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Robert Klitzman - Designing Babies: How Technology is Changing the Ways We Create Children

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Robert Klitzman Designing Babies: How Technology is Changing the Ways We Create Children
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Since the first test tube baby was born over 40 years ago, In Vitro Fertilization and other Assisted Reproductive Technologies (ARTs) have advanced in extraordinary ways, producing millions of babies. An estimated 20% of American couples use infertility services to help them conceive, and that number is growing. Such technologies permit thousands of people, including gay and lesbian couples and single parents, to have offspring. Couples can now transmit or avoid passing on certain genes to their children, including those for chronic disease and, probably sometime soon, height and eye color as well. Prospective parents routinely choose even the sex of their future child and whether or not to have twins. The possibilities of this rapidly developing technology are astounding-especially in the United States, where the procedures are practically unregulated and a large commercial market for buying and selling human eggs is swiftly growing. New gene-editing technology, known as CRISPR, allows for even more direct manipulation of embryos genes. As these possibilities are increasingly realized, potential parents, doctors, and policy-makers face complex and critical questions about the use-or possible misuse-of ARTs. Designing Babies confronts these questions, examining the ethical, social, and policy concerns surrounding reproductive technology. Based on in-depth interviews with providers and patients, Robert Klitzman explores how individuals and couples are facing quandaries of whether, when, and how to use ARTs. He articulates the full range of these crucial issues, from the economic pressures patients face to the moral and social challenges they encounter as they make decisions which will profoundly shape the life of their offspring. In doing so, he reveals the broader social and biological implications of controlling genetics, ultimately arguing for closer regulation of procedures which affect the lives of generations to come and the future of our species as a whole.

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Designing Babies ALSO BY ROBERT L KLITZMAN MD A Year-long Night Tales of A - photo 1
Designing Babies
ALSO BY ROBERT L. KLITZMAN, MD

A Year-long Night: Tales of A Medical Internship

In a House of Dreams and Glass: Becoming a Psychiatrist

Being Positive: The Lives of Men and Women with HIV

The Trembling Mountain: A Personal Account of Kuru, Cannibals, and Mad Cow Disease

Mortal Secrets: Truth and Lies in the Age of AIDS

When Doctors Become Patients

Am I My Genes?: Confronting Fate and Family Secrets in the Age of Genetic Testing

The Ethics Police?: The Struggle to Make Human Research Safe

Designing Babies How Technology is Changing the Ways We Create Children - image 2

Oxford University Press is a department of the University of Oxford. It furthers the Universitys objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and certain other countries.

Published in the United States of America by Oxford University Press

198 Madison Avenue, New York, NY 10016, United States of America.

Oxford University Press 2020

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license, or under terms agreed with the appropriate reproduction rights organization. Inquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above.

You must not circulate this work in any other form and you must impose this same condition on any acquirer.

CIP data is on file at the Library of Congress

ISBN 9780190054472

eISBN 9780190054496

This material is not intended to be, and should not be considered, a substitute for medical or other professional advice. Treatment for the conditions described in this material is highly dependent on the individual circumstances. And, while this material is designed to offer accurate information with respect to the subject matter covered and to be current as of the time it was written, research and knowledge about medical and health issues is constantly evolving and dose schedules for medications are being revised continually, with new side effects recognized and accounted for regularly. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulation. The publisher and the authors make no representations or warranties to readers, express or implied, as to the accuracy or completeness of this material. Without limiting the foregoing, the publisher and the authors make no representations or warranties as to the accuracy or efficacy of the drug dosages mentioned in the material. The authors and the publisher do not accept, and expressly disclaim, any responsibility for any liability, loss or risk that may be claimed or incurred as a consequence of the use and/or application of any of the contents of this material.

In memory of my mother

God created man in His own image... male and female created He them. And God blessed them; and God said unto them: Be fruitful, and multiply, and replenish the earth.

Genesis 1:2223

Buying is much more American than thinking.

Andy Warhol

Contents
Designing Babies

Do you want to be the father of my child? a friend, Abby, asked me a few years ago.

What do you mean? I asked, surprised.

Im looking for a sperm donor. She was now 37 years old and wanted to have a child. Four years earlier, she had broken up with her long-term boyfriend and since then had been single. Two years before she asked me this question, she had applied to an agency to adopt a child. I had written a reference letter for her, stating that she would be an excellent parentwarm, loving, and resourceful. She was a painter, with a large group of artistic friends who would be helpful and supportive. Unfortunately, the agency rejected her.

Her fatherhood question perplexed me. We were fond of each other but recently had seen each other only a few times a year and were less close than in the past.

Im serious! she said, sensing my hesitation. Ive thought of going to a sperm bank, but Id prefer to use someone I know. Youd be perfect!

The proposition was tempting. I do not have children. Here, perhaps, was my chance, my only opportunity to have one. Let me think about it, I stammered, uncertain and partly to buy time.

You wouldnt have to do anything other than donate the sperm, she added, matter-of-factly.

Over the next several days, I began to ponder her question. Giving my sperm to someone felt odd, unfamiliar. But, I thought, that alone should not determine my decision. Presumably, she would take the lead in raising the child. Yet I wondered how involved I would or should be in helping her raise our offspring. Creating a child who contained roughly half my genes and would, presumably, look and act like me in certain ways but who would belong to someone else felt weird. I would be the biological father, but would or should I also take on the social role of being one? What if she wanted me to have more, or less, of a role? A child of mine, my own flesh and blood, would also presumably be raised mostly by her. She was a bit disorganized, which could be endearing in a friend but not necessarily ideal in a parent. What if I disagreed with her about how to raise our child?

I wondered what to do and how other people made these decisions, and I began to investigate, asking others and searching the medical literature. Increasingly, I heard of other friends going to infertility clinics. Female friends had asked their sisters for eggs. Gay and lesbian friends were having children, buying other peoples eggs or sperm. Walter and John, a gay couple I knew in Los Angeles, deliberated for almost a year over whether to select an ambitious 6-foot, blond, blue-eyed Princeton pre-med tennis player or a laid-back UCLA folk-rock singer who worked as a volunteer, helping refugees. Individuals selling their eggs face potential medical risks from the medications and surgical procedures involved and generally proceed because they need or want the money.

We are entering a new world of mechanical reproduction and face myriad questions.

Little was known about the specifics of reproduction until 1674 when Antonie Van Leeuwenhoek, a cloth merchant in Delft, examined his own semen under a microscope and discovered sperm. For decades afterwards, sperm were each thought to contain a homunculusa little person. He and others assumed that sperm contained the future human being, and that the egg merely nourished it.

In 1780, Lazzaro Spallanzani, a remarkable Italian Catholic priest and biologist, discovered that reproduction among animals requires both sperm and eggs. He performed the first in vitro fertilization (IVF), with frogs, and the first artificial fertilization, in a dog.

He also discovered that microbes can move through air and were killed by boiling water and that bats fly at night due not to eyesight but to some other sense (as we now know: their hearing).

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