonymous sperm donation. These films have had a big impact on engaging the public in conversation. While I have briefed legislators on Capitol Hill and at the state level, and testified at the European Parliament at Brussels on Human Egg Trafficking, I have found that through film, telling authentic and real people’s stories, I have been able to change people’s attitudes and thinking. Like the young woman at Loyola-Marymount who came up to me after watching Eggsploitation and said, I’m so glad I came tonight, I was just about to sell my eggs to pay my graduate school tuition. Infertility is nothing new. It has been with us since the beginning of time. I understand the heartache of the barren womb, as we recall Rachel crying out to God, “Give me children, lest I die”. What is new, however are these modern day technologies which seek to address the barren womb and make baby-making available to all (is 50 the new 30 for motherhood?) So, maybe with all of these new technologies, it is time for a New Feminism. I’ve always said, women (me included) have a unique role in pointing us in the right direction. For such a time as this, I’m here to do my part.