Making babies: Ivy League supermodel-style.

Everything Conceivable--How Assisted Reproduction Is Changing Men, Women, and the World Liza Mundy (Knopf, 2007, 432pp) 9781400044283, $26.95

HOW DO YOU BAPTIZE THREE small boys who sprang from two different mothers? What ritual best serves to recognize the triplets' genetic mother, a young flight attendant who "donated" her eggs to their birth mother? In Everything Conceivable, this complicated dilemma is resolved by a thoughtful minister, who solemnly blesses the egg donor as an "angel," who by God's "abiding grace helped to place [the children] in the arms of their parents." After the ceremony, the flustered flight attendant-egg donor is bustled off to a post-baptismal lunch, where she meets the extended family, bounces the other woman's babies on her knee, gulps a margarita, and then flies back home to Denver, contemplating the possibility of someday asking the couple whose children she created whether she might use some of their leftover embryos for herself.

Welcome to the wild new world of reproduction, where traditional players in the nuclear family are tossed about like so many cards in a deck. In this well-researched and vividly described book, Liza Mundy follows dozens of topsy-turvy tales from the reproductive edge. There is, for example, the story of Doug Okun and Eric Ethington, two attractive gay men determined to conceive and parent a child. They visit a swank surrogacy agency, compile a marketing profile of themselves, and eventually discover Ann Nelson, a mother of four from West Virginia, who agrees to carry their child. Then they start searching for another woman to provide the eggs, reasoning, as Mundy tells us, that "of course she would have to be fabulous, your basic Ivy League supermodel." When these eggs don't make it, Eric and Doug start all over again, becoming even pickier in the process: "The thing that became very very important to me," Eric recalls, "was music. Music and sports, as an indicator of well-roundedness." They finally find their perfect girl; fertilize her eggs with a mixture of their sperm; fly Ann to California; and then, finally, watch as four embryos are transferred to her womb. Thirty-five weeks later, Ann delivers Elizabeth Ruby and Sophia Rose, biological twins and genetic half-sisters born of two mothers and raised by two dads.

Or consider Kristina, a woman who suffers from severe endometriosis. Early in her thirties, she and her husband adopted an infant named Megan. Then, she recalls to Mundy, Kristina got "baby fever" and became determined to conceive another child. She underwent in vitro fertilization and produced four embryos, all of which were subsequently transferred to her womb. Three survived, but were born with various troubling medical issues. Once the infants were home, Kristina quickly found herself juggling four children, postpartum depression, and a collapsing marriage. "I'm well medicated, let's just say that," she confides to Mundy. "Like all the other triplets morns I know. We're all on Zoloft."

There is not much in Everything Conceivable that has not been told before: the brilliant doctors, the ecstatic parents, the mind-bending technology that fixes nature's gaps. Yet Mundy, a reporter for the Washington Post, tells these tales vividly and with a reporter's keen eye for detail. In one vignette, an expectant mother cries on the examining table as technicians probe her developing fetuses, deciding which of the three--the smallest? the farthest? the boy?--to "reduce." In another, an elementary school teacher tells of cradling her three tiny babies as they die, victims of being born way too early. People reveal all sorts of intimacies to the author, and she bares it all for us to see.

As a set of personal stories, Everything Conceivable is intriguing. The embryos generally survive. The parents are joyful and the babies gorgeous. Yet the stories have an oddly disquieting effect. For while Mundy does not hesitate to give us gory details, she seems resolutely determined not to draw any broader conclusions from them, or to view them through any moral or ethical lens. Instead, agonizing decisions and life-threatening situations are treated parenthetically, as with the three boys conceived by donor eggs: "After the birth of the triplets," Mundy reports matter-of-factly, "which was horrific and nearly fatal--Laura hemorrhaged badly after the triple C-section, losing half the blood in her body--Laura e-mailed Kendra photos of the newborns. Kendra put the pictures up in her townhouse. She e-mailed them to friends." Now, presumably it's nice to learn that the egg donor delighted in her far-off progeny and that she and the birth mother have become friends. But somehow the material between the dashes seems far more deserving of our attention. The birth mother had three embryos transferred to her womb. She hemorrhaged during delivery and nearly died. These details are bundled away, allowing us to revel instead in the intricacies of a new-age baptism.

AN EVEN MORE FRIGHTENING subplot runs through the story of Doug and Eric, the gay couple who hired Ann Nelson to bear their daughters. While the two men are dashing across the country to attend their daughters' birth, Ann starts hemorrhaging. Doctors race to stop the bleeding and ultimately perform an emergency hysterectomy to save her life. The tragedy of this trauma is that it was probably both predictable and preventable. Ann, we hear parenthetically, was overweight. She had delivered her own children by Caesarean section and was at increased risk for uterine rupture. Yet the doctors and prospective fathers agreed to transfer four embryos to her, creating an accident waiting to happen.

It is in not dwelling on these accidents-in-waiting that Mundy's book falls short. She seems so enchanted by her subjects and so sympathetic to their plights that she refuses to touch more than briefly on the questions raised by her stories. Should any woman--and particularly a paid surrogate--have four embryos transferred to her womb? Should fertility doctors be allowed to create such high-risk pregnancies, passing the actual dangers along to the obstetricians who must treat these patients? And how are we to think about the plight of others dragged along in the harrowing quest for high-tech babies? For this reader, the most poignant stories of Everything Conceivable concerned the peripheral players: David Nelson, Ann's husband, who gallantly stood photographing Doug and Eric's newborn daughters while his own wife lay nearly dying from their birth; Megan, the little girl whose mother subsequently gave birth to premature triplets. A year after their birth, Mundy reports, the triplets are doing well. But Megan is not. Instead, her parents have divorced and she is in therapy, trying to cope with the sibling abundance that has been thrust upon her.

Even as reproductive technologies advance at warp speed, discussions of reproduction slip into time-worn patterns. We want babies to be born healthy. We want families to cherish their offspring. And we want to conclude, as Mundy does, that the critical element of the baby-making equation, regardless of the technology involved, is love. The problem with love, though, in parenthood and elsewhere, is that it is too often blind. Parents are entranced by their offspring and unwilling to question the mechanism of their conception. In some deep Darwinian pocket of their souls, they need to believe that the particular child they have acquired is precisely the child they were destined to have, the only magical mixing of egg and sperm that could ever have made sense. Yet when science intrudes as heavily into the realm of nature as it has with reproductive medicine, an impartial observer should be moved to feel not just compassion at the sign of others' offspring but also some sense of excess. How many babies are too much for a family to handle? When is a mother too old or too sick to conceive? And how much choice should any parent have in determining his offspring's traits? Everything Conceivable pushes us towards these questions, but leaves us tantalizingly short of answers.

DEBORA SPAR is the Spangler Family professor, senior associate dean and director of research at Harvard Business School. She is the author of The Baby Business (Harvard Business School Press, 2006).

A shorter version of this review appeared in the Washington Post.