Where the slippery slope began.

Pandora's Baby

How the First Test Tube Babies Sparked the Reproductive Revolution

Robin Marantz Henig 

Houghton Mifflin, $25,256 pp.

Of all the human biological capacities, procreation is one of the strangest. Unlike any of the others, some people desperately want to use that capacity to have children and some people no less desperately want to avoid having children. No such diversity exists with our capacity to see, taste, smell, think, walk, or hear. We all want them and when, now and then, someone does not, that is taken as prima facie evidence of derangement. A desire not to have children is now common among many married couples and no less so among many cohabiting couples; and the number of such couples grows all the time.

Yet if couples of that kind can display a striking singlemindedness, it is as nothing compared with the infertile couple desperate to have a child. The childless will often go to endless trouble and great expense, and put up with a regimen of medicine and self-discipline that can make military boot camp look easy. While surely not the only means of relieving infertility, in vitro fertilization (IVF) is now probably the most widely, and routinely, used. What was, through most of the 1970s, a highly controversial line of research, condemned by the pope and many moralists and theologians, and treated with suspicion by physicians and research scientists, now elicits little ethical or scientific interest. It worked. End of story. At most there are now some calls for a reform of fertility clinics, for the most part unregulated, but the fact that it has taken so many years for those calls to arise is itself testimony to the high place infertility treatment has achieved in modern medicine.

Robin Marantz Henig tells the story of the emergence and growth of IVF in an interesting and nuanced way, and it is a story well worth telling. As she accurately puts it, the American IVF effort "reveals what can happen when society faces a new and frightening technology: how it is first greeted with resistance and expectation of the worst, then with grudging permission, then with acceptance, and finally with incorporation so seamlessly into the culture that no one even notices it any more." Henig interweaves a number of threads in the story she tells, one of them the work of Dr. Landrum B. Shettles in making the first American attempt at IVF with Doris and John Del Zio, another that of the research efforts of Robert Edwards and Patrick Steptoe in England, and the third the various ethical and regulatory battles that broke out along the way.

Shettles was considered by most of his colleagues at the Columbia Presbyterian Medical Center in New York an odd duck, given to strange working hours, a taste for publicity, and an indifference to the niceties of academic-medical research. The dean of his department, Dr. Raymond Vande Wiele, a Catholic, sought first to rein him in because of some books and articles on how to pick the sex of a child-to-be, which he felt displayed poor science. His next skirmish with Shettles was far more dramatic. Mixing an egg from Doris Del Zio with the sperm of her husband John in a test tube with some other ingredients, he hoped to create a fertilized egg. Vande Wiele caught wind of that effort, got the test tube, and poured the mix out. The Del Zios then sued him and, in a trial much covered by the press, Doris accused him of pouring their "baby" down the drain.

In the midst of the trial, word came from England in July 1968 that, as a result of the research of Edwards and Steptoe, Baby Louise Brown had been born. The event was celebrated with a media blitz and considerable public excitement, but the timing was terrible for Vande Wiele, who shortly thereafter lost the case. Two prominent ethicists, Paul Ramsey and Leon R. Kass (now the chairman of the President's Council on Bioethics), harsh critics of the research as it was progressing, lost as well. Ramsey argued that the research was wrong because of the potential medical risk to the fetus and then to the eventual child, while Kass held that the very effort was part of a "new holy war against human nature." Ramsey was probably right, but it is not known just how many bad results, with what damage to fetuses, came about as the result of Edwards and Steptoe's efforts to bring forth Louise Brown. Hardly anyone worried about that worry once they had succeeded.

Even if Kass was right that it was a holy war against nature, it turned out that infertility was treated as an evil that called forth a more important war in the eyes of the public and those thousands of couples unable to have a child other-wise. As a historical footnote I would add that, thereafter, a generation of ethicists in the 1960s and 1970s who were ready to be skeptical of new medical technologies gave way to a younger generation, far more prepared to bless rather than condemn radical medical research. As Henig notes, after the 1970s one bioethical commission after another approved embryo research and it was not hard to find ethicists who, after the birth of the cloned sheep Dolly, saw no real harm in the possibility of human cloning. If it could be said that Ramsey and Kass were, in their own way, prophets of a valuable and necessary kind, it is not helpful to those who would later address different issues that they were on the losing side--particularly when the winning side consists of thousands of happy parents and their healthy children who would not otherwise exist.

Yet some qualifications are in order. Much infertility in recent years can be traced to late procreation, women who bear children in their thirties and forties, and to sexually transmitted disease. Infertility, I believe, is best understood as a public-health issue, which would be greatly relieved by dealing with its social causes. Instead, as too often happens, it was turned into a medical problem and, with IVF, treated as an issue ripe for a high-technology solution. And a solution it was, but not without some medical costs. Many children born of IVF are of low birth weight and are more likely than other newborns to suffer from a variety of birth defects. About 56 percent of IVF babies are twins or triplets or more because of the American practice of implanting three or more embryos, not typically done in Europe. Yet those who want children badly are a dedicated group, ready to do what it takes to succeed and to run the varied medical risks IVF entails.

One other point. The techniques of IVF opened the way technologically for human cloning, embryo and stem-cell research. There is indeed a slippery slope, but it is not reassuring to realize that the slope can begin with something that is such a source of joy, a baby of one's own. Read this book. That is a story we need to think about, and Robin Marantz Henig has told it beautifully.

Daniel Callahan is director of the international program at The Hastings Center, and author of the recently published What Price Better Health? Hazards of the Research Imperative (University of California Press).