Miriam Zoll's memoir about trying to get pregnant in near-middle-age, Cracked Open: Liberty, Fertility, and the Pursuit of High-Tech Babies, is more than a personal account of the failed promise of Assisted Reproductive Technologies [ART] for her and her husband. It's also an exposé, lambasting the business of selling dreams to people desperate for biological offspring and a clear-eyed assessment of the high failure rate - 150,000 tries resulted in only 47,090 live births in 2010 - of in vitro fertilization, egg donation and surrogacy for the many women who use them.
Zoll reports that one in eight US couples presently experience infertility, making the market for treatment a potential gold mine. "Across the globe today an estimated 9 percent of women aged 20 to 44 experience infertility lasting more than 12 months," she begins. "Most who seek out ART are between the ages of 30 and 39." The reasons for the problem, she continues, are manifold, and include poor sperm quality, ovulation disorders, tubal defects, endometriosis, uterine or cervical anomalies as well as "unexplained factors," which undoubtedly include environmental degradation.
For Zoll, the bottom line was that by the time she felt ready to reproduce, she couldn't get pregnant. During her 20s and early 30s, she writes, her focus was on developing a meaningful career and paying off student loans. She was also looking for true love and her on-again-off-again relationship with Michael Shashoua took nearly a decade to land on solid ground. By that point, both were in their mid-thirties.
At first, both Zoll and Shashoua pooh-poohed their inability to conceive. Then, Zoll explains, a consultation with a noted fertility expert revealed something she did not want to hear, "that I had deluded myself with misinformation and false hope about my own biology." To wit, she'd assumed that "technology had finally eclipsed Mother Nature" and that her biological clock didn't matter as much for her as it had for her mother and grandmother.
As Zoll unpacks this newly-acquired information, she discovers that she isn't the only person who's been misinformed about the relationship between age and fertility. Studies conducted in four countries - Canada, Israel, Sweden and the United States - found that most people falsely believe that fertility begins to plummet only after a woman reaches her mid-40s, a fallacy with dire consequences for many 30-somethings who wish to have babies.
In Zoll's case, panic ran head-on into the desire to procreate and became a 24/7 fixation. As she approached 40, she and Shashoua tried multiple methods to get pregnant. First, there was egg extraction, a process that required Zoll to take medication to stimulate egg production. "Clinic nurses taught us how to inject very expensive hormones - often $5000 for one round - like Follistim, Ganirelix and Luveris - into my abdomen," she explains.
To her credit, Zoll is well aware of her class privilege and notes that the astronomical cost of these drugs restricts egg extraction to the financially well-heeled. But that's not her only concern. As a longtime activist for reproductive justice who serves on the board of the Boston Women's Health Book Collective, Zoll also worried about the largely-unstudied health risks of being jabbed with chemicals, often repeatedly. Still, she pushed her worries aside to focus on becoming pregnant.
Not surprisingly, she, Shashoua and her doctors were thrilled when the extraction process generated five eggs. "If the eggs thrived," she explains, "they would be harvested from my ovaries and fertilized with Michael's sperm. If the embryos sustained healthy cell division of seven cells or more, the clinic staff would then transfer them into my womb."
Despite high hopes, the effort was unsuccessful. Over the next six years, Zoll tried in vitro fertilization [at $12,500 a pop] and egg donation. Finally, when everything else failed, she and Shashoua turned to adoption.
Zoll's account of becoming a "fertility junkie" is by turns sad and horrifying. Not only does it allow the reader to experience the pair's angst over their inability to reproduce naturally, it exposes an enterprise that is simultaneously deceptive and greedy. The egg donor industry, Zoll writes, is but one example, bringing in a staggering $38 million a year. Even more stunning, she adds that the field is growing by 6 to 8 percent a year.
If you're not feeling queasy yet - how about the fact that many women are lured to egg donation as a way to supplement paltry salaries or stay at home with the kid[s] they're raising? Seeing it as "easy money," thousands of largely low-income women fill themselves with potentially dangerous drugs and, later, subject themselves to surgery to extract the eggs. The haul - a seemingly-hefty $6,000 in six weeks - can seem like a miracle to someone who normally earns $7.25 an hour.
And it gets thornier: "Few, if any, insurance companies cover egg donor cycles," Zoll reports, "so only the well-off or those people crazy enough to take out a second mortgage could afford the donor cycle fees, which on average cost $30,000."
Still, after much ethical hemming and hawing, Zoll and her spouse bit the bullet and chose an egg donor. Again the process failed, not once but twice.
It was then that Zoll and Shashoua's collective conscience began to nag. "The surreal experience of using donor eggs reeked of high-technology playing God," Zoll concludes. "It reeked of my own narcissism and our obsession to procreate. Considering the millions of children already born who needed parents, was it really that big a deal that we birth a biologically-linked child?"
They're good questions, and before Zoll and Shastoua answered them, they did a lot of breast-beating. In addition, Zoll expresses great shame over being unable to do something that generations of women before her have done. Her honesty is heartfelt, even as it is confounding to women, like me, who have never experienced this pull. At the same time, Zoll and Shashoua's eventual decision to adopt is worth cheering, and their unbridled joy when Samuel Victor becomes part of their lives is touching and lovely.
Cracked Open is, first-and-foremost, Zoll's account of being sold a bill of goods by the fertility industry. That she and Shashoua did not understand the high failure rate associated with reproductive technologies - opting to revel in the promise depicted in photos of smiling adults holding newborns that adorn ART clinic walls - is indicative of the denial at the heart of many prospective parents' compulsion to create a child.
Furthermore, Zoll's indictment of the ART industry is impassioned. Likewise, her revelations about the harrowing process of entering a technological netherworld serve as a cautionary tale for anyone planning to walk that road. That said, at least one of the book's messages is sure to be contentious. Zoll argues that the media and medical establishment have conspired to tell women that they can postpone childbearing until they've grounded themselves in careers. Zoll's regret at having done this is enormous. Like many of her generation's most privileged women, she assumed "that we could rely on science to help us become mothers in our late 30s or early 40s. This pattern of thinking was embedded in our culture . . . To learn later, after painful personal experience, that the vast majority of reproductive technologies do not, in fact, result in live births is a double tragedy. Not only are we coping with the loss of a deep primal desire to birth offspring, we must also come to terms with the fact that we built an entire women-can-finally-have-it-all adult life on an illusion."
That this was true for Zoll is apparent; that it is not true for every woman is less so.
What we can agree on is that there are as many questions as answers for those wishing to employ assisted reproductive technologies to create genetic children. In a foreword to Cracked Open, law professor Michele Goodwin and executive director of Our Bodies Ourselves, Judy Norsigian, call ART "a vast experiment" and conclude that "many do not realize the extent to which they surrender their bodies, sexualities, and emotional lives to doctors, syringes, and drugs that might lead them into parenthood."
Cracked Open goes a long way in highlighting the otherwise hidden underside of the ART industry. While Zoll's personal experience will not resonate with every reader, she should be commended for casting an unflinching eye on the business of baby-making and raising important concerns about medical intervention, reproductive profiteering and the ethical issues at the center of family formation.