The Baby Business: How Money, Science, and Politics Drive the Commerce of Conception

Indeed. We have come a long way since the Book of Genesis. Today, the market would provide Rachel and Jacob a multitude of choices. They could buy some sperm ([...]), eggs ([...]) or frozen embryos ([...]). They could lease a womb or opt for in-vitro fertilization (IVF); or better yet, IVF with intra-cytoplasmic sperm injection (ICSI) or with pre-implantation genetic diagnosis (PGD). Pretty soon cloning may also be an option, though as of now many of the experiments with sheep and pet cats appear to have gone haywire due to birth defects and premature ageing. `Scientific progress' in the area of assisted reproduction has separated the act of sex from reproduction. In effect, what fertility clinics sell is the process. The components can be sourced from third parties, put together in a laboratory and then transferred to a leased womb through a gestational surrogacy contract. This is probably good - infertile women no longer have to implore their husbands to sleep with the maid. In addition, it has created an upstream market, or one for inputs and components. Presumably this is good too - selling a baby may sound morally reprehensible, but selling sperm or eggs doesn't sound that bad. Sperm is cheap. The average price is about $300. Eggs go for between $2500 and $50000 - the right combination of beauty and brains costs more. What many people find objectionable is that new reproductive technologies provide choice. If people have choice they will exercise it - after all everyone wants the `perfect' baby.In her fascinating book The Baby Business, Debora Spar lays out all the choices available to present day Rachels and Jacobs. Approximately 15% of women and 10-15% of men in the U.S. have fertility problems. In 2002 about 17% of married women in the U.S. were either infertile or had impaired fecundity. In 1995 there were 6.1 million infertile women in the U.S. and approximately a third of them sought some type of treatment and only 1% sought assisted reproductive treatment. The baby business is big business - excluding adoption and PGD, it was a $3 billion market in the US in 2004 with a third being accounted for by IVF and another third by fertility drugs.Spar argues that step one is to call a spade a spade. Eggs may be `donated' but donors get compensated in the form of gifts, which include massages and diamond necklaces. Spar writes of an attorney by the name of Noel Keane who started a brokerage business in the surrogacy market in the mid 1970's. At one point Keane tried to eliminate payment for surrogacy and found that the "supple dried up". Clearly, the main motivation for adoption brokers and medical doctors alike is money. It is a business. Once we acknowledge this we have to deal with property rights - something that even children understand - it's my toy! It's mine because I paid for it and in the market economy transactions involve not just the exchange of goods for money but also the rights to do whatever we please with those goods. If those rights are violated - we can call the police and seek redress from the judicial system. But the baby business is different - it's my car and I can sell it - sure. It's my sperm and I can sell it - OK. It's my blood - it's my kidney - it's my baby - I can sell them. Back off! You can donate your blood and maybe even your kidney - but forget about selling babies - that's not on. Really?The baby business is indeed a funny business. All the consumer is interested in is the end product - they want a baby but nobody is selling them. Instead people are selling inputs such as sperm or eggs and services. The birth mother in an adoption situation is merely carrying the baby, the agent is facilitating, in the case of IVF the medical doctor is providing an alternative process rather than infertility treatment - everyone is selling services and no one is selling the end product. The laws of demand and supply do not work in this business - willingness to pay continues to be incredibly high. People will do anything to get baby, or the willingness to pay is very high. The story of Rachel and Jacob is telling enough, but Spar writes about a lady who went through 9 cycles of IVF, produced 198 eggs and failed to get pregnant. Prices continue to be high in this market even though scale has increased, so for example the real price of IVF has not fallen in the last 20 years even though the practice has become more prevalent.All markets need rules - the baby business is no different. Compared to other developed countries the market in the U.S. is relatively unregulated. Rules differ across countries, which leads to arbitrage. People travel across borders to avoid restrictive national rules. Further, regulators need to recognize that all the different avenues from adoption to IVF are substitutes, albeit imperfect, so how you regulate one market has an impact on another. Spar does not deal with the moral issues of the baby business and neither does she judge the market. Instead she suggests alternative regulatory options. These include for example, banning the business altogether, treating it like a luxury good which implies inequitable access and using the donation model as in the case of kidneys, which will lead to shortages and queuing. In addition she calls for a political debate in the U.S., which should address issues relating to access to information, equity, direct and indirect costs and the limits to parental choice.This is an important an intriguing book, unfortunately it is unlikely to attract the broad readership it deserves. This is because infertility is not a mainstream issue. Having said that however, it will not take much for politicians and the public at large to pay serious attention to the message of this book. What is likely to set off the debate is the link between cloning embryonic stem cells and the market for high tech reproduction no matter how tenuous- all it will take is an eager customer with a very high willingness to pay, an ambitious scientist and a botched experiment.This review first appeared on a now defunct blog on June 16, 2006

Ms. Spar's book provides incredible insights into this commercial industry whose revenues are built on the hopes and dreams of building families. I had the pleasure of meeting and hearing Professor Spar speak about her research and insights at a Harvard Business School reunion weekend in 2006 when I was struggling with infertility after our first child and giving up my successful career to support my husband and our family. Ms. Spar's book is an objective assessment of this industry in terms of the key players, its drivers and issues. Very helpful to understand especially if you are dealing with fertility clinics to understand what drives them. I am not big on government regulation in general but the "conception industry" is one where some government oversight could better protect and educate families and those who want to help these families. If I had only known and read Ms. Spar's book before I began our journey, it would have been less heartwrenching. I have consistently recommended this book to my friends and colleagues who are struggling with fertility and considering other means to have children. Our journey ended well as we were blessed with another child -- my verson of "having it all" as an AMA woman ("advanced maternal age" as the doctors labelled me) who waited to have children later in life. Here's to beating the odds and the clock!

This book is an investigation into the various components of child acquisition outside of plain sexual conception by the intended parents. So the book covers adoption, surrogacy, IVF, cloning, and the numerous other technological ways of creating human life. Written as a dispassionate inquiry, the author examines the various issues associated with each method, profiles the historical development of each method, and most importantly, looks at how different localities around the world handle each issue. So the author does a great job of showing evolution over time, and differentation over space. There are numerous tables spread throughout the chapters that provide a lot of numerical data, such as the cost of IVF at different centers in the US. Hence the book also serves as a how-to-guide for would-be parents contemplating adoption, IVF, etc... All in all, a good book with enough science to explain the facts, but simple enough for any college student to read.

Definitely worth the read.

I love this book for what it is. Some other reviers commented on the Stoic nature of the work. They are accurate about that. However, that is why I like it. The book isn't meant to say what's right or wrong or make judgements. The author does raise some ethical and moral questions but makes no attempt to answer them. As someone who has spent some time on the infertility hamster wheel and also has a background in Economics, I found this book fabulous. It is very dense, containing a very informative mix of economics, history and science. It is all about the market for babies.

The picture on the cover is creepy but this book is well written and easy to understand. It's amazing and disgusting how much it costs to get help when you can't get pregnant the old fashioned way. If you're looking for a self or planning guide this is not the book for you. If you or your husband is the finance/business type and likes to read, this helsp explain why the doctor assisted pregnancy process is so outrageously expensive.

I saw this book in the library at school and checked it out. I made some notes on it and then decided it had enough significant information on in vitro etc. that I would buy it. It contains an interesting history of efforts to overcome infertility and then gets into modern Assisted Reproductive Technology (ART). Interesting book!