It's All in the Genes, Except When It Isn't

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By Liza Mundy
Sunday, December 17, 2006

There's a lot we don't know about the pregnancy of Mary Cheney -- but a few things we do. We know that the vice president's openly gay 37-year-old daughter is expecting a baby whom her parents are happily preparing to welcome as their sixth grandchild. We know that she plans to raise the child with her longtime partner, Heather Poe. And we know that there must be a man involved somewhere -- either a friend or acquaintance (a "known donor") or a donor from a sperm bank.

In short, we know that this pregnancy involves what's called, in the fertility business, "collaborative reproduction."

That's the trade term for a situation in which a couple (or a single person) conceives with help from a third party who probably won't be involved in raising the child, but who agrees, as one egg broker put it, to "genetically contribute to the conception process." It's a situation unprecedented in human history, but now common to the point of being commonplace. Yet these technologies are setting in motion a social experiment that will unfold over decades, creating hundreds of thousands of families in which the role of genetic ties will be newly tested -- and the meaning of family reevaluated.

In the United States, donated sperm is used in 80,000 to 100,000 inseminations each year. In 2003, at least 15,000 in vitro fertilization procedures -- in which the gametes, a woman's eggs and a man's sperm, are united in a petri dish and the resulting embryos are transferred into a uterus -- were performed with donated eggs; that number grows by 20 percent annually. More than 1,000 babies are born each year through surrogacy, in which a woman carries a child for another woman or, increasingly, for two gay men.

These explosively popular science-enabled multi-parent arrangements are altering our understanding of what parents are and how families can be formed. And they're confusing our thinking about genetic relationship and its importance to the parent-child bond. Collaborative reproduction is becoming widespread at precisely the moment when we've become ultra aware of how genes run the show in the unfolding of a human being: controlling everything from physical attributes such as height and hair color to a predisposition for certain illnesses to a tendency toward shyness or a taste for fine wine.

Interviewing hundreds of families for a book on assisted reproduction, I've been struck by how conscious people are of the power of genetic inheritance -- and yet how bewildered they are about how a missing genetic connection might affect their family.

Reproductive medicine and the profit-making industry that has grown up around it send a powerfully mixed message, encouraging parents to accept that genes are crucial to the formation of their children, yet irrelevant to the formation of a relationship with those children. Genes matter, the message is, except when they don't.

"Let's face it: Donor gametes is an experiment," one fertility doctor aptly put it. "Who the hell knows how it's going to turn out?"

An irony of assisted reproductive technology is that it was invented to help infertile couples have biological children, yet quickly became a way for people to knowingly conceive children who would be biologically related to just one parent.

Only six years after IVF first succeeded in 1978, with the birth of Louise Brown to a British couple, doctors discovered that it was startlingly easy to achieve a pregnancy in a woman by using eggs from another. By the 1990s, egg donation had caught on as a way to help women in their late 30s and 40s whose eggs were no longer viable. So popular is egg donation in Washington that one clinic scours rural Pennsylvania for donors. The area's more than 15 clinics compete with ads hyping the quantity and quality of available donors.

Meanwhile, sperm donation has been around for more than a century. The first known procedure was performed in 1884 by a doctor who inseminated an anesthetized patient with sperm from a medical student, without asking her permission or telling her afterward. By World War II, donor sperm was a routine "treatment" offered to married couples. In 1992, a variant of IVF in which a single sperm cell can be injected into an egg made it possible for many infertile men to have biological children. Since then, single women and lesbians have become the majority of the clientele seeking sperm donation.

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© 2006 The Washington Post Company

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