Originally, I was going to wait until I finished reading The Baby Business: How Money, Science, and Politics Drive the Commerce of Conception by Debora L. Spar before reviewing this book. But to do justice to that book, which, thus far is much, much better, I am separating out my review of Everything Conceivable.

IVF is controversial with certain elements of our society. I know people who have used various Advanced Reproductive Techniques (ART) to have children – including IVF and donor technology. I also know many people who have adopted or are adoptees. Unfortunately, this book sensationalizes something that really isn’t all that sensational.

Ms. Mundy choses to concentrate on the sensational higher order multiples, gay men using surrogate plus donor egg technology, and the trauma of selective reduction. She also left fact-checking behind. Her statistics can easily be dismissed by anyone able to use Google. Only in passing does she discuss the far more down-to-earth issues of insurance, lack of research funding, and the toll this treatment takes on the patients.

In passing Ms. Mundy speaks of the pain and isolation that many infertile couples feel as they tackle what she rightly calls the disease of infertility. She barely speaks to the disruption any type of ART cycle causes in a couple’s lives. And if they are using donor egg, their donor’s life. Instead of speaking to the financial and emotional toll for the average patient, she goes straight to the fear factor. An entire chapter is devoted to the idea that treating male and female infertility will cause the human race to become infertile. Though I am cautious about most science, I doubt that is true since quite a bit of infertility (not all) occurs because of the consequences of other diseases – cancer, STD’s, endometriosis, PID, tuberculosis, pneumonia, mumps, etc., in both men and women. Not all of these have a genetic component. Fear-mongering is not reporting.

Ms. Mundy turns to lesbians and gays in their pursuit of parenthood before segueing into single women desiring motherhood. Here she discusses surrogacy using a story of a mother on the East Coast who decides to carry twins for a gay couple on the West Coast. She ends up having a hysterectomy due to complications. This is not the majority of infertility patients – or surrogates – but it does sell books. Unfortunately, it also misrepresents the plight of millions of couples struggling to have a child.

Ms. Mundy over sensationalizes donor technologies. Sperm donation has been around since the 19th century. Though, the way it was introduces was quite unethical – the doctor didn’t tell the patients’ involved – it is no longer quite as controversial as it once was. Egg donation is very new, introduced in the 1980s, it has allowed women born without ovaries or in their mid-40s to have children. The latest statistics have reported that no woman over 45 has been successful in using her own eggs in IVF. So, if a celebrity in her mid-40s is having children, there is a 99.999% chance that the children are from donor eggs. This fact is largely unknown by the public at large – much to the detriment of the education of young men and women planning out their lives.

The discussion of donor technology brought her to a discussion of the rights of children to know or not know whether they are from donor technology. And a discussion of whether the identity of the donor be available to the child – different, compelling cases, can be made for both sides. This is a discussion worth having, but, unfortunately, by the time she gets to this point she has chosen to focus on the more controversial uses of ART and IVF.

From the donor technology chapter Ms. Mundy goes right back to high profile controversies with high order multiples (HOM’s). Her focus on HOM’s does not recognize the complexity that leads to this outcome. She does not even mention that in states with mandated insurance coverage for IVF there are significantly fewer twins or HOM’s. Many people believe ART = IVF. ART includes the use of a variety of techniques – including medicated IUI’s and injectable medications. Unfortunately, people start believing ART is IVF. When IVF results in HOM’s it is often after the couple has failed numerous times with IVF cycle after IVF cycle. There are no reputable clinics that transfer more than 2 blastocysts in a first IVF unless the blastocysts are very, very poor quality.

Of course, Ms. Mundy, instead of concentrating on why HOM’s come into being moves right into selective reduction. This procedure is never gone into lightly. Her insistence that the majority of patients are IVF patients is simply not borne out by doing simple searches in the literature. (I cannot speak to reducing twin pregnancies.) IUI’s are the most common cause of HOM’s. Medicated IUI’s which have been canceled due to super-ovulation do not preclude a couple desperate to have children from having sex. And, that is where a good portion of these cases come from.

The final chapters are on ethics and embryo freezing. First, let me clarify my own belief that embryos are not human beings, rather they are potential human lives. From a reproductive science point of view, the majority of embryos ever fertilized are rejected by the mother’s body for a multiplicity of unknown reasons. In my mind, it is foolish to consider a grouping of cells with no discernible consciousness as “alive”. With that said, Ms. Mundy goes into the glut of frozen embryos that are currently being stored with no known future. Some very few couples allow those embryos to be adopted by other couples. Most unfortunately, this industry is controlled by a far right Christian group currently that insists on some very dangerous medical practices. Practices which contribute to HOM’s rather than decreasing risk. And, due to the ban on federal funding, even those couples willing to allow their possibly not viable embryos to be used in research, cannot.

A case in point is cytoplasmic transfer which was outlawed in the USA due to Congress’s inability to understand even basic science. In cytoplasmic transfer, the cytoplasm from a healthy donor egg is extracted and injected into another woman’s older egg to help sustain it. It does introduce the other woman’s mitochondrial DNA. This made some very uneducated people believe that doctors were cloning. When a friend told me she would have to travel to Lebanon (pre-Iraq) to have the procedure done I was appalled at the lack of scientific oversight. Cloning is the replication of a living creature. This is not cloning. Rather, it is on the same level as giving a transplant of any sort and should not be outlawed by laws governing cloning! All mitochondrial DNA can be traced back to the same mother in Africa millions of years ago. Everybody pretty much shares a finite number of mitochondrial DNA groups that could be matched between donor and recipient alleviating fears of mixing mitochondria. Instead of level headed scientific oversight, we get knee jerk reactions. (This was not discussed in her book.)

I was greatly disappointed in this book – as I expected after hearing an interview with this woman on the Diane Rehm show. In that show, she was allowed to propagate false information that I was able to sit at my computer and find the statistics refuting her. Yes, I know statistics lie, but she did not deal with any of the very real issues that the average infertility patients deal with.

I cannot recommend this book. It is poorly researched, adds fuel to fires that do not need more fuel, and does not even touch on the very real issues facing the majority of infertile couples dealing with this issue. Truthfully, the biggest issue is that we have allowed a small, radical, religious segment of our society control of what should be being controlled by scientific rigor.

Another area that is given some passing acknowledgment – but not fully developed – is the complicity of both the Women’s Movement and men in the growing numbers of women in their mid- to late 30s or 40s finding out they cannot have their own biological child because no one cared to inform them that there was a definite reproductive window. As a matter of fact, the major feminist groups attacked Reproductive Endocrinologists who did try to start an awareness campaign for women about their fertility. Why aren’t we educating young men and women about their reproductive lives? Again, a rabid section of the Religious Right and a conspiracy of Feminist Fervor has been allowed to overrule science based education. Every young man and woman should have a thorough understanding of how their and their potential partner’s reproductive tract works. Teach it as clinically as possible, with scientific names and out in the sunshine and the titillation will be absent. Trust me, if it is taught in the same way English grammar and Mathematics are, teenagers (too late) will not be running out and having sex.

The reality is this book falls short of its promise by focusing on the stories in the headlines rather than the real day-to-day stories of people in need of fertility clinics and their technology. The statistics she relied on can easily be dismissed by looking at the Society for Assisted Reproductive Technology (SART), American Society of Reproductive Medicine (ASRM) or Center for Disease Control (CDC) web sites. Unfortunately, today’s user of the CDC site must be wary of non-scientific religious ideology having replaced sound scientific evidence. Ideally, there would be a World Health Organization group assessing fertility clinics.