Book Review: ‘Cracked Open: Liberty, Fertility, and the Pursuit of High-Tech Babies’

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Commentary Book Review: ‘Cracked Open: Liberty, Fertility, and the Pursuit of High-Tech Babies’

Book Review: ‘Cracked Open: Liberty, Fertility, and the Pursuit of High-Tech Babies’

Eleanor J. Bader

Miriam Zoll's horrifying personal story about using a host of assisted reproductive technologies, including in vitro fertilization and egg donation, in an effort to have a child is part memoir and part exposé of an unscrupulous, high-profit industry. It’s a compelling read.

Cracked Open: Liberty, Fertility, and the Pursuit of High-Tech Babies, by Miriam Zoll, Interlink Books, 198 pages, $20. Reviewed by Eleanor J. Bader.

Most of us know someone who wanted to get pregnant but couldn’t. For some, it was because of endometriosis, ovary or uterine anomalies, tubal defects, or choosing a guy whose sperm was simply not up to the task. For others, the causes were likely less obvious. Dubbed “unexplained infertility factors,” the category includes environmental contamination, chemical exposure, and random bad luck.

Whether the cause is known or unknown, the problem is growing. Already, reproductive health experts estimate that 7.3 million people of childbearing age—and that’s just in the United States—are infertile, meaning that they are unable to conceive after 12 months of trying.

Miriam Zoll, author of Cracked Open, is one of them. Her horrifying personal story about using a host of assisted reproductive technologies (ART), including in vitro fertilization (IVF) and egg donation, in an effort to have a child is part memoir and part exposé of an unscrupulous, high-profit industry. It’s a compelling read.

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Zoll begins by describing the media fixation on older celebrities who’ve given birth. She writes:

A few years ago, photographer Annie Leibovitz birthed her first child at the age of fifty-two, while actress Geena Davis delivered at forty-eight and super model Christy Brinkley at forty-four. More recently we read about singers Mariah Carey and Celine Dion delivering twins at forty-one and forty-two and actresses Courtney Cox and Marcia Cross became mothers at forty-three and forty-five, respectively.

These accounts, she explains, make pregnancy in middle- or near-middle-age not only seem possible, but easy. But usually it isn’t.

Zoll and her partner, Michael Shashoua, were 35 years old when they married. Neither had given much thought to parenting, believing they had plenty of time to start a family. Then, suddenly, they were turning 40 and desperately wanted a child. Despite their best efforts, Zoll did not become pregnant. They consulted a specialist who told them that age was the likely culprit, a finding that left them shaken but determined to beat the odds. After all, Zoll writes, his warning seemed preposterous since they’d heard about many older women having offspring. In fact, Zoll’s own mother was 39 years old when she gave birth to Miriam.

“Year after year, the headlines and cultural messages screamed out: ‘Relax and sit back. You’ve got science on your side,’” Zoll writes. “I’d believed that technology had finally eclipsed Mother Nature and that my biological clock didn’t matter as much as it used to.”

That she was wrong only became clear in hindsight. Not believing that age mattered, Zoll and Shashoua jumped onto the ART carousel, hoping against hope that they’d be able to use technology to grab the golden ring of a biological child. The clinics they went to stoked their optimism, highlighting their successes and barely mentioning their failures. Had the pair probed more fully—had they not been in denial—they would have learned that IVF is successful for only 6 to 10 percent of women over the age of 40. They would also have discovered that while 48 percent of women using donor eggs become pregnant, between 15 and 20 percent of them will miscarry after the egg is implanted.

Perhaps Zoll and Shashuoa suffered from magical thinking. Nonetheless, Zoll believed that wanting a baby was enough, and in short order she began injecting largely untested hormones into her abdomen to stimulate follicle growth. The cost: $5,000 a try.

“Like a good laying hen, I generated five eggs on my first cycle,” she reports. ”This pleased the doctors. If the eggs thrived they would then be harvested from my ovaries and fertilized with Michael’s sperm. If the embryos sustained healthy cell division of seven cells or more, the clinic staff would then transfer them into my womb.”

Everything went according to plan, yet the process failed. So they did it again. And again. They then turned to an egg donor, a process that is not only extremely costly (upwards of $20,000) but full of moral and ethical considerations, which caused the pair to question what it means to have a biological child if you are using someone else’s genetic material.

Zoll and Shashoua grappled with this concern, but by this point she says that they had become “fertility junkies.” She further confesses that the lure of having a baby had become such an obsession that they were ready to do just about anything to become pregnant. Sadly, nothing worked. Six years passed, marked by treatment after treatment, but they remained childless.

They finally adopted, which is something that in retrospect maybe should have been considered when the first doctor—the only one who was honest with them—told them that their chances of conceiving were slim-to-none. It’s a happy ending, however bittersweet.

Cracked Open is at its best when addressing the ways in which ART clinics sell hope to women and couples, gay and straight, who want nothing more than to have a genetic child. Its depiction of the ways staff minimize the physical and emotional ordeal they’ll go through is similarly eye-opening. In addition, the commodification of childbirth is clearly presented and the obvious class issues that make ART available to only a small segment of the population—most insurance plans do not cover infertility care—are sensitively presented.

What’s more, Zoll’s personal travails are spelled out and her account of getting caught up in the frenzy of conception is heartbreaking and awful. At the same time, the book’s focus on the imperative to procreate will mystify readers who have never felt this pull. Even more significant, I fear that Zoll’s advocacy of women having children when they are in their 20s or early 30s will be used by policymakers to justify restricting women to a less competitive and less well-paid “mommy track” rather than fostering a movement that would make it easier to juggle raising a family and holding a demanding job. Already, the anti-choice American Life League has a posting on its website indirectly touting this conclusion.

As Zoll sees it, she and the women of her generation were lied to.

For many whose infertility was linked to age, not genetics, the promise of reproductive technologies figured prominently from an early age in the way we mapped the trajectory of our lives. We would spend so many years in college, so many years in graduate school; hopefully, we would find a mate early on, but even if we didn’t we could build our professional standing and income knowing that we could rely on science to help us become mothers in our late thirties or early forties. … To later learn that the vast majority of reproductive technologies do not, in fact, result in live births is a tragedy.

Class privilege aside, this denouement sidesteps the fact that in order to reproduce at all, most women—single or coupled, age  22 or 42—need available and affordable child care, housing, and health care as well as flexible work schedules. Furthermore, it’s not just women who need these things. If we are ever going to increase male involvement in childrearing, dads, uncles, teachers, and coaches also need social supports to enhance their efforts.

Cracked Open does not tackle these issues. Still, in exposing the greedy and callous underside of the fertility industry, Zoll has written a powerful cautionary tale. It is must-reading for anyone thinking of entering the brave new world of assisted reproductive technologies. As an unknown 16th century pundit put it, “forewarned, forearmed.”