How Far Should We Push Mother Nature?

THE NEWS CAME BURSTING OUT of Europe and rattled bedrooms around the world. First, a 59-year-old British businesswoman gave birth to twins, using donated eggs implanted in her uterus at a fertility clinic in Rome. Her coup was quickly eclipsed by the news that a 62-year-old Italian woman, who visited the same clinic, will deliver a baby in June. Next came the word that a black woman in Italy had recently given birth to a white baby using donor eggs; she and her Caucasian husband said they wanted to give their child "a better future." Then came an even bigger bombshell: press reports from Scotland said researchers had delivered baby mice using the ovaries of aborted mouse fetuses. There was talk that the process might someday be duplicated in humans, raising the freakish prospect of creating babies whose genetic mothers had never been born.

Things used to be so simple. A father provided sperm, a mother provided the egg and if something went wrong or if either partner was too old. that was just tough luck. But the Brave New World of reproductive technology, and particularly in-vitro fertilization (IVF), has changed all that forever. It is now technologically possible for a single infant to have five contributing parents: sperm donor, egg donor, surrogate mother, in addition to the mom and pop who raise him. The news from Europe showed that once again, technology was pushing the boundaries of the possible, raising questions society isn't prepared to answer or even debate in a cogent way. Is there no upper limit on the age at which women can bear children? (And what's wrong with that, if men can be fathers in their 70s and get ribbed by admiring buddies?) "In the future, people may wait till they retire to have kids--flip the whole life course," mused Arthur Caplan, director of the Center for Bio-medical Ethics at the University of Minnesota. Beyond timing when to have their children, should couples be able to select their race? If the Scottish researchers continue their work, could a woman someday abort her daughter and give birth to her own grandchildren? (Talk about skip-generation families.)

To the millions of American couples on the emotional front lines of infertility, the ethical hypotheticals paled against the excitement of new possibilities. "Five years ago, this would have never happened to me," says Charline Pacourek, 45, who subjected herself to seven years of hormone injections, ovulation stimulation, artificial insemination, egg retrieval and embryo transfers. In November she learned that she is finally pregnant, thanks to eggs donated by a friend. Pacourek calls her baby a "miracle--it's fantastic! I would recommend this for anyone."

In Europe, however, government ministers were racing to curtail the high-tech options. French officials proposed banning IVF for women past menopause. Italy announced plans to limit artificial pregnancies at clinics like Dr. Severino Antinori's, where the 59-year-old and 62-year-old women got pregnant. Alarmed that the British woman had gone to Italy after being denied IVF at home, British Health Secretary Virginia Bottomley said she would seek uniform rules across Europe to prevent what some called "procreative tourism." But it's doubtful that the EC could ever agree on such touchy issues. "They have enough problems deciding what sort of cheese should be sold," said Oxford philosophy teacher Jonathan Glover. Germany, still chastened by the legacy of the Nazi experiments, prohibits fertilization by donated sperm or eggs, or any genetic manipulation of embryos.

In the United States, too, there were some calls to stop pushing the frontier of reproductive technology, or at least pause to consider where it is going. "We need to start to define those lines in society that we will not cross," said Dr. Thomas Baffin, codirector of the Stanford University Center for Biomedical Ethics. European-style laws are unlikely here, however. There are no federal rules or guidelines governing the estimated 300 assisted-fertility clinics operating nationwide, which generate some $2 billion in business a year. Starting this fall, a new law sponsored by Rep. Ron Wyden of Oregon will require clinics to report their success rates uniformly, so that consumers can sort out their wildly competing claims. But there are no rules specifying who clinics can or can't treat by age, marital status or any other factor.

Nor are there rules requiring fertility clinics to match donors and recipients according to characteristics like race and religion. In that sense, the era of "designer babies" is already here. Sperm-bank customers can flip through catalogs listing the height, hair color, eye color, ancestry--sometimes even the IQ--of potential donors. Many donated eggs come from friends or family members; Maryann Fiore's sister provided the eggs for her triplets, born when she was 44. But some programs also have descriptions of potential egg donors from which couples can choose. Debbie Karnell, a nurse at a West Coast fertility clinic, decided to try IVF with donor eggs when she saw the caliber of the women who volunteered. At first, Karnell says she was attracted to the prettiest ones. But in the end, she chose a donor who was young and had already proved her fertility. It worked for Karnell too: she had a baby five months ago, at the age of 46.

Biotech gadfly Jeremy Rifkin worries that selecting racial and genetic characteristics is a dangerous step toward eugenics, and thinks that donor eggs should be outlawed. But to many ethicists, the only thing more frightening than unfettered reproductive technology would be Congress playing God and imposing limits. "This is an individual matter, an ethical and moral choice, not the business of government or call-in talk shows," says University of Southern California law professor Susan Estrich. (She also thinks that if society is going to get upset about who's having babies, "we ought to worry more about children having children than a few wealthy middle-aged women with enough resources to do this.") Most couples pursuing IVF technology are indeed affluent; each attempt with donor eggs can cost $10,000 to $20,000, and some women undergo repeated efforts before succeeding or giving up. Only a few states require insurance companies to fund IVF procedures. And because of the expense and long odds, it is one of the few technologies specifically excluded under Bill Clinton's health-reform proposal.

Bluntly put, that leaves rich people free to pursue baby-making technology, and others out of luck. But some ethicists see no problem in that standard: as Caplan views it, society can't stop you from having a child, but it doesn't owe you one by any means. He also says the debate over a double standard for older men and women ignores the simple fact that older men can produce sperm naturally, while older women need help. "No one is talking about devoting a lot of technology to getting impotent old men to have babies," Caplan says.

Dr. Geoffrey Sher, medical director of the Pacific Fertility Medical Center in San Francisco, says he had misgivings the first time a woman in her 50s came into his office seeking to become pregnant. "I thought, 'Why should we get into this? We don't need this controversy." But the woman's husband, who was 40 years old, challenged Sher's prejudices by asking if he'd have qualms if their ages were reversed. Sher had to admit he wouldn't, and after that, he decided to resolve every case on an individual basis. His clinic, with one of the largest donor-egg programs in the country, has treated more than 100 women over 40, and a handful past 50. He claims that 56 percent give birth on the first try, regardless of their age, as long as the donor is under 35 and the recipient has a healthy uterus.

Older mothers face some greater risks to their own health from pregnancy. But most IVF programs, like Sher's, carefully screen out candidates who are not in excellent condition. Using donor eggs from younger women eliminates the increased risk of genetic and other problems in an older woman's own eggs. Most doctors are more concerned that fifty-something mothers won't have the physical stamina to put up with midnight feedings or chase after toddlers. But experts on aging pooh-pooh such fears, noting that scores of grandmothers are energetically raising grandchildren by default these days. "A woman of 59 or 61 on average is pretty healthy today," says Dr. Marcia Ory of the National Institute on Aging-Couples with the financial means to pursue IVF can probably afford a nanny, she notes, and may be better equipped emotionally as well. "Mature mothers make good mothers, especially in contrast to a child-parent of 15."

But isn't it cruel for parents to bear a child when they might not five to see him or her reach puberty or college? "It's not avery nice prospect for a child of 10 or 12 to go to sleep every night, praying that his or her mother will live as long as he needs her," says Gail Sheehy, author of "Passages" and "The Silent Passage: Menopause." Georgette Bennett thought about that a lot when she decided to try IVF two years ago, when she was 45 and her husband was 21 years older. She got pregnant on the first attempt using her own eggs and sperm her husband had frozen years earlier. The nine months she carried her son was "the world's easiest pregnancy. I never stopped working, never took a single nap." Sadly, her husband died seven weeks before his son was born. Still, Bennett, 47, calls 16-month-old Joshua-Marc "a great monument to my husband." She also says she appointed guardians, and "very consciously set about peopling my son's life with a wide diversity of folk of all ages."

For older parents who already have grown kids, the new technology can complicate family relationships. Jonie Mosby Mitchell, a country singer and nightclub owner, had four children with ease in her first marriage: "Boom. Boom. Boom. Boom," she says. She remarried 17 years ago and adopted a baby girl in 1988. She was planning to adopt again when she read an article about postmenopausal pregnancies and decided to try it. She was 52 when she gave birth to Morgan, now 21 months old. One of her older daughters was pregnant the same time she was. Another is pregnant now, and Mitchell has three grandchildren who are older than their uncle. Her new kids call her first husband "grampa" She says her older offspring are a little uncomfortable with all this. (Her oldest daughter said, "Mom, if you've got extra time, spend it with my kids,") Having young children in her 50s "is not an easy job," Mitchell admits. "They fight and they argue and they fuss and they want. It poops me out." But overall, she thinks she is a better mother this time than when she was younger and worked on the road.

In truth, IVF clinics see very few 50-something women hoping to start second families. Far more of their patients are women in their 40s who delayed marriage and childbearing, then were surprised to discover how difficult it was to conceive, and how desperately they wanted to. Author Anne Taylor Fleming, now 44, struggled for 10 years to get pregnant before abandoning the attempt, an odyssey she describes in her forthcoming book, "Motherhood Deferred: A Woman's Journey." She says a whole generation of women have been caught in the boomerang of changing attitudes toward motherhood: they were born in the family-focused 1950s, came of age in the '60s era of contraception and free love, and then followed the feminist advice of the '70s to "make money, be equal to men, don't get caught." When they realized that wanting children might be part of feminism too, Fleming says, many were unprepared, as she was. Despite her career, happy marriage and four stepsons, Fleming says, "I was startled by the strong emotion of both wanting a baby and the inability to have one--just knocked sideways."

Like Fleming, many infertile couples eventually have to come to terms with reproductive failure and reconcile themselves to adoption--if they can find an agency that will accept them--or being childless. Does the news that a few 50- and 60-year-old women are having babies really offer more hope--or more long-odds promises to chase? "With so many new techniques at their disposal, it's harder for doctors to say, "We've gone as far as we can go.' And the couples themselves have an even harder time saying "Enough is enough'," says Ronny Diamond, a New York social worker who counsels infertile couples. Fleming agrees: "It is sort of bitter joy that something else dangles out there." But she says that going through fertility attempts "humbles you about making choices for other women."

For all the startling headlines and new hopes, IVF is "still a horrible, expensive, stressful, emotionally trying crisis in a couple's life and no one would put themselves through it on purpose," says Carole LieberWilkins, a therapist who counsels couples in West Los Angeles. Even if doctors can slow down the biological clock for some women that doesn't mean that younger women can take late-life pregnancy for granted, or that retirement communities will be setting up day-care centers. Someday scientists may be able to hormonally manipulate men to carry fetuses, or grow human embryos in animal surrogates. (Could your mother, as well as your forefathers, be a chimpanzee?) But marching hand in hand with reproductive breakthroughs is the idea that society has to set priorities, and accept some limits, in an era of scarce medical resources. It will be up to many of these high-tech babies in the future to try to balance all those competing needs.