Global surrogacy: When making babies is no fun. Op-ed by Leslie Morgan Steiner

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Leslie Morgan Steiner at TEDMED 2014
Leslie Morgan Steiner at TEDMED 2014: The inconceivable costs of baby-making

As a mother and writer on women’s issues, I believe nothing is more intimate an issue for every woman—actually, every human being—than the desire to have a child.

Now, my children were all conceived and born naturally. They enjoy full robust health. But I discovered that infertility—the myriad variations of disease and biological abnormality that cause specific men and women to be unable to create children together—strikes randomly. Anyone can be infertile. Infertility is surprisingly common; the inability to have children afflicts 10-12% of the human population.

There is no surefire way to prove you are fertile in advance, for example you cannot use a blood test to screen newborns or teenagers for the inability to have children as one might for hemophilia or celiac disease. Part of infertility’s cruelty is the surprise of its assault. You rarely learn you are infertile until you try, and fail, to have a baby.

When I found all of this out, I wondered: what would I have done if I were infertile?

That was when I stumbled upon the seemingly strange new solution of surrogacy—paying another woman to carry a baby for you. Surrogacy has actually always been a solution to the age-old problem of infertility. In fact, surrogacy (via concubine) is mentioned over 20 times in the Old Testament.

Today, the global medical community, funded by generations of desperate infertile women, has figured out exciting—and disturbing—new ways to create babies no matter the obstacles. The medical term is Gestational Surrogacy (GS). A new-and-improved version of an ancient solution to childlessness.

Today, thanks to in vitro fertilization (IVF) and other advances in assisted reproductive technology, babies can be created with sperm from one source, an egg from another, and a uterus from yet another. In England today, women who are carriers of rare mitochondrial disease can actually use their DNA in a healthy donor egg cell to bypass the defective mitochondria, thereby creating an IVF scenario with three biological sources. Surrogates today are not biologically or genetically connected to the babies they gestate. This simplifies many ethical, legal, and parenting issues.

And creates new ones.

Modern surrogacy is transforming humans’ centuries-old definition of motherhood.

Today a newborn can have two mothers or two fathers, or no mother, or no father. A baby can actually have zero legal parents, as in a few isolated cases where a gestational surrogate carried a baby created with donor egg and sperm, and a clinic mix-up blocked authorities from tracking down and proving any legal parent.

Today anyone—a 25-year-old with uterine fibroids, a 40-year-old woman with a cancerous uterus, two married gay men, a nun—can have a baby, their biological baby, via surrogate.

As long as they can afford it, because surrogacy in the U.S. can cost $100,000 or more.

Gestational surrogacy has become better known in recent years due to international celebrities such as musician Elton John, comedian Jimmy Fallon, and actresses Nicole Kidman, Elizabeth Banks and Sarah Jessica Parker who have all had babies via U.S. gestational surrogates.

But the rise of GS is important for normal people too.

Like Gerry and Rhonda Wile, a nurse and firefighter from Arizona, who shared their story with me for my book The Baby Chase.

Gerry and Rhonda met and married in their late 20s. Gerry was already a father, but he’d had a vasectomy, which he didn’t tell Rhonda about for six years (but that’s another story).

As for Rhonda, for her entire life she had an extremely rare, undiagnosed medical condition that allowed her to get pregnant easily—and she did—but the same condition caused her to miscarry 100% of these pregnancies.

Prior to 20th century medical technology, Rhonda would have gotten pregnant and miscarried dozens of times throughout her reproductive years—as often as 3-4 times a year—for decades, without ever understanding what was wrong with her biologically. For too many centuries, infertility was a lifelong, mystifying curse. A perennial loss that often left sufferers, women in particular, feeling rejected by their husbands, families, communities, and even by God.

So what did the Wiles do?

What would you do?

Today there are several options for the world’s infertile. Treatment, adoption, accepting that you will live your life without children. But for the Wiles, there was only one solution. Surrogacy meant the Wiles could create the family they dreamed of using Gerry’s sperm, Rhonda’s eggs (or what turned out to be eggs from a donor), and an unrelated gestational carrier.

Gestational surrogacy is an exciting, awe-inspiring new medical innovation that makes it possible for infertile couples like Gerry and Rhonda, and millions of other people, to have babies and become parents.

Leslie and the Wiles family
Leslie and the Wiles family

Surrogacy today heralds the end of infertility, the death of an affliction that has plagued humans since the beginning of time. However, surrogacy in the United States is financially out of reach to most people. This is why some people, like Gerry and Rhonda Wile, travel to other countries to find affordable, legal surrogates to create their babies.

The final surprise about surrogacy is that it’s personal. It’s human. It’s about you and me and the people we love.

What if you had to travel 8,000 miles to have your baby—and risk not being able to bring her back with you?

Or had to choose between being openly gay and having your own biological offspring?

Or your health insurance said you were too old, or too religious, or not religious enough to qualify for infertility reimbursement?

Or your God said no, you can’t treat your disease…you must live your life without the children you’ve dreamt of having since you were a child yourself.

Imagine the betrayal you would feel if your country, your political leaders, your neighbors, your God, refused you a baby, merely because the treatment for your disease made people uncomfortable.

Would this make you want—or deserve—a baby any less?

In her TEDMED 2014 talk, Leslie Morgan Steiner, journalist and bestselling author, brought the audience along on her journey to learn the truth about a successful gestational surrogacy industry on the far side of the world–and how it could provide a model to help solve several social problems in the US.

 

Protecting Antibiotics: Q&A with Ramanan Laxminarayan

Antibiotics have relegated life-threatening bacterial infections to our medical history books, or so think the vast majority of us. However, inappropriate antibiotic usage – for viral infections, in animal feed, in over-the-counter availability in some countries, and even over-treatment of some bacterial conditions – has also fueled the development of antibiotic resistance. This decrease in antibiotic efficacy coupled with the pharmaceutical companies’ slow development of new antibiotics are threatening our future fight against bacterial adversaries.

In his TEDMED 2014 talk, Ramanan Laxminarayan discusses how protecting antibiotics is a global issue and a worldwide responsibility, not one limited to a specific area of the world. He recently took the time from his busy schedule preparing for the CDC’s Get Smart About Antibiotics Week to answer a few follow-up questions:

What motivated you to speak at TEDMED?

I’ve been thinking about antibiotic resistance for nearly 20 years now, and have spoken about this problem and possible solutions to audiences ranging from clinicians, epidemiologists, hospital administrators, policymakers, economists, and even physicists.  But, the opportunity to reach a much wider audience through a format like TEDMED is rare and is probably better than even writing a book in terms of getting a message across.

Ramanan Laxminarayan on the TEDMED stage.  - Sandy Huffaker
Ramanan Laxminarayan on the TEDMED stage. – Sandy Huffaker

Why does this talk matter now? What impact do you hope the talk will have?

Like many others, I believe that we bear the responsibility of leaving the natural state of the planet in at least as good condition as it was in when we were first given responsibility for it.  I come to the problem of resistance from that perspective.  If we have fundamentally altered the microbial ecology of the planet, that is not very different from what we have done to the chemical composition of its air and water.  Antibiotics are amongst the most valuable natural resources we have been endowed with, and we have not recognized them as such.

What is the legacy that you want to leave?

Hopefully, my work has awakened, in a few people’s consciousness, the idea that we need a huge change in how we approach antibiotics.  If we are successful, then maybe in a few years, asking for an unnecessary course of antibiotics from your doctor will be the same as asking for a last drink for the road, or for a cigarette from a fellow passenger on an airplane.

Please share anything else you wish you could have included in your talk.

I would have loved to talk about my other passion: what it takes to deliver pediatric vaccines to 27 million children each year in India.  Fortunately, I had a chance to give a TEDx talk about this topic earlier this month. I’d also perhaps like to talk about the information structure of epidemics, if the TEDMED team ever makes the mistake of inviting me back.