Baby business

Anyone who’s ever considered fertility treatment, adoption or alternative ways to have children has had to deal with the business side of a very personal decision.

In terms of fertility, many in my generation of peers seem to have prioritized their careers while in their twenties. For those reasons and because we all believe that medical technology is pushing out the biological envelope (despite our mothers, aunts, and anyone who could speak telling us that was not true), most of my girlfriends are having/will have/had their children while in the thirties.

There are, of course, the lucky ones, who think about getting pregnant and the next second, they are miraculously expecting. I think this is fabulous and am truly happy for them (you know who you are! 🙂 )

But the norm seems different. Most of the women I know (both in India and here in the US), have had some experience with the fertility process. Usually the Ob/Gyn gets you going but as soon as you go to a fertility specialist, it is a factory of sorts. Get tested to make sure both partners are fine, start with IUI, if it doesn’t work go to IVF. I mean factory in a good way since there are clear processes and everyone knows what to do and what’s next. But you very quickly realize that it is a business. In case you don’t realize it when you walk in, you will as soon as your insurance stops covering you (most insurance doesn’t cover IVF) and you realize that each cycle involves a significant monetary cost.

In addition, there is an “alternative” channel and I think it is great that it exists. Not just for gay and lesbian couples but also for couples who want to have the children be biologically related to at least one parent. Very close friends have happy, healthy kids this way, and here again, there is a process, albeit a slightly different one — find an egg donor and/or sperm donor, pay for fertilization and storage, find a carrier/surrogate and impregnate said carrier. Couples are paying for every step in the process, the most expensive being the carrier since the time involvement is the longest.

And then there is adoption, which has it’s own complications. Instead of paying for pieces of biological “content”, you are paying for a child. It is easier to say that a parent and child are “matched”, but the costs of travel, paying all the agencies and the fees all add up. Whether it is blatant or not, there is payment involved.

Into this fascinating world comes Debora Spar. From an article in Harvard Business School’s Working Knowledge:

“We have a business that doesn’t feel like a business,” said Spar. “Nobody wants to acknowledge the extent of commercialization.” Yet Americans alone spent $2.7 billion on fertility treatments in 2002. Procedures such as egg and sperm donation, in vitro fertilization (IVF), surrogacy, and adoption demand payments of $10,000 and up.

Despite the classic components of supply, demand, advertising, and differentiation, this market does not function normally, said Spar:

  • Prices are excessive. “We have a product that 90 percent of the population gets for free. The other ten or fifteen percent have to pay anywhere from $25,000 to $60,000 and up. You don’t see that kind of inequity often.”
  • Inconsistent standards of payment. Only ten U.S. states have some sort of mandate regarding insurance coverage for fertility treatments. In some cases, desperate couples are relocating for the sole purpose of obtaining coverage.
  • Ambiguous legislation regarding ownership of children. “Court decisions have been all over the map,” said Spar.
  • Absence of property rights. “Do you own a child—even your child? Do you own your body?” asked Spar. “The law says yes and no.” Until there is more clarity, the market cannot thrive.

I think Spar raises some really important points about the disfunctional “market” that need to be addressed. There is too little structure right now – who you work for and where you live has a huge impact on how much conceiving/procuring your child is going to cost. Most insurance in NY, for example, is not required to cover IVF. What is a middle-class couple (let alone a poor couple) who is infertile supposed to do? We certainly don’t punish poorer people with diseases this way – why is infertility a special case?

In cases where the sperm or eggs are “bought”, there are several legal issues that Spar highlights. In some countries in Europe for example, paying for an egg is illegal – what rights does that mean to parents of such children? Lawyers in such cases get reams of documentation and signatures in the hopes of protecting their clients, but it is an evolving space.

And finally, Spar raises an extremely interesting point – does the cost parents bear entitle them to choices like gender and other genetic characteristics?

Spar suggests four lenses within which to frame this debate:

First is simply information. We should think about the kind of information that is most important to us (health data, for example, or cost data or comparative studies of clinical success rates or adoption placements) and then provide these data through public sources. Right now, it’s simply too hard for would-be parents to get accurate and reliable information.

The second is cost. Because no one likes to think of children as existing in a market, we have been very wary of discussing cost. But it costs money to acquire a child through non-traditional means. So we need to be very upfront in discussing what these costs are, and which pieces of them should be borne by society, rather than by the parents themselves.

A third framework would relate to equity. As a society, we need to think about what fairness means in this realm. Is the ability to reproduce a basic human right? Is it part of medical care? And does it extend to all people, regardless of their age, sexual preference, and health condition? Once we get even a rough consensus around this issue (even if that consensus is forged at a state, rather than a national level) we can begin to craft policies that make sense.

Finally, tough as it may be, I think that we also need to think about appropriate limits to parental choice. Where should we draw the line on what kinds of children people can create, and what kinds of technology they can employ? We’ve already said no to reproductive cloning. There may well be other prohibitions that we also want to consider.

I think that’s a great start. Ever single issue she raises is worthy of hours of discussion and we need to have discussions like this in the policy realm. It will clarify and hopefully ease this process for thousands of couples dealing with a very emotional issue.

And I have added Spar’s book to my reading list – can’t wait for it to get here.

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  • Anonymous

    I have a girlfriend who went through the whole IVF process and she had a tough time. It took like 3 tries before she got pregnant. And she was only 28 at the time, so not sure if it has anything to do with age.

    Anyways, she had to have injections every single day – she was poked and prodded all over, but was a great patient. I guess she was willing to do anything to have that baby. Not sure if everyone’s IVF experiences are the same, but hats off to women who are willing to go through this. Sounded painful as hell.

    Is it really as expensive to adopt? Does it really give you that feeling of giving another child a chance at a life that he/she might not otherwise have? How about surrogacy? Maybe I’ve seen too many movies, but isnt the fear of not being able to get custody in the end, a real worry?

    If someone is actually going through the IVF experience, can you tell me your reasoning as compared to adoption? I mean, do you really not mind going through all that pain?

  • Shripriya

    @ Anon – while it is true that age is not the only reason for fertility issues, it is also true that fertility issues rise dramatically post-thirty.

    With regard to adoption versus IVF – that’s a personal decision that each person makes. I find a lot of people who preach the benefits of adoption are those who have their own biological kids. A weird double-standard if I ever saw one. I’ve also seen a fabulous trend where lots of couples in India are adopting their second child. A good way to fulfill both needs/desires.

    Finally, while I appreciate your commenting, I blog so that I can have conversations with people and get to know them. So please indulge me by using your name in future. And I’d love to hear about your own points of view – do you have a child, have you adopted a child etc.?

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  • I read this article last year since I am interested in other types of baby businesses and was absolutely riveted by it! In my worldview every person deserves what they truly want and are capable of cherishing and for a lot of people for evolutionary reasons and otherwise babies are and likely to remain the Holy Grail among personal desires. I think it is unfortunate that commerce has reared its ugly side of denying this opportunity to everyone who wants a baby but I think sometimes I am grateful that in our time we are at least able to pursue by any means possible what in prior generations might have been impossible dreams and who knows this technology could become the airplanes of the future – I am hopeful 🙂 Modernity and its many miracles!

  • Anonymous

    First of all, there’s a reason I don’t want to leave my name – I dont want to be identified. I have left my name on other posts of yours and I enjoy the discussion, but this one… I want my privacy. Hope thats ok.

    Yes I have adopted a little baby girl. I never did go through the IVF process – a little bit because it was too expensive, a little bit because I didnt want to go through the pain and mostly because I wanted to give another baby a chance at a better (hopefully) life. I definitely don’t have the double standards. I just chose adoption from the start. Personally for me I don’t think it worked out more expensive than IVF.

    There, I’ve bared my soul. Its a well-guarded secret which is why I dont want to mention my name. What about you? Are you going through the IVF process? Do you already have kids? Are you thinking of adopting or have already adopted?

    Its definitely a personal battle and some people will go to any lengths to make sure the baby is theirs even through surrogacy, but I just couldn’t do it. I’d love to see someone else actually talk about this through personal experience instead of in the 3rd person.

  • Shripriya

    @ Prithvi – How wonderfully put “every person deserves what they truly want and are capable of cherishing”. So true. And yes, we are lucky to live in an age where medical technology has advanced and the world has shrunk so that IVF and global adoption are both possible.

    @ Anon – Thanks for the followup – I am sure the joy of being a mother is unsurpassed. And I totally respect your privacy and the decisions that you made! As you say, this is a very personal topic and one that warrants privacy. Since this is my blog, I, unlike you, don’t have the benefits of such privacy 🙂 So I will have to leave you guessing!

    What I can tell you is that I believe that every person in the world has the right to decide whether, how and when to have a child. And, I blog about anything that intrigues me, not just stuff that affects me personally. 😀

    Finally, if someone wants to blog about their personal experience, my comment section is yours!

  • anonymous-man

    I’ll identify myself to the owner of the blog. Hope that’s OK with all the rest.

    I’m an Indian man – we have one kid through an IVF (2 years old) and have 2 more(!) on the way (again IVF). We (i.e. my gutsy wife!) did the usual IUI thingee which did not work out well. We are testament that things _do_ get more difficult once you cross 30 and gets progressively more so.

    If IVF is the chosen route there are ways to “manage” costs: meds from Canada (or better still, India, if you can swing it); treatment in India if you can work it (typically costs about $3000 per cycle if you don’t have additional procedures like ICSI – and can be done in as little as 2 weeks – of course timing is everything). Anyway … the end result is awesome – worth the emotional and financial turmoil when it works.

  • Anon

    I have been reading this entire discussion thread. I am 31- married for 7 years and trying to have a baby.

    Anon, I would like to know about the IVF experience because I think that is the option left for me. Just want to share/discuss anxieties/experience and learn from it.

    I think its a shame that insurance companies do not cover infertility treatments. Am I being bitter when I say that some people have all the luck in the world and some have to struggle so much for something with has made India into a 940 billion strong country? I think I am, but after many disappointments my cynicism may be justified.

  • Shripriya

    @ Anonymous-man: Thanks for the very informative comment. Congratulations on your twin babies and all the very best!

    @ Anon: I’m sorry you are going through such a tough time. Please don’t apologize for choosing IVF – it is a personal decision and no one should feel guilty for wanting a child.
    In either the US or India, a fertility specialist should probably be your first stop. Maybe your ObGyn could recommend one? With regards to the details of the procedure itself, some quick research on the internet should give you tons of information. Per Anonymous-man, if you are not covered for IVF, there are lots of ways to reduce costs. I wish you the very best of luck in fulfilling your dreams.

  • The timing of a baby is a personal decision and therefore respected. But let me share my experience in the indian context.

    1. I started trying for a baby in 2004 and conceived in 2005. I am 28 now. Becasue of my genetic framework, my baby was a monster and had to undergo a c-section. All well so far. But, now i feel i should have had the child earlier. For 2 reasons. One is that raising a child is back breakng work especially if you are a nuclear family. and2 unlike a normal delivery i have to wait for min one year before i conceive again. Doing the math: till the age of 50 from the age of 28 i would be taking on a learnng curve. Where is the time for myself?

    2. My sister-in-law could not have a baby after trying for many years. She finally adopted at the age of 39. Today the kid is 9 years old and the mother is 48. After work and running the house she now finds coping with a 9 year old impossible. On the other hand, the girl fnds it odd as to why her mother is not like the young mothers. It reached a stage when she asked her mom to not come to school coz kids thought she was so old. Now the mother thinks that adoption was a mistake.

    There is a lot more to havng babies than just pregnancy and delivery.

  • radha

    Hi, Just a comment to the previous comment , I’m an Indian woman too and i have had the good fortune to have 2 kids without any problems, i do disagree with the timing thing though, I have a son who’s 7 and a daughter who’s 1 . I decided to concentrate on my career after my son and now am established and had a girl when i was 33. sure till i’m 50 i have a learning curve, so what . I do believe mothers in their 30’s are better equipped to deal with kids and if the downside is that i will be the oldest mom when she goes to school. probably so but i’ll also be the most content with a fantastic education,career and sense of accomplishing and having it all in life . If you keep fit/ exercise and have a young mind 30’s and 40’s is not old it’s the prime of your life.

    And as for time for myself, i have plenty. i go with friends once a month, we take vacations, i read books watch documentaries and movies with my husband etc., etc., it all comes down to structure and how you raise your kids. my kids are in bed by 8.30 that gives me an easy 1.5 hrs by myself at night everyday !!!! so just like i adjusted to a husband i did to my kids so yes if i had to do it again, i would have my son a bit later too maybe in my 30’s…

    just my 2 cents worth.

  • Shripriya

    @ Cinamon – I think timing is also personal. No doubt the new human being in your life will change things – I think how you choose to adapt to it determines your experience. I know lots of moms who make the kids the central focus. I know lots of moms who manage to do what they did before. Whatever makes each one happy, I guess. Thanks for sharing your perspectives.

    @ Radha – I think when each person has kids depends on their unique situation. It seems like you’ve managed to weave your kids into the equation instead of completely changing the equation. Finding time for yourself must be so great and it probably keeps you sane too! Congratulations!

  • Anon Man 2

    Hi, After trying iui (4-5) and ivf (2) (total 6 years of treatment with a gap of 3 years between 2 ivfs) she finally refused to go further.(All her decisions with 0 pressure from me). I agree , it is very difficult for the woman.Extra hormones and expectations wreck “normal” life.Those 6-7 years were so stressfull.

    money was not a factor in our case (60-70k (Rs) per ivf cycle 1997-02) but think it should not be that much.

    Finally one day we decided enough is enough. registered for adoption. and 3 years back xxx came in our life.

    my advise is.. one should be “ready” for adoption, no point in hurrying. you “know” when both of you are ready. Before that you should have a “closure” on treatment.

    friends say to me that we wasted 6 years and should have adopted earlier but if we had without knowing for sure that it was not possible to have our own, i dont know, there could be something at the back of mind.

    Now we are sure and happy.

  • Karin

    I agree with the poster who said, too many parents of biological children are preaching adoption to those of us who are infertile.

    A parent of bio children who hasn’t been through years of infertility can NOT understand what we go through. I find it sad and rather hypocritical also, that these parents had their own children but tell everyone else to adopt!!