"18 WAYS TO MAKE A BABY"

PBS Airdate: October 9, 2001

Go to the companion Web site
NARRATOR: Frozen at minus-380 degrees Fahrenheit, a human embryo is selected to
be thawed, resulting in the birth of Melina, now four years old. Her brother Luc
was created in the same way. Their parents are Will, a lawyer in Los Angeles, a
nd Marcellin who's a surgeon.
They've been able to have children because of a discovery made in 1978 that by bri
nging together a man's sperm and a woman's egg in a laboratory, a baby could sta
rt its life outside the human body. It's called "in vitro fertilization."
WILL: Marcellin was the sperm donor for one and I was the sperm donor for the
other. But we don't tell the public or even our close friends or family who that
is. But our children will know. Marcellin is from a very large family; he's the
youngest of twenty. I am an only child, so I sort of always idealized family li
fe in a big family. To me, it was just a basic human desire to want to have chil
dren.
NARRATOR: Since neither Will nor Marcellin could carry their baby, they searched
for a woman willing to serve as a surrogate mother.
WILL: Many of the women we knew who wanted to help us didn't really want to ca
rry a child that they were biologically related to. And with IVF, our friend sai
d, "Okay, if the egg's not from me, I would feel comfortable carrying the child.
"
NARRATOR: In vitro fertilization has enabled thousands of couples to create the
family they desperately want. It has also opened a gateway to a brave new world wh
ere a child can have five parents, or be born to a mother in her sixties; where
a baby can have its sex determined before conception or be created with borrowed
DNA; where an embryo, no larger than a speck of dust, can have its genes scanne
d for diseases, or one day be designed with new strengths and talents.
LEE SILVER (Princeton University): What IVF does is it takes the process of repr
oduction out of the darkness of the womb, into the light of the laboratory. And
all of the sudden you can do anything you want with these human embryos and eggs
, which couldn't be done before.
NARRATOR: A new revolution in making babies is underway, one that could allow us
to influence and even shape the genetic fate of our children.
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ANNE: I think it's very difficult for anybody to explain why they want a child
. And the thing that I always felt so strongly about why, as an infertile person,
do I have to explain why I want a child, where somebody who's not infertile does
n't? And it's something nobody is prepared for. Nobody is prepared for somebody

to sit across a desk from them and say, "I'm sorry, but you can't have a child."
NARRATOR: One out of every six couples struggles with infertility.
ILYSA: You come to realize how lucky so many other people are that they don't h
ave a situation like this. And there are worse things, I definitely agree. But t
o us...we were devastated.
NARRATOR: For many, in vitro fertilization is their last hope for a child, despi
te the stark reality that it fails 70 percent of the time.
JAMES GRIFO (NYU School of Medicine): These patients have often gone through yea
rs of trying to get pregnant. They're really stressed just from that alone, and
often by the time they reach the office of the specialist are depressed because
of this illness. And not many people view this as an illness, but infertility is
a rotten, horrible disease. And, no, it's not a disease that will kill you, but
it wreaks havoc in these patients' lives. It is not a cosmetic illness.
NARRATOR: The disease of infertility once seemed incurable until the miraculous bi
rth of Louise Brown in 1978. Her arrival marked an historic moment, for Louise w
as the first human baby ever conceived outside a mother's womb.
British doctors Robert Edwards and Patrick Steptoe had labored for years trying
to help women with blocked fallopian tubes. They could surgically remove their e
ggs and fertilize them in the lab, yet they couldn't figure out why the embryos
failed to develop into pregnancies once they were returned to the mother.
ROBERT EDWARDS (Bourne Hall Clinic): We had got all the techniques ready, right
up to the point of implantation beautiful embryos and checked out the chromosomes an
d everything about them. And it was clear this method had to work. There was too
much knowledge already in mice and rabbits and goats. Mind you, the techniques
we were doing were in advance of those, so we felt that the human was not so dif
ferent...that the method could not not work.
NARRATOR: The breakthrough came when Steptoe and Edwards decided to transfer the
embryo earlier, allowing it to divide only three times before placing it in the
womb.
ROBERT EDWARDS: I can see the embryo beautifully.
We were trying to come earlier and earlier, really to avoid long-term cultures.
That was my primary aim. And so suddenly the system started to work and we were
there.
NARRATOR: Three years later, NOVA filmed the birth of America's first "test tube
" baby, Elizabeth Jordan Carr.
Although Louise Brown was healthy at birth, many feared that IVF babies could we
ll be abnormal. Ultrasound had shown that Elizabeth was small, and the doctors t
hat created her, Georgeanna and Howard Jones were extremely worried.
HOWARD JONES (Jones Institute for Reproductive Medicine): I had written out a pr
ess release that said that we'd been disappointed at birth that the child was ab
normal, but that we did have a couple of other pregnancies coming along behind t
hat. And we would hope that the others were perfectly okay. And fortunately, I d
idn't have to use that.
PEDIATRICIAN: "All right, ladies, here she is Elizabeth! That's right. I knew you
would like it to be a girl."

ARTHUR CAPLAN (Center for Bioethics, University of Pennsylvania): I think the ma

jor moral concern was, "Were you going to have a child born who had birth defect
s? Were you going to have developmental abnormalities? Would something go wrong
later in the life of that person?" And I think the terror was that, somehow, doi
ng something in a dish was going to create a person that was less than healthy.
NARRATOR: But the terror faded quickly. As the press followed Louise Brown and E
lizabeth Carr, it was clear that the girls who had made medical history were gro
wing up to be perfectly normal.
ELIZABETH CARR (First American to be conceived through IVF): Every year people p
op up and say, "Oh, we'd like to do an update on Elizabeth." And every year I sa
y, "Well, I'm the same as I was last year, just a year older. That's it." It's k
ind of like they expect a wonderful answer like, "Oh yes, I feel so different. I
feel so special. And I don't."
NARRATOR: Initially, IVF could only help a small percentage of infertile couples
. Today, it has become the starting point for treating almost every cause of inf
ertility as defective eggs, weak sperm, or abnormal chromosomes once insurmountabl
e obstacles are overcome. Radical new techniques have proven that life on the cell
ular level is easier to manipulate than ever imagined.
But for those who embark on this high-tech process, IVF remains a grueling ordea
l. The first hurdle is to endure daily injections of powerful drugs to force the
ovary to produce more than one egg.
DARREN: Ilysa had gone through three weeks of taking shots, you know? All over h
er body bruises...getting up every morning at six in the morning to go to give b
lood. And you have a lot of guilt seeing your spouse go through all this stuff,
knowing that if I didn't have this problem she wouldn't have to do this. She's v
ery fertile. I mean that's the best part.
NARRATOR: Infertility was often seen as a woman's curse, but in fact 40 percent
of cases can be attributed to male problems like Darren's.
DR. ZEV ROSENWAKS (New York-Weill Cornell Medical Center): The sperm count is ve
ry, very low. And when you have such low sperm count, the challenge is to select
a normal sperm, or what looks like a normal sperm, and to get fertilization. Ho
wever, so long as we have some sperm and they're alive, we can allow the sperm t
o get to the egg.
NARRATOR: Because Darren's sperm are too weak to reach Ilysa's eggs, her eggs mu
st be surgically retrieved. Using a long thin needle, Rosenwaks probes her ovary
. One by one the tiny eggs are sucked out into test tubes and taken to the lab.
It is the quality and number of the eggs and sperm that will determine the outco
me.
DR. ZEV ROSENWAKS: We had fifteen mature eggs, and there are several motile sper
m, but very, very few. So they are looking...they have to search out quite a bit
. And the hope is, of course, to get at least an equal number of sperm to the nu
mber of eggs we have. And this is the kind of situation we're dealing with here.
NARRATOR: A fertile man will produce millions of sperm. Today the doctors have f
ound only 12 of Darren's to work with. Using a thin glass needle, one sperm is g
rabbed by its tail. Then Ilysa's egg is placed into position.
It was only by accident that scientist Gian Palermo discovered he could inject a
sperm into an egg without damaging it.
GIANPIERO PALERMO (New York-Weill Cornell Medical Center): Well I was placing sp

erm around the egg, underneath the shell, then, accidentally, I perforated the m
embrane of the egg. And then one sperm went inside. Ironically, I didn't pay muc
h attention. I thought the egg would not survive the procedure. And I put a ques
tion mark to it because I thought it was going to die. But that was the only egg
that fertilized. It finally was transferred to the patient, and this became the
first ICSI baby.
NARRATOR: Palermo called his discovery "ICSI" for intracytoplasmic sperm injecti
on. Amazingly, creating a human being through the manual injection of sperm prov
ed to be just as effective as natural fertilization. The only known safety risk
seemed to be the possibility of passing on the gene for male infertility.
ICSI's success would push forward a new frontier of reproductive biology. If a f
ragile human egg could be penetrated without harm, perhaps a human embryo might
be manipulated in any number of ways.
These new techniques would open up uncharted territory for another couple, Anne
and Michael, as conventional treatments failed them.
ANNE: People that are faced with infertility don't have the same decisions as
people that aren't. And these decisions, they're not what we would want. These a
re the choices we're left with. If I could make a choice, I would like it if my
husband and I could get pregnant on our own. And it's easy to sit there and say
what you would or wouldn't do when you're not in those shoes.
DAVID SABLE (Saint Barnabas Medical Center): She'd been trying for over four yea
rs. And she had done several treatments. She'd done some of the more...kind of l
ow-key treatments, you know? Medication by itself, medication with insemination
using her husband's sperm. She had had the full battery of diagnostic tests, non
e of which really revealed a smoking-gun cause as to why she was having difficul
ty. And she was climbing the ladder from least aggressive to most aggressive tre
atment.
NARRATOR: During Anne's first IVF cycle, her doctors retrieved 35 eggs an astoundi
ng number. Yet once the eggs were fertilized in the lab and began dividing, embr
yologist Jacques Cohen noticed fragments, little pieces of cells that are left b
ehind when embryos divide inefficiently.
JACQUES COHEN (Saint Barnabas Medical Center): And normally they're not really a
hindrance to further development and pregnancy, because they occur in about 85
percent of all embryos. But when you have a lot of them, it interferes with norm
al development. The cells then cannot interact. And that's what happened in thei
r case. There were so many of them that you couldn't even count the number of ce
lls. Let's say you had a four-cell embryo or an eight-cell embryo. You couldn't
make a count, which you normally can.
ANNE: So on the one hand, I have an answer which is finally...after like three
years...I finally have an answer of why I'm not getting pregnant. Then, on the
other hand I have this news that I don't know if this is going to be fixable. Th
is may be a permanent problem that we could never fix.
NARRATOR: For decades, no one dared to invade the inner sanctum of an embryo for
fear of harming it. But in 1990, Cohen began piercing the shells of fertilized
eggs that appeared brittle to help them hatch.
Today, he uses this technique to enter Anne's embryos and remove their fragments
. This plastic surgery is now routine in many IVF clinics, in order to boost a p
oor quality embryo's chance of implanting.
DAVID SABLE: To be honest, in the beginning I don't think we were sure whether w

e were just making the embryos look better, or whether we were actually helping
them to develop. And then when we put the data together, it turned out that, yes
, indeed there's a window of accumulation of fragments from about 15 to about 30
percent of the embryo. Previously, that embryo didn't have much of a chance of
implanting and turning into a pregnancy. But if you remove those fragments, they
had a very good chance of turning into a pregnancy.
NARRATOR: Five of the best quality embryos were transferred back to Anne. Althou
gh she became pregnant, six weeks later, she lost the baby.
ANNE: During all this time, we were surrounded by people that were getting pre
gnant. And here we were putting our financial savings into this. A typical IVF c
ycle in this area costs 12 to 15 thousand dollars. And you would invest your tim
e, emotions, and your money. And to have a result like this...you just feel like
you've been beaten.
NARRATOR: Anne endured one more IVF cycle. Once again she conceived and then mis
carried. Although she was only 29 years old, it seemed unlikely that she would g
et pregnant using her own eggs.
Failure is not the only risk of IVF. For those patients lucky enough to become p
regnant, one-third will deliver more than one baby.
Laura and David May became the parents of triplets after three of their four emb
ryos implanted. Although they were desperate to have children, they were not pre
pared for the high risk of a multiple pregnancy.
LAURA MAY:
I had to go into the hospital and they had, like, a little pump
that they installed to help control the contractions. I just ballooned. And the
most painful part was I no longer had ankles.
DAVID MAY:
We gave her six meals a day to make sure that all the nutrients
and everything that she needed, and the children needed, were there.
LAURA MAY:
We had the option to abort some to increase the odds of the othe
r ones being healthy. But we had tried five years and there was no question in o
ur minds. We were going for the multiple.
NARRATOR: Fortunately, Laura May delivered three healthy children. But not every
family is as lucky. Most triplets and higher order multiples are born premature
ly. Thirty percent will weigh less than two pounds.
ARTHUR CAPLAN: And the data that we have on that shows that about one in four of
those babies is going to have serious disability not mild disability, but real de
velopmental handicaps in life.
NARRATOR: Given the enormous risks, why not limit the number of embryos transfer
red back to the mother?
JAMES GRIFO: When a patient goes through an IVF cycle, and goes through all of w
hat's involved, they want the best possible chance. Now how do you give them the
best possible chance? By putting back more embryos. And how are clinics compare
d? People look at success rates. Even though they don't understand the nuances a
nd differences between patient populations, they want the one with the best perc
entage. So there is this incredible pressure on us to have high pregnancy rates.
NARRATOR: Because 70 percent of all embryos fail to develop, doctors transfer ba
ck several in the hope that at least one will turn into a baby.
DOUG POWERS: You know, when you look at an embryo under the microscope, as beaut

iful as it is on the first day after fertilization, when they're single cells, t
hey just almost all look the same. You can't pick out the highest quality embryo
on that first day.
NARRATOR: Since the early days of IVF, doctors have transferred fertilized eggs
back to the mother when they reach the eight-cell stage. But recently, labs have
been getting better at keeping embryos alive.
DOUG POWERS (Boston IVF): The hope has been to let nature take its course and ke
ep them in culture for a few more days after the stage we call the blastocyst, whe
n, really, the embryo proper starts developing. And the thought is, at that stag
e, nature will have selected, in our incubators, the best embryos.
NARRATOR: By transferring back only two embryos at the blastocyst stage, doctors
avoid the risks of multiples without diminishing the chance of a pregnancy. But
not every embryo can make it to the fifth day.
At Cornell University, Ilysa and Darren anxiously await news about their 13 fert
ilized eggs. Fortunately, eight have become viable blastocysts. Now the challeng
e is to pick the two that are most likely to survive.
ILYSA: Yes, there is a possibility of having twins and I'd be ecstatic. I'd be,
like,so happy. I even joked, you know, "Can I request them?" And they're like,
"No." But you just want something to stick and hopefully it will work. But if it
doesn't we would do it again.
NARRATOR: Although more than half the couples going through IVF walk away childl
ess, Darren and Ilysa hope that they will be the lucky ones who defy the odds.
Back in the lab, their two embryos are located beneath the microscope and carefu
lly sucked up in a catheter. Having live embryos transferred to her womb will be
the closest Ilysa has ever come to being pregnant. But to become babies they mu
st implant.
DR. ZEV ROSENWAKS: With blastocyst transfer, we have a very high success rate. N
evertheless, it's age-dependent, and in the early thirties it's 50 percent. It's
still 50-50. At the end of the day it's the biology and the competence of that
embryo, and that depends on both the egg and the sperm, and their combination.
DARREN: The most difficult part of IVF is everyday you're waiting for results on
something waiting to find out how much sperm and how many eggs there were. Then a
day later you're waiting to see, "Hey, when are they going to inject them back
into you?" And that was very stressful. That was four days of just waiting. And
now you don't hear anything until you find out if you have a child or not. So no
w will be the greatest of all results, but you won't know for two weeks.
NARRATOR: As technology advances, the treatment of infertility has been transfor
med from a small medical specialty into a four-billion-dollar-a-year industry. A
t this trade fair, sales teams from all over the world pitch their services to d
octors, hospitals and couples desperate for a baby.
The Center for Surrogate Parenting is in business to find surrogates and egg don
ors for infertile couples.
WILLIAM HANDEL (Center for Surrogate Parenting): This field started with everybo
dy thinking that it was ungodly, satanistic. I couldn't get a doctor to even tal
k to me when I first started. I was considered such a maverick. Doctors were afr
aid of being put in jail. I cannot think of any other field of medicine that in
20 years has gone from being a pariah to being considered mainstream this quickl
y.

NARRATOR: Many clinics insist that egg donors remain anonymous, but Bill Handel
has launched a thriving business finding applicants willing to reveal their back
grounds, and matching them with infertile couples.
WILLIAM HANDEL: Our Internet site, EggDonor.Com, offers the profiles of 300 of o
ur egg donors.
NURSE: What are you looking for?
WOMAN: Do you have Jewish donors?
NURSE: Absolutely.
WOMAN: In our area?
NURSE: And your area is...?
COUPLE: In California?
NURSE: Yes, we do.
COUPLE: Okay. Just click Jewish here?
NURSE: Yes.
COUPLE: Brown hair, brown eyes.
WILLIAM HANDEL: You can go on "blond, blue-eyed, Caucasian, Christian woman," an
d it will then select everybody in our database that has those characteristics.
NURSE: And we'll submit.
NARRATOR: Bringing a third person into the reproductive process raises many trou
bling questions. For an infertility patient like Anne, turning to egg donation o
r even adoption meant forsaking a biological tie to her child. As she grappled w
ith this dilemma, the research team at Saint Barnabas Hospital was pushing forwa
rd a new frontier of reproductive biology involving the exchanging of parts, fro
m one egg cell to another. They offered Anne an experimental procedure called cy
toplasmic transfer, designed to help women whose eggs divide inefficiently.
DAVID SABLE: The reason that an egg might not be able to do its job very well is
that it may have abnormal chromosomes inside. On the same hand there's a possib
ility that there's a defect in the ability of the egg to distribute its normal c
hromosomes. And we most suspect that that's true in younger women, who we believ
e still have genetically normal eggs, and in whom the usual in vitro fertilizati
on techniques uniformly result in very poorly developing embryos.
NARRATOR: The procedure would preserve the nucleus of Anne's eggs that contain o
ver 99 percent of her chromosomes, the DNA or genetic material that makes her un
ique.
She would borrow from a donor egg a portion of its cytoplasm, containing tiny ce
llular structures. Among them are thousands of mitochondria that provide energy
for the cell to divide, and incidentally, carry DNA for a small number of genes.
In theory, a deficiency in the cytoplasm might prevent an egg from developing no
rmally.
STEEN WILLADSEN (Saint Barnabas Medical Center): The idea behind it was that, if

there were situations where it appeared that cytoplasm was damaged or insuffici
ent in one way or another, even if one was unable to say precisely what it was t
hat was wrong with it, one might be able to replace it with presumed normal cyto
plasm.
NARRATOR: Cohen and Willadsen experimented with animal models, mixing the cytopl
asm from different mothers of the same species. As they had hoped, the babies ap
peared healthy and normal.
Although the doctors felt confident enough to proceed, Anne struggled with the r
isks.
ANNE: When you're left with these choices, egg donation or adoption, or doing
this new procedure... Egg donation...you don't know who is donating this egg. It
's all anonymous egg donation. You don't know any dispositions towards illnesses
, whether it be mental or physical illnesses. And you don't know how your childr
en are going to react to the news when they grow up that they are not geneticall
y your child. With adoption, you have the same risks, except the adoptive mother
could want this child back in their life.
So you're looking at three options that are risky, and you have to decide emotio
nally, medically and financially which have the fewer risks.
NARRATOR: Deciding to proceed with cytoplasmic transfer, Anne and a donor had th
eir eggs harvested. Then Cohen removed the cytoplasm from the donor's egg, caref
ully avoiding it's nucleus.
STEEN WILLADSEN: One could argue, as indeed some people are arguing, that all th
is is unnatural, and it shouldn't be done, and just leave it alone. But on the o
ther hand, if we want to gain more insight that can be of benefit in the area of
human reproduction, well then, every now and then the boundaries have to be mov
ed a little bit. You simply cannot gain experience without experimenting. And it
's as simple as that.
NARRATOR: By using the fertilization technique of ICSI, donor cytoplasm can be s
afely injected into Anne's eggs along with her husband's sperm. Three days later
, when the developing embryos were examined, they appeared less fragmented. Four
were selected for transfer.
JACQUES COHEN: I think looking at her pictures of the four embryos that were tra
nsferred in a final cytoplasmic attempt, and comparing them to the photographic
material we have available from the previous attempt, there were more cells and
the cells looked healthier. And therefore, my impression is that at least in one
or two of the embryos there seemed to be a higher chance of development.
NARRATOR: Unlike Anne, the majority of patients who turn to IVF are in their lat
e thirties or early forties. Many find it difficult to get pregnant simply becau
se of the age of their eggs.
JAMES GRIFO: Our peak fertility is in the mid-twenties, early twenties. And yet
most of us are delaying childbearing until the late thirties. Now it is clear th
at one of the reasons the older patients don't get pregnant with the same effici
ency as the younger patients is that the embryos are chromosomally abnormal at a
higher rate. And it all correlates with the egg and what happens to the egg.
NARRATOR: During a woman's childbearing years, one egg is ovulated each month. I
f it is fertilized, it will replicate its chromosomes and then divide, splitting
them in half.
JAMES GRIFO: Now, when that process happens in a young woman's egg, it goes alon

g just fine. When it happens in an older woman's egg, it doesn't. Chromosomes ge

t lost or are missing and you make an unhealthy embryo from that. So the theory
is that there's something in the machinery or the cytoplasm, not the nuclear por
tion of the egg, but the surrounding portion of the egg, that moves those chromo
somes around that causes these defects in the older woman.
NARRATOR: To avoid the possibility of chromosomal damage, Grifo went one step fu
rther than cytoplasmic transfer. He carefully took the nucleus from an older wom
an's egg and injected it into a younger donor egg that had had its nucleus remov
ed. The reconstructed egg was then fertilized and allowed to divide using the ma
chinery in the cytoplasm of the younger donor.
JAMES
ilize
bryos
n the

GRIFO: And we were able to reconstruct an egg in that fashion get it to fert
and make embryos. And we did it in a couple patients and we transferred em
and nobody got pregnant. We only transferred three or four embryos total i
experiment, but then we got into trouble.

NARRATOR: Criticized for unacceptable human experimentation, Grifo returned to t

he lab. Nuclear transfer techniques had recently been used to clone animals. And
although Grifo was not trying to clone a human being, some feared his work migh
t take us one step closer.
LEE SILVER:
There's a lot of criticism of human reproductive biologists who
are using all of these new technologies to allow people to have babies. Because
as a scientist you do all of this background research, and you don't try anythin
g until you're absolutely 100 percent confident. But in these cases we have wome
n and men who are desperate to have children. And what the reproductive biologis
ts are working on is the basic premise that if you do a manipulation, and you've
manipulated it too far, you don't get a birth defect, you get no fetus or baby.
NARRATOR: On December 20, 1998, Anne delivered a healthy baby girl named Katie.
She was the third child born using cytoplasmic transfer.
ANNE: This was my closure. This birth was closure to 5 years of infertility, a
nd I really think this whole experience, when I look back on it, it makes me app
reciate my daughter and my family so much. And every day I look at her in amazem
ent that she's here. And that she's my child. She knows her background, she know
s her roots, and to me, that's important.
NARRATOR: Katie has a mix of her parents' genes, as well as traces of mitochondr
ial DNA from the egg donor.
But was cytoplasmic transfer responsible for her birth?
DR. DON WOLF (Oregon Regional Primate Research Center): My problem with cytoplas
mic transfer is I can't conceptualize very well what in fact is the significant
component that is being transferred from the cytoplasm of a donor egg to the cyt
oplasm of the infertile woman's egg that's conferring upon that egg some kind of
improvement in quality. If, in fact, that's happening. I mean, the numbers at t
his point don't allow us to say anything in terms of efficacy. And clearly they
don't allow us to say much in terms of safety.
LEE SILVER:
There's no scientific proof that the genetic change brought abou
t the development of this child, but there is scientific proof that this child h
as DNA from a source other than her parents. And so, this is the first instance
of genetic engineering. Whether or not the genes themselves really had an impact
on allowing this child to be born, the threshold has been crossed. We have alre
ady engineered embryos, and so people can't say, "Well we have to wait until a c
ertain point." It's already been done.

NARRATOR: With each new breakthrough in making babies, the limitations and rando
mness of nature are slowly being overcome. One of the most intractable barriers
egg donation has pushed back is the limit of age.
Back in 1980, when Arceli Keh got married, she was entering menopause and had no
chance of becoming pregnant or even adopting a child. For years, she followed t
he development of IVF, hoping that new techniques might help her become a mother
. She saw her chance with egg donation, and at age 60, decided to bend the rules
.
ARCELI KEH (Woman who gave birth at 63): I really lied about my age because they
have this age limit of 55. So I think I will not qualify if I will not lie abou
t my age. And I really want to have a baby.
RICHARD PAULSON: She presented herself as someone who
hin our age guideline of 55 underwent the usual kinds
g a treadmill test and a variety of other blood tests
ents, and as far as we were concerned,we thought that
ne patient.

was fifty years old well wit

of medical testing, includin
that we do on all the pati
she was just another routi

NARRATOR: Mrs. Keh took hormones to force the tissues lining the walls of her ut
erus to thicken. Within months, her womb returned to its pre-menopausal state, c
apable of sustaining a pregnancy. Then donated eggs, fertilized with her husband
's sperm, were transferred back.
After spending 40,000 dollars and enduring five IVF cycles, she gave birth to Ci
ndy. At age 63, she was the oldest woman to ever have a baby.
RICHARD PAULSON (USC Center for Infertility): The deception had been obvious. Sh
e knew that she had deceived us. She did it consciously, and successfully, becau
se she had attained the goal that she had wanted to. What should I tell her? Sco
ld her for being non-forthright? I congratulated her.
ARCELI KEH:
I feel very happy, actually. She changed our life for a better o
ne. I just hope God will give me a much longer life, you know, to be around her.
ARTHUR CAPLAN: When
or mate may be old
ight want to set an
the couple. So that
"We're nervous that
are protected."

an older woman has a baby, it's very likely that her partner
as well. And I think it's risky to create orphans. So, you m
age limit, if not on the age of the woman, then at least on
you do what we do in adoption, which is to say at some age,
you can't be around to make sure that the child's interests

NARRATOR:
The creation of families with borrowed eggs, sperm or wombs has
raised a myriad of complex issues. One of the most difficult is explaining to ch
ildren how they came to be.
WILL:

"Oh help! There is a mouse about the house!"

MELINA: "That's okay."

WILL:

"And it gave Mrs. B a fright."

MELINA: "That's okay."

WILL: When we turned to IVF from traditional methods, such as artificial insem
ination, one of the things we did think about was what story we tell our childre
n. Because when you start separating the functions of carrying the child versus
donating the genetic material, then it becomes more complex.

NARRATOR: Will and Marcellin created a birth book to explain to Melina why she d
oesn't have a mother in the traditional sense.
WILL: It's a very simple story about how her daddy and papa met, fell in love,
wanted a family. And how men don't have eggs and women have eggs and men can't
carry children or deliver children, but women can. And papa and daddy searched t
he world to find two women who would help them.
JAMES GRIFO: There's, like, 18 different ways to make a baby now, because of the
technologies. And, you know, that makes us have to rethink, "What is a family?"
Well, the fact is, what it means to be a family is to have a parent or two pare
nts raise a child, and care for the child, and have an attachment to that child
that nobody else has, and a responsibility to that child that no one else has. A
nd that's really what matters.
NARRATOR: Assisted reproduction began with the idealistic goal of helping infert
ile couples have babies. But increasingly, it has given parents greater control
over their unborn offspring. At a leading infertility clinic in Virginia, a tech
nology called "microsort" is enhancing the ability of science to determine one o
f a child's most important traits its sex.
JOSEPH SCHULMAN (Genetics & IVF Institute): The commonest types of individuals t
hat we help are families who are at risk for having children with x-link disorde
rs. These are disorders that effect males and therefore microsort can be very he
lpful in producing disease-free, female offspring in these families. And the oth
er largest group come to us for family balancing, where they already have a prep
onderance of children of one gender in the family and they wish to weight the od
ds in favor of the opposite gender.
NARRATOR: Of the 23 chromosomes carried by the sperm, only one determines gender
. Sperm carrying an X chromosome will produce a girl. Sperm carrying a Y chromos
ome will produce a boy. For $3200, sophisticated machines can detect the minute
differences in size between male and female sperm and sort them.
JOSEPH SCHULMAN: The chance of having a girl, when that is sought, exceeds ninet
y percent. And the chance of having a son exceeds seventy percent.
ARTHUR CAPLAN: I think what's involved here is not the choice of boy or girl, it
's the fear of sexism. If we knew the percentage of boys and girls would be abou
t the same, I don't think anybody would care. So, I think the issue isn't choice
of sex. It's actually, "Is it going to distort the make-up of the population or
reinforce stereotypes about men and women?"
NARRATOR: Sex selection has already led to an imbalance in India where there are
an estimated 40 million fewer women, primarily because of the routine abortion
of female fetuses. In China, the desire for boys at one point changed the sex ra
tio to 153 Chinese males for every 100 females. In contrast to the rest of the w
orld, American parents are using microsort to have baby girls.
JAMES GRIFO: I think if patients want to use it, and want to spend the amount of
money that's required that's their choice. To me, it's the wrong message. To me
, gender is not a disease, and I'm not going to select against it. You know, I w
ant people to have healthy babies. And whether it's a healthy boy or a healthy g
irl, I don't care.
NARRATOR: Choosing a baby's sex is a far cry from designing our children. But ev
entually, parents will have even more choices using a powerful technique called
pre-implantation genetic diagnosis or PGD. From a single cell plucked from an em
bryo, doctors can analyze individual chromosomes and genes.

This microsurgery rarely harms embryos, and helps doctors figure out which ones
are disease-free. One of the earliest pioneers to use PGD was Barbara Nastro.
BARBARA NASTRO: I had many chemical...what they refer to as chemical pregnancies
. So that means that I would become pregnant, and then within a couple of weeks
of holding the pregnancy, it would fizzle out.
DAVID SABLE: When you see that, it's very suggestive that many of the fertilized
eggs have abnormal chromosomes, and that nature is just doing its best to stop
these abnormal pregnancies from developing.
NARRATOR: At age 41, Barbara underwent IVF in order to use PGD to test her embry
os. A single cell was plucked from each one and analyzed with fluorescent dyes t
argeted to bond with five specific chromosomes most prone to have either an extr
a copy or a missing one.
Embryos with the correct number of chromosomes, like this one with matching pair
s of color signals, could be transferred back. In contrast, this embryo is missi
ng one if its red signals, and would not develop normally.
Barbara had nine fertilized eggs to test.
DAVID SABLE: And it turned out that four of them were chromosomally abnormal, in
cluding some of the embryos that looked very, very good that typically, we would h
ave transferred, and would have resulted in another miscarriage. And we subseque
ntly transferred the normal embryos and a successful pregnancy occurred.
NARRATOR: Barbara gave birth to healthy fraternal twins, Gabriel and Luke. Altho
ugh PGD spared her repeated miscarriages, its cost, in conjunction with IVF, was
almost prohibitive.
BARBARA NASTRO: The pre-genetic determination test alone as I recall, is about $
20,000. Plus...then when our babies were born early...premature...six weeks...th
ey then had to spend three weeks in the NIC Unit. That alone, I believe, was som
ewhere around several hundred thousand dollars for them to be there for that len
gth of time. It's an enormous amount of money money that is inconceivable to most
couples.
NARRATOR: But for parents who risk passing on inherited diseases like cystic fib
rosis, PGD offers the hope of having a healthy baby. At the moment, scientists c
an look for genes related to several dozen diseases. But our ability to screen e
mbryos will improve exponentially as a result of the decoding of the human genom
e.
LEE SILVER:
And what's going to happen over the next decade is we're going t
o understand how those genes cause all sorts of diseases like asthma or juvenile
diabetes, or severe depression, or predisposition to heart disease or Alzheimer
's diseases. All of these diseases are going to be understood in terms of their
genetic influence.
NARRATOR: To exploit this knowledge, technology is emerging that allows DNA frag
ments containing thousands of genes to be analyzed with automated gene scanners.
In the future, DNA computer chips may be able tell you every single form of the
approximate thirty thousand genes that you've got.
GATTACA CLIP: "They used to say that a child conceived in love has a greater cha
nce of happiness."
NARRATOR: Hollywood has already imagined the implications of this powerful techn
ology.

GATTACA PROGENY (played by ETHAN HAWKE): I will never understand how my mother p
ut her faith in God's hands rather than those of her local geneticist. Ten finge
rs, ten toes that's all that used to matter. Not now. Now only seconds old, the
exact time and cause of my death was already known.
GATTACA NURSE: Neurological condition, 60 percent probability; manic depression,
42 percent probability; A-D-D, 89 percent probability; heart disorder, 99 perce
nt probability; life expectancy 30 point 2 years.
LEE SILVER:
The amazing thing about Gattaca is that it is scientifically rig
ht on the mark. Because it will be possible in the future to take a drop of bloo
d from a child, and know the pre-dispositions to every kind of disease that this
child is going to face in his or her life. DNA chips revolutionized our ability
to look at human genes and it will be possible in the future to use a DNA chip
on embryos.
ARTHUR CAPLAN: What I envision in 20 years, is that someone will be able to go t
o the in vitro clinic who's very fertile, who has no infertility problems at all
, but simply says, "If you can tell me a lot about the kind of child that I'm li
kely going to have, then I'm going to spend the money and use an artificial way
to create a baby...to kind of get a better baby."
LEE SILVER:
And then what a couple would be able to do is to look at their c
omputer screen and look at what the child's height would be, certainly; what the
hair color would be; whether the child's going to go bald; whether the child's
going to get asthma; whether the child's going to be a bit aggressive or shy. Al
l of these things are going to come out of looking at a DNA chip profile from ea
ch of these embryos.
NARRATOR: The limitation to pre-implantation genetic diagnosis is that parents c
an only select for genes that embryos already have. But scientists have begun in
serting new genes into embryos, endowing thousands of animals with unusual trait
s.
A specific gene from a jellyfish can make mammals glow in the dark. Molecules in
volved in learning and memory can be genetically augmented to create smarter mic
e.
As reproductive biology and genetics merge, will parents of the future have the
tools to design their children with new strengths and talents?
JAMES GRIFO: Yes. These things could happen. Right now they don't. We don't know
the genes for hair color, eye color or intelligence. We don't know how to selec
t for them. We don't know how to analyze for them. So these fears, while based i
n the potential reality that they could occur, are really unfounded.
ARTHUR CAPLAN: I think we'll see this happen. I think it's going to be very diff
icult to say to people, "You can't do this," because in a sense, today, we're al
ready down that road.Some people do everything they can to environmentally advan
tage their kids. Do we say they're morally wrong? In fact, we say they're doing
a morally good thing. It's good to give your child, in a competitive market soci
ety, the best shot at success. And I think that's the ethos that's going to carr
y us right straight into using pre-implantation genetic testing and new genetic
knowledge to design our descendents.
NARRATOR: In many ways, the brave new world of assisted reproduction promises fa
r more benefits than perils. In the 21st century, newborn children will be spare
d lethal diseases that plagued past generations. As the mysteries of reproductio
n give way to knowledge, even infertility might be overcome.

For Ilysa and Darren ICSI has paid off. They are now the elated parents of a hea
lthy baby girl named Sarah, born January 29th, 2001.
Anne's daughter, Katie appears to be healthy and developing normally. Although c
ytoplasmic transfer is still highly experimental, for the small group of patient
s that have turned to it, 36 percent have become pregnant.
LEE SILVER:
People are afraid of the unknown and most people, therefore, rej
ect new technology. It takes the mavericks, the maverick scientists and the peop
le who have some guts to work with the maverick scientists and clinicians to bri
ng the technology into the public domain.
JAMES GRIFO: There are risks to these things, but there's also risk to not treat
ing disease. And people forget that. People forget how hard it is to live with i
nfertility. People forget how devastating that is. And people don't understand w
hy patients are willing to take these unknown kinds of risks to have that child,
because they forget about the disease.