(From U.S. News & World Report, The New York Times, Newsweek, The Washington Post Weekly Magazine)

Last November, when seven babies emerged from a single womb, that of Iowa's Bobbi McCaughey, the immediate result was media frenzy. Banner headlines screamed of miracles, but not all of the reaction was ultimately favorable. "The human womb was not designed to carry a litter," huffed one doctor quoted by a national magazine. And while the McCaugheys drew praise from abortion opponents for opting not to "selectively abort" any of the fetuses, some experts questioned how Bobbi became pregnant with so many in the first place.

Newsweek was one of the few national publications to draw attention to this aspect of the McCaughey sideshow, pointing out that, for a woman undergoing infertility treatment, doctors typically use ultrasound to see how many eggs she has produced and recommend she abstain from intercourse if she has too many. "If you see seven follicles about to erupt, you don't have to inseminate, you don't have to have intercourse," said Dr. Louis Keith, president of the Center for the Study of Multiple Birth and a professor of obstetrics and gynecology at Northwestern University. "The appropriate means to stop this is by canceling the entire cycle."

In light of these revelations, the McCaugheys' remarks that, "God could have given us one, but God's entitled to give us seven. It's our commission to raise them," are nothing short of mystifying to some people. Were the McCaugheys poorly informed by their doctors of the complex combination of drugs and technology that resulted in the successful birth? Surely they couldn't have missed the 66-member medical team that delivered the babies. Or the state-of-the-art NICU where the babies were kept for months, at a cost some experts said could run to several thousand dollars, per infant, per day. Dr. Peter Heyl, a maternal-fetal specialist at Eastern Virginia Medical School in Norfolk, told Newsweek, "My hunch is we're into six-figure fees getting the seven kids out of the hospital."

Perhaps the McCaugheys, like many people of decided faith, see little distinction between God's will and their own. The McCaugheys' faith has certainly been rewarded. The seven infants survived their birth, and all are now safely home. And the McCaugheys have been showered with help and support, including a custom-fitted mini-van, a lifetime supply of pampers, and an offer by a local dentist to fix Bobbi's teeth — all free of charge.

To the many mothers struggling with inadequate medical care, housing, day care and public education for their children, the blessings showered on the McCaughey septuplets must seem miraculous indeed.

Surfing for Sperm
Since the inception of the Internet, people have been using on-line services and chat rooms to access potential mates. Now, according to U.S. News & World Report, it's possible to bypass all those tedious courtship rituals and go straight to impregnation, using the web to surf for sperm vendors. Several firms (with names like Cryogenic Laboratories, Options National Fertility Registry, and California Cryobank) offer on-line customers a variety of resources, including the ability to select vendor characteristics, vendor profiles, and (most importantly) same-day shipping of sperm.

But if the sperm you buy turns out to have a few genetic defects, or if it turns out that your offspring needs a kidney or some bone marrow when she grows up, and her genetic nearest and dearest are the likeliest donor candidates, don't go trying to track them down. Sperm vendors routinely sign waivers guaranteeing them complete, lifelong anonymity. And labs are notoriously lax about keeping track of such details anyway.

All You Need is . . . an Ethicist
Ovum: Purchased. Sperm: Purchased. Gestational mother: Surrogate. Purchasers of resulting human: Divorced. Outcome: Up to the courts.

More than 1000 women undergo in vitro fertilization every week, and countless others receive some kind of infertility treatment. In a field where experimentation is rampant, the drive to test the latest techniques on patients is often fueled by patients themselves, who will do anything to have a child.

Federal law forbids experimentation on embryos to research cures for disease. But the human embryos created in the labs of for-profit fertility clinics, where some have been sitting on ice for as long as 15 years, are subject to little or no regulation. The Washington Post reports that "some of the recent exciting breakthroughs in reproductive medicine have been the result of ethically questionable practices, in which women served as subjects in ill-defined research projects or their eggs or embryos were. . .used in experiments and eventually tossed in the garbage." And selective abortion for women undergoing fertility treatments is the recommended means of embryo reduction in clinics throughout the U.S.

It is becoming routine for a woman undergoing chemotherapy to have some of her ova frozen so that she will still be able to bear children when her treatments are over. If the woman passes away, her parents may want to use the frozen ova to produce their own grandchildren, or "grandcicles" as one doting potential grandma called them.

The choices and benefits created by assisted reproduction also bring with them a range of possible harms, one of them being what theologian Ted Peters calls "perfect child syndrome." Peters envisions a world in which neighborhood children conceived the oldfashioned way may come to feel they are genetically inferior. Or, since technology seldom works exactly as it should, parents could withdraw love from the "technology assisted" child if it turns out to be less than perfect after all. "Quality control is the commodification factor," Peters says.

In other words, the range of choices created by these new technologies turns would-be parents into consumers of perhaps the ultimate product: their offspring.

Un-Natural Selection
One interesting aspect of the latest infertility treatments has gone largely unnoticed by the media, and that is their impact on human evolution. Take icsi-intracytoplasmic sperm injection, the technique of injecting sperm directly into the ovum, for example. This technique is routinely performed, and the best (by pregnancy rate) labs rely on it exclusively, according to Dr. Michael Zinamen, a reproductive medicine specialist at Loyola University School of Medicine.

The advantage here is that any old sperm will do (it doesn't have to be a particularly aggressive one. In fact, it can be a sperm cell from the testes of a man with 0 sperm count).

When children are conceived via sexual intercourse, natural selection, that nasty old Darwinian notion of survival of the fittest, reigns. Only the "best" sperm make it through the various hurdles in the way of conception. When the sperm injection technique is used, however, "all of the natural selection processes that have evolved over the millennia are effectively bypassed," says Zinamen.

The impact on future generations is unknown.

Chicago Pays Couples to Conceive
Thirteen states mandate that health plans cover some form of infertility treatment. Only two states, Massachusetts and Illinois, mandate that in vitro fertilization (in which sperm and egg are combined in a petri dish and the resulting embryo is implanted in the prospective mother's womb) be covered. In vitro fertilization typically costs about $10,000 per treatment and is rarely successful on the first attempt.

Though self-employed insurers are exempt under the Illinois law, the City of Chicago agreed, as of January 1, to fund infertility treatments for employees enrolled in its PPO. The decision was the result of a ruling by U.S. District Judge Suzanne B. Conlon that inability to conceive is a disability under the Americans with Disabilities Act. "There have been other cases where federal judges have made similar rulings, and the city's attorneys felt they wouldn't be successful" in continuing to fight, said Jennifer Hoyle, public information officer for the City of Chicago Law Department. "So we cut our losses and settled the suit."

Of the city's 41,000 employees, the majority — about 27,000 — are enrolled in the PPO. So far, no one has calculated how many future Democrats this will add to the rolls.