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The Big Business of Making Babies

The Brave New World we now experience is filled with a myriad of moral dilemmas–and none demands more urgent attention than those related to human reproduction and the massive technological advances that are related to human fertility and babies.

In one sense, these moral dilemmas directly affect only a small percentage of the American population. The vast majority of babies born in the United States are conceived through natural means–completely without the assistance of reproductive technologies. Nevertheless, a growing number of American couples find themselves facing difficulty conceiving and bearing a child. Furthermore, homosexual couples–both male and female–increasingly demand a “right” to have children, and these are joined by some unmarried individuals who have similar access to these technologies.

In any event, the field of reproductive technologies now represents a fast-growing sector of the economy–and one that produces a significant profit. All this raises a crucial moral question: is an unregulated free market in reproductive technologies and materials such as human gametes destined to undermine human dignity and the sanctity of human life?

The emergence of a free market economy in donor organs, a market now spreading around the globe, should serve as a significant warning that reproductive technologies and gametes, along with other factors involved in human reproduction, represent a lucrative market that has already caught the attention and interest of many corporations, entrepreneurs, and individuals.

This market has now caught the attention of the Harvard Business Review [HBR]. In its February 2006 issue, HBR features a “big picture” article by Harvard business professor Debora L. Spar. In “Where Babies Come From: Supply and Demand in an Infant Marketplace,” Professor Spar acknowledges that many persons would find the very notion of a “market” in the arena of human reproduction to be distasteful or worse. “There are markets in real estate, markets in used cars, markets filled with farmers selling green beans and cheese,” Spar observes. “But a market in human fertility–sperm, eggs, hormones, surrogate mothers, embryos? Babies, or the means to make them, aren’t supposed to be sold. They aren’t supposed to be bought. They aren’t supposed to have prices fixed upon them.”

Nevertheless, Spar acknowledges that “there is a market for babies, one that stretches across the globe and encompasses hundreds of thousands of people.” This may not be a conventional market in the sense of farm commodities or mortgages, but this new market in human reproduction has been created by “a deep and persistent demand from people who have been denied the blessings of reproduction, along with a wide and steadily increasing supply of ways to produce babies when nature proves inadequate.”

As Spar explains, this new market in human reproduction includes for-profit fertility clinics, drug companies, doctors, and medical firms that rake in huge profits in the baby-making business. In 2001, almost 41,000 children were born in the United States through in vitro fertilization technologies [IVF].” Beyond this, another six thousand were produced by donated eggs and approximately six hundred were carried to term by rented wombs–most often identified as surrogate mothers.

Professor Spar is no newcomer to these issues. She serves as Spangler Family Professor of Business Administration at the Harvard Business School and Harvard Business School Press has just released her new book, The Baby Business: How Money, Science, and Politics Drive the Commerce of Conception. Professor Spar’s concern is straightforwardly related to business and economics. She raises a host of moral issues, but her most pressing concern seems to be the lack of clear legal definitions protecting property rights for all involved. In her article, she looks at the business of making babies like any other business, and raises the issue of government regulation as a means of defining rights, lowering prices, and expanding access.

In the United States, the business of human reproduction is almost totally unregulated. The federal government has taken little interest in this market and state and local governments rarely set regulations related to human reproduction. “Part of this reluctance may be rooted in America’s typical laissez-faire response to emerging markets,” Spar observes. “Unlike its European counterparts, the U. S. government historically has been loath to constrain high-growth, high-technology markets and industries.”

Thus, unlike many European countries, the United States has no national policies on the use of IVF or on the creation and destruction of human embryos. Technologies such as preimplantation genetic diagnosis [PGD] are unregulated and widely available, allowing parents to examine an embryo for fitness before deciding to implant it in the womb. Through the use of this technology, parents can effectively choose the sex of their baby, and can also choose among various genetic traits. Unwanted embryos are routinely discarded and destroyed.

Looking around the world, Professor Spar sees a very different picture. The government of Israel sees assisted reproduction as a national cause, with the nation permitting most forms of high-tech human reproduction and paying for fertility treatments until a couple has at least two children. Germany, on the other hand, is still haunted by the memory of the Nazi medical experiments and allows no human egg transfers, no surrogate mothers, and no PGD.

As a model for the United States, Professor Spar seems to look approvingly at Britain’s Human Fertilisation and Embryology Authority, the quasi-government agency that oversees all aspects of reproductive technology and trade in that nation. As Professor Spar reports, the HFEA “licenses and monitors all IVF clinics, sets price caps for egg donation, and assesses applications for PGD.”

In the United States, the free market rules. As one reproductive specialist told Spar, “We have been able to sail under regulatory visibility . . . If we had been under scrutiny, many steps would have been forbidden.”

That is probably an understatement. The development of these reproductive technologies has not only escaped most regulatory attention, but the awareness of most American citizens as well.

These new reproductive technologies promise huge profits and an expanding market. At present, most individuals and couples seeking advanced reproductive technologies are wealthier than the national average. A cycle of in vitro fertilization costs an average of 12,400 dollars. PGD costs 3500 dollars, and the market for human eggs and sperm is almost completely without regulation–or price ceiling.

Spar reports that enterprising companies now represent the cutting edge of this profit sector. “The global market for sperm, for example, is dominated by a small number of high-volume, high-profit firms. So is the market for the hormones that women take to induce ovulation.” Beyond this, “egg brokers” and fertility centers “seem already to be evolving along a similar course, with smaller centers consolidating into networks like Integramed America and larger centers like Boston IVF reaping the substantial profits of scale.”

Along with other markets, the market in human reproductive technologies demands opportunities for expansion. “In the absence of outside pressure, the market will try to satisfy most client desires in the interest of creating new business,” Professor Spar observes. This means that, lacking regulation by the government or other authorities, any consumer demand for reproductive technologies or human gametes is likely to be met in one way or another, by one firm or another.

Other developments loom on the horizon. In Great Britain, an increasing number of healthy women–who complain of no fertility problems of any kind–are now seeking access to reproductive technologies because they are uninterested in conceiving children through intercourse. Some of these women report that they are simply “too busy” for sex, but still desire children. Beyond these, single women and lesbian couples are now a significant segment of the consumer market for human sperm. In turn, homosexual male couples now seek children through donor eggs and surrogate wombs in increasing numbers.

“Such applications could add millions of customers to the fertility trade,” Professor Spar acknowledges, “but only if prices come down, access is widened, and rules are established.”

One of Professor Spar’s primary concerns is the lack of clear property rights in current law. Who owns human embryos? Do clinics? Do parents? What are the rights and responsibilities of sperm donors, and of the children conceived through donor sperm? These questions are only hints of an incredibly complex system of moral and legal issues that remain unanswered. In the present unregulated marketplace, demand is generally met with supply, one way or the other.

In the end, Professor Spar proposes that the baby business should be “governed by a system of property rights” that would bring regularity, clarity, and predictability to the marketplace. She acknowledges that these medical technologies come with “Solomonic choices” and moral dilemmas. She suggests that Americans should “decide, as a society, just what we consider acceptable in the baby trade.”

She asks: “Are we comfortable allowing commercial exchange in the pursuit of procreation? Are we willing to permit parents and their doctors to manipulate the embryos that will become their offspring? How will we determine which procedures push the trade too far?”

Professor Spar’s article raises a number of the most important economic and legal issues related to the marketplace of human reproduction. Nevertheless, even more significant questions and dilemmas demand our attention. The lack of a moral consensus on these crucial questions has provided an environment in which the Culture of Death has taken advantage of the free market in order to further its product lines and increase its profits. Are we willing for human dignity to be bought and sold in the marketplace?