EMBRYO CULTURE: MAKING BABIES IN THE TWENTY-FIRST CENTURYBeth Kohl
(Farrar, Straus and Giroux)
Beth Kohl used to face down pro-lifers at abortion rights rallies and refuse to back politicians who didn't prioritize a woman's right to choose. But after being diagnosed with polycystic ovarian disorder, a leading cause of infertility, ten years ago, what she once considered a purely political issue became a lot more personal.
To have children of their own, Kohl, who's now 39, and her husband, Gary Feinerman, opted for in vitro fertilization. Kohl underwent the process five times, having close to 20 eggs fertilized and three embryos transferred to her womb during each cycle. As a result they have three children: Sophia, seven, and fraternal twins Anna and Lily, five. In her first book, Embryo Culture: Making Babies in the Twenty-First Century, published by Farrar, Straus and Giroux in August, Kohl documents the experience, her extensive research into IVF, and how these changed her beliefs.
Kohl, a Winnetka-based freelance writer, was frustrated by what she found when she began looking for info on IVF. "I wish I'd had a regular person's voice in my head," she says. "There's a certain fertility-speak and I found it off-putting." These days there's an abundance of blogs and chat rooms devoted to IVF, but some women who frequent them also use a kind of insider language; Kohl says they call their frozen embryos "embies," give them nicknames like "Frosty," and generally anthropomorphize them.
Kohl doesn't display these tendencies but she does admit to developing a strong attachment and sense of responsibility to her fertilized eggs. Embryo Culture grounds her resulting personal dilemmas within the context of the broader moral and legal questions faced by scientists, doctors, and fertility patients. Unlike some European countries, the U.S. has no federal limits on embryo transfers, for example. When Kohl decided how many embryos to transfer per cycle, she weighed her increased chances for conception against the increased risk of high-order multiples (triplets, quadruplets, etc), which would threaten both her own health and the health of her children. (According to a 2002-'05 national study, IVF patients under 35 had an average of 2.5 embryos transferred per cycle, with 33 percent becoming pregnant with twins and 5.8 percent with triplets or more.)
During her third round of IVF, Kohl realized that if each of the three embryos transferred developed in her womb, she wouldn't necessarily be able to "selectively reduce" one or two—even if her doctor deemed it necessary. She never had to make that decision, but the experience made her reevaluate her beliefs on reproductive rights and abortion. It "taught me how profound this choice is and that what's at stake extends far beyond exercising one's rights or minimizing one's complications," she writes. Kohl emphasizes that she hasn't embraced fetal legal rights and still fully supports keeping abortion legal but says the issue is way more nuanced in her mind now: "I have a new respect for the ability of cells to develop into more complex beings—into, well, children."
Raised in Milwaukee in a conservative Jewish household, Kohl says her faith in a traditional God and the teachings of her religion have also been deeply shaken. During her first couple cycles of IVF, Kohl believed that if a transferred embryo failed to result in a pregnancy it was God's will. Now she chalks it up to chance: "If it's a doctor manipulating my system, fetching Gary's and my genetic material and combining it to produce fertilized eggs, where is God's hand?"
And while all branches of Judaism permit IVF in theory, Kohl was bothered by the rationale (or lack thereof) for some of the restrictions it places on the process. Her rabbi told her that as the Talmud recognizes motherhood through birth, if a Jewish couple used a non-Jewish surrogate the baby would technically not be Jewish. When she asked him about the ethics of IVF, he deferred to an ancient textbook. "To have a rabbi tell me that Maimonides had a position on this issue," says Kohl, "this rabbi who lived before any of this even existed—I just said, 'What are you talking about?'"
Kohl still takes her own daughters to temple to give them a sense of their roots and culture. During a recent reading and Q and A in her hometown, Kohl's brother, who was there with her mom, raised his hand and asked, "Do you no longer believe in God?" Kohl says now, "I'd be much more comfortable answering that question in front of the pope, but in front of my mom—I don't want her to think she failed." She hemmed and hawed and eventually said she wasn't sure but that she thought it was healthy to question everything. (Her mom was OK with that.)
Kohl had worried that the way her kids were conceived might complicate things when they inevitably questioned where they came from, but so far it hasn't been a problem—just the opposite, in fact. Several weeks ago seven-year-old Sophia saw a pregnant woman and asked how the baby had got inside her. Given a very basic explanation of sex, the little girl replied, "Really? That's horrible! Is that what you and Dada did?"
"No," Kohl told her, "and that's what the book is about."
"Oh, that is such a relief!" said Sophia.
"I'm so glad I wrote that book!" Kohl jokes.
A year ago Kohl decided to undergo another round of IVF. She had already started the hormone therapy necessary for the process when her editor called to say it would be terrible timing to have a newborn when the book was published. Kohl temporarily scrapped the idea. Since then her husband has decided he doesn't want a fourth child and thinks they should donate their seven leftover embryos to science. Kohl, who's theoretically in favor of stem cell research, is struggling with the idea of donating her potential offspring, "whose destiny I feel compelled and duty bound to fulfill." For now, her embryos remain frozen.v