#1717

"Making Babies"

Airdate: June 1, 1999

Written and Produced by Doug Hamilton and Sarah Spinks

Directed by Doug Hamilton

NARRATOR: This is Kieran, born December 17th; Ella - or maybe Bella, her parents haven't decided - due next month; and this is Matthew. All healthy, normal babies, but how each was created is anything but normal. They were all conceived with extraordinary new medical technologies.

LEE SILVER, Ph.D., Princeton University: I think this is a revolutionary evolutionary point in our history as a species.

NIGEL CAMERON, Bioethicist, Trinity International University: I mean, this is very much science fiction all of a sudden, and much sooner than anybody had thought, becoming science fact.

NARRATOR: Today, as we find ourselves on the cusp of being able to clone a human, the question is, how far will we go in our efforts to engineer a baby?

SUSAN VAUGHAN: It makes you feel a little bit like you're getting into territory that's really eugenics, and that a little scary.

MINA GATES: We did not do this to create a child better-looking or stronger or faster than us. We just want a baby.

NARRATOR: Tonight on FRONTLINE, the brave new world of Making Babies.

NARRATOR: This is the new act of conception, performed in a basement laboratory at the University of California in San Francisco, an extraordinary new technique called ICSI, or intra-cytoplasmic sperm injection.

NARRATOR: A single sperm is sucked up into a thin sharp tube and injected directly into a woman's egg.

NARRATOR: Twenty-one years after the first test-tube baby, the science of reproduction has made remarkable advances in the ability to create life. Today sperm can be frozen in vats of liquid nitrogen and chosen over the Internet.

NARRATOR: Woman's eggs can be surgically removed and fertilized in sterile laboratories. Embryos - potential children - can be frozen and stored in metal canisters for years. Each year more than 20,000 babies are born with the help of these new technologies. It's a booming field, creating lives that would otherwise never have existed, but also raising troubling questions.

Dr. SAMUEL WOOD, Infertility Specialist, La Jolla, California: It's an amazing area of medicine in that way. From the beginning, no one really knew if any of these techniques were going to prove to be effective or safe, so there's a grand leap of faith each time. Because the goal is so important, we feel like it's like worth that leap.

GEORGE ANNAS, Bioethicist, Boston University: It's not just a matter of can we do it? It's a question of what are we doing and why? And is this good for children ultimately?

NARRATOR: Kevin and Mina Gates wanted a baby for years.

MINA GATES: We've had such a wonderful five years together. We love each other a lot, and we wanted to see a union of our love, and we wanted to experience what so many people experience normally, and so naturally, just to be able to have our own child. But the specter of having an ill child was scary.

NARRATOR: Their fears were very real. Kevin suffers from a life-threatening genetic condition called Kartagener's Syndrome.

KEVIN GATES: The lungs are abnormal. Mine don't work properly, and that affects the breathing and- a lot.

MINA GATES: Also, it's characterized by cytosinversus, which means everything in Kevin's body is backward. His heart is on the right side of his body. His appendix is on his opposite side. Everything is switched.

NARRATOR: A few years ago, it would have been impossible for Kevin to father a child because his condition leaves his sperm defective, but now these new medical techniques make it possible. The only problem is the baby could inherit his Kartagener's.

Dr. PAUL TUREK, Male Infertility Specialist, UCSF: They had, essentially, a lethal disease that could be passed on to a child, and did they want to pass that on?

KEVIN GATES: I knew that if the worst-case scenario is that we have a kid with Kartagener's, that's fine. So I was probably much more at ease with that issue.

MINA GATES: Kevin has had a wonderful life so far. Kevin has had 45 years of relatively good health, and he has led a full life. He has played all the sports he wanted. He has married. He has gone to college. He has a very full life. He's begun businesses, and has a good livelihood. Who is to say that we are not- even if our child did have Kartagener's, she would have had a full life.

NARRATOR: The Gateses decided to go forward, but because there were no living sperm in Kevin's ejaculate, Dr. Paul Turek had to surgically remove some from his testicle.

MINA GATES: All I wanted was one of Kevin's sperms. That's all I wanted.

NARRATOR: Using the new ICSI technique, Kevin's sperm was injected into each of the eggs harvested from Mina. On the incubator shelf in the embryology lab, the fertilized eggs grew into 12 viable embryos. Embryologist Joe Conaghan prepared two of the healthiest to put back into Mina in the hope that she would become pregnant. Then he froze the rest in a canister of liquid nitrogen. Sadly, Mina miscarried.

MINA GATES: I wouldn't want anyone to experience the frustration we felt trying to get pregnant and the emotional sense of loss that we felt.

NARRATOR: The Gateses are not alone. In three quarters of all in vitro fertilization attempts, the procedure fails to produce a child. Still, infertile couples will go to extraordinary lengths for the chance to become pregnant.

PAULA GREELEY, R.N., Cornell University Medical Center: There's mornings here at the height of the series where you walk in, and the waiting room at 7:00 A.M. is filled with, you know, over 100 patients, and we do 100 blood draws and 60 to 80 ultrasounds. It's a busy place.

NARRATOR: Paula Greeley is the nurse manager in the busiest fertility clinic in New York, Cornell's Center for Reproductive Medicine. In recent years, fertility clinics like this one have seen an explosion of patients seeking treatment.

LAURA, Infertility Patient: You feel like everyone is going through infertility. There are just hundreds and hundreds of people that I've encountered in New York.

NARRATOR: Greeley oversees a staff of 20 that each year monitors more than 1,500 women trying to get pregnant.

PAULA GREELEY: Infertility is definitely a different type of medicine than any other area that I've been exposed to. My history is that I came from the operating room, which I thought was stressful. I used to scrub on the open-heart cases, and I thought, "You know, I need a change. This is stressful. I think I'll go over and work in that nice new infertility office."

NARRATOR: Early in the morning, women come in for a series of tests that must be run every day for two weeks to determine when their eggs are ready to be harvested. It is a grueling regimen of doctor's appointments and powerful hormones.

LAURA: You feel very different from the medications, and so it's sometimes difficult to handle your everyday tasks.

KATE, Infertility Patient: I mean, drugs like Lupron, for example, depress me, made me- basically, you're pre-menopausal for weeks on end.

PAULA GREELEY: It's a very hard thing for a patient to go through because it's something they want more in life than anything, and it's- probably it's something that they have the least control over.

LAURA: You're hoping that it works, but you also don't want to get your hopes up so that you're not too disappointed if it doesn't.

KATE: It does envelope your life. It's your every thought. My husband, who's very gentle and sweet, said in a very sweet way at one point, "Let's try to talk about something else." For three and a half weeks, this was all we talked about. And he was right.

NARRATOR: High-tech infertility treatments usually must be paid for out of the patient's pocket because they are generally not covered by insurance. The costs can range from a few thousand dollars to over $100,000 for multiple treatments.

MINA GATES: I felt so selfish. I felt, "How can I- we're spending all this time and money and effort," and I really did feel selfish at times. But we did- after that first miscarriage, it was really so upsetting that I was ready to move on to adoption. And Kevin said, "Honey, why don't we try one more time?"

NARRATOR: There are now more than 300 fertility clinics in the U.S., like this one in California run by Dr. Samuel Wood.

I think there's going to be a huge revolution in fertility over the next 10 to 20 years. Virtually no couple will be unable to have a baby, except for those few that are at the extremes of reproductive life.

One couple we worked with, the female partner was a backup singer in a rock band, and she was getting later in life. As I recall, she was 39 or 40 and was very concerned that she would lose the chance to have children that were hers biologically, so she chose to use a gestational surrogate in which her eggs and her husband's sperm were placed, after fertilization, into a surrogate. She could continue her career and yet maintain her ability to have a biological child.

INTERVIEWER: And what do you think of that?

Dr. SAMUEL WOOD: I think that couples should have a right to choose their method of reproduction, and that unless it's outside the bounds of ethical and legal behavior, they should have the right to do that.

DEB WASSER: We must have looked like two girls going through the personals.

NARRATOR: Susan Vaughan and Deb Wasser are surfing the Internet, looking for the perfect guy.

SUSAN VAUGHAN: I was flabbergasted that you could go on the Internet and in, like, in a minute, download the entire catalogue of guys, their profiles and their handwriting and, you know, all sorts of information about them.

NARRATOR: What they're looking at are sperm donors from a sperm bank across the country in Los Angeles called the California Cryobank.

SUSAN VAUGHAN: You could go through on the computer screen and say, "They have to be over 6-3, blond hair, blue eyes. This has to be their religious background." And it would spit out a list of, "Well, here are five guys that fit those criteria." It's amazing.

DEB WASSER: And this was quite puzzling to us because of course we would say, "Well, is it genetic." You know, what matters in choosing a donor sperm? And they would- the California Cryobank has these questions. "What's your favorite color?" "What's your favorite food?" "What's your favorite animal?" You have no idea how many guys like wolves- you know, how many of their favorite animals were wolves.

NARRATOR: Deb and Susan, a lesbian couple, have been together for 14 years. Last year they decided to have a baby.

SUSAN VAUGHAN: We decided to carry the camera and the camera case just to see what it will be like to have a baby and all this stuff.

NARRATOR: Deb, a New York filmmaker, began documenting the process and agreed to share some of her footage with FRONTLINE.

SUSAN VAUGHAN: Finding the sperm was a really long process.

DEB WASSER: I mean, how do you compare a person's answer, you know, "I want to get paid obscene amounts of money for doing what I love" to someone a person who says "I want to be involved with and possibly leading a non-profit group that wants to pursue justice for the powerless people in the U.S."?

NARRATOR: The Cryobank provides 26-page profiles of each donor with descriptions and medical histories. You can even order audiotapes of the men.

DEB WASSER: We'd go down these lists, and we had so many of them. And there was the wolf man and the bat man and the pop tart man and the pink and green man, you know, as we would try to remember them by their color, food or- and you wonder, "Why is it important?"

And the answer I finally felt was that, to use an example, if a man says, you know, "My favorite food is," you know, "Italian and Chinese cuisine," versus the guy who says, you know, "My favorite food is Mom's mashed potatoes, extra gravy and pop tarts. Put 'em in the microwave, heat them up. Yum." You know, I like that guy. I like the guy who's specific, imaginative, descriptive, if that's genetic.

SUSAN VAUGHAN: It makes you feel a little bit like you're getting into territory that's really eugenics, and that's a little scary. You start thinking, "Well," you know, "taller people have"- you know, life is easier for them or, you know, this or that kind of hair people tend to like, or- you start thinking in a way that's really kind of not the way I would have wanted to be thinking about it. But it's very hard to avoid.

DEB WASSER: I remember another guy that we really, really liked. They asked him, "What is your ambition? Where will you be in 20 years?" And he said- he was a music and a philosophy major, and he said, "I want- in 20 years I want to be making music that makes quadriplegics dance and bricks cry." Could be genius, could be nuts. You know, I mean, how do you assess this stuff, you know? I look at these papers- it was quite a hard decision.

NARRATOR: At the California Cryobank, sperm is analyzed, processed and frozen for at least six months. Potential sperm donors are screened for genetic disease and low sperm count. Those accepted come in twice a week and are paid up to $50 a time.

Dr. CAPPY ROTHMAN, Medical Director, California Cryobank: We now know the ideal man. He's six feet tall. He has blue or green eyes. He has blond or brown hair, medium complexion, college graduate, and has dimples.

NARRATOR: The laboratory prides itself on providing customers with all the information they want, except for one key thing. All sperm donors are anonymous, and there are no pictures.

That's where LaTrice Allen comes in. She is the Cryobank's donor matching counselor. For $40 a half-hour, LaTrice will guide a client through the selection process.

LaTRICE ALLEN: Some people say that, you know, "How does it feel to play God?" And I'm definitely not anywhere near playing God. I'm just one of his helpers.

NARRATOR: Not everyone wants to match a husband's looks. The Cryobank estimates that 40 percent of its clients are single women.

LaTRICE ALLEN: They'll either send a photograph in of a brother or father, or sometimes they'll send in clippings from magazines of popular actors, it seems like whoever's in the limelight at that particular time.

LaTRICE ALLEN: Like, when Titanic came out and Leonardo di Caprio was the popular thing, everyone- well, not everyone, but the clients who were in that category would call in and say, "I want someone who looks like Leonard di Caprio."

NARRATOR: Even at a Los Angeles sperm bank, not all the donors look like movie stars, so LaTrice and a committee of women from the office have developed a way of rating the men.

The highest we've given so far is an 8.5. I don't think we'll ever give higher than an 8.5. We're pretty critical with dissecting their facial features, so to speak.

INTERVIEWER: You're tough.

LaTRICE ALLEN: Yes! That's probably why I'm still single. You can take that off there!

MARILYN RAY, M.P.H., Counselor, California Cryobank: I really hate- is camera off now?

INTERVIEWER: No, it's not.

MARILYN RAY: I hate the whole thing of the whole physical thing. I really don't like it.

INTERVIEWER: Why?

MARILYN RAY: Because I don't- I don't think we use much of a- it's not the scientific approach, you know? It's so subjective. It's so subjective.

NARRATOR: Marilyn Ray also counsels clients at the Cryobank, but on the genetic history of the donors. She says that the clients are often overwhelmed.

MARILYN RAY: I spend a lot of time explaining to patients that no one can separate out nature versus nurture, and we certainly haven't. We cannot say how much nature or genetics contributes to intelligence, and how much the environment the child grows up in contributes, or the schools or the society. But I do remind patients that the patient, the mother, the recipient, will be contributing half of the genetics.

NARRATOR: The more we learn about genetics, however, the more we are surprised by how important genes are.

LEE SILVER, Ph.D., Princeton University: When we put a mouse into the middle of the apparatus, the mouse has a choice. The mouse can walk out on this open plank and look over the edge, or the mouse can go into this enclosed area where it's nice and safe.

NARRATOR: Lee Silver is a professor of genetics at Princeton University. In this experiment he is testing mice for genes that make them more prone to take risks.

LEE SILVER: He looks right over the edge. This guy has no fear, just sort of walks out over the plank. So these mice, these six mice, have genes that predispose them towards risk-taking behavior, what we call novelty-seeking. He has no interest in going inside the enclosure.

Why don't we put a mouse in now who is predisposed towards avoiding risk. This mouse is much more likely to just go back in the corner, the safe spot. This animal realizes that the walls are protecting it. Basically, he is spending almost all its time inside the enclosed arm.

And this is the most amazing thing, is that, you know, this guy has different genes. And if you look very carefully, you can see there's a clear difference that we can measure between the way he behaves and the way that the Black-6 mouse behaves.

And it doesn't matter how raise them. It doesn't matter if you foster them between parents. The genes determine that the Black-6 mouse is going to be more curious, more likely to go on the open plank 100 feet above the ground, and the DBA mouse is going to spend most of its time in the enclosure.

DEB WASSER: We had an enormous chart of all of these guys just to try to keep them straight, and also because you had to make sure that the guys were in stock, you know? So you had to sort of constantly update it. And we liked this guy in August. Was he still available in September.

SUSAN VAUGHAN: One bank that we looked at, they had, you know, a guitar-playing lawyer who was very popular, and he sold out at the beginning of the month every month. So if you want him, you better know that, and you better call them, like, early in the day on the first of the month.

LaTRICE ALLEN: I have a lot of clients that say, "If I don't laugh about it, it would just drive me completely crazy," you know, because they're making a decision that's going to affect them the rest of their lives. I mean, we have a pretty good, you know, procedure here, but we don't have a return policy like Nordstrom's does. Once you have a child, you can't bring it back and say, "I want a refund."

DEB WASSER: At the last moment, when we really had to make a decision because it's time, so that we were down to the wire, we had to have that sperm Fed-Exed overnight because I was ready. And then suddenly, it became terribly serious because- because this is going to be a person. It's a real part of your life. And what are you making your choices about, you know? And suddenly, it's sort of frightening how much we had laughed throughout the whole time, and we really had to decide.

NARRATOR: Infertility is a big business.

PAM MADSEN: This is probably the largest conference I think that's ever held for patients who are experiencing infertility.

NARRATOR: Here in a vast New York convention hotel, couples can shop for the latest in infertility treatment.

INFERTILITY PATIENT: We've been trying to have a child ourselves and going to our doctors, but we want to know about donor eggs, and we want to know what's involved, you know, so we've come here to get more information.

INFERTILITY PATIENT: We've been going through treatments for three years, more or less. We just had one unsuccessful IVF cycle very recently last year.

NARRATOR: Each year in the U.S., 1.2 million people seek some type of treatment for infertility, spending up to $2 billion.

NARRATOR: With little insurance coverage, couples must fend for themselves in a booming for-profit market.

INFERTILITY PATIENT: We took out a second mortgage on our house. And we were fortunate that we had a home.

GEORGE ANNAS, Bioethicist, Boston University: The whole world of assisted reproduction has been described, I think aptly, as kind of the Wild West mated with American commerce and modern marketing. And what you see is a number of very highly successful clinics viciously competing for patients.

GEORGE ANNAS: So you have a variety of highly professional individuals pitching their wares - their success rates, their new technology, their cutting-edge technology - to this highly susceptible group of infertile couples who almost- almost willing to try anything, and almost pay any price to get a baby.

NARRATOR: George Annas sits on the ethics board of the American Society for Reproductive Medicine. He says that this highly competitive area of medicine is notable for its lack of regulation.

GEORGE ANNAS: The industry has consistently resisted regulation. The argument of the industry is public policy should have nothing to do with this. This is a private decision between infertile couples and their physicians to do whatever the physician can help them do to have a baby.

NARRATOR: Pre-maturity is one of the biggest health risks for babies, and carrying more than one baby greatly increases that risk. Annas says the lack of regulation has led to a high number of multiple births, the direct result of doctors implanting too many embryos in an effort to get their patients pregnant.

GEORGE ANNAS: I mean, there's just no excuse for any infertility specialist to ever be involved in a large number of multiple pregnancies. Their excuse is, "Well, that's what the couple wanted. We were just giving them babies." That's no excuse.

NARRATOR: Chris and Michelle Whitcomb never expected serious medical problems when they underwent infertility treatments. Last February, their twin girls were born three months early, weighing just over one and a half pounds each.

MICHELLE WHITCOMB: The fears are endless. The day-to-day, the constant worrying- it's a roller-coaster ride. They did wonderful for six days, and now they kind of crashed and burned, both of them at the same time today. The "fight or flight" reaction in your body is basically flipped on constantly, non-stop.

NARRATOR: The babies were fighting for their lives in the Newborn Intensive Care Unit at California Pacific Medical Center

CHRIS WHITCOMB: Well, it's just, you know, whether or not they're going to, you know, make it. I mean that's, you know-

MICHELLE WHITCOMB: Whether they're going to live or die, what the consequences are later, you know what I mean? That's a whole other issue.

CHRIS WHITCOMB: You've got to kind of live in the moment, though, you know? You kind of have to take everything day by day.

NARRATOR: Michelle became pregnant through in vitro fertilization at one of the most popular clinics in California. At first she conceived triplets, but with her doctors decided to abort one fetus in the hope of saving the other two. This has become a common practice.

CHRIS WHITCOMB: You know, the novelty of having multiple, you know, births sounds really great, but the- you know, risk associated with it and the difficulty it takes to actually get through it, it's not for the average person.

Dr. MICHAEL KATZ, Obstetrician, California Pacific Medical Center: The need and the pain that you have when you have infertility is such that you just tend to filter out all the bad news. The only news you want to hear is, "Yes, we're pregnant."

MICHELLE WHITCOMB: You get a big packet at the infertility clinic of all the drugs and all of the everything. You don't get one piece of information about premature babies and multiples. I don't remember getting anything.

CHRIS WHITCOMB: Well, you get- you get stuff about the risk of multiple pregnancy, but I don't think you really get the full gravity of what that means.

Dr. MICHAEL KATZ: The problems are a whole host of issues- cerebral palsy, mental retardation, blindness, very significant handicaps at certain gestational stages, which are just haunting you for the rest of this child's life.

NARRATOR: Dr. Michael Katz, the Whitcombs' obstetrician, thinks society is not addressing some of the hidden costs of infertility treatments. He estimates the intensive care for the Whitcomb preemies, for example, could be nearly a half million dollars.

Dr. MICHAEL KATZ: The question is not whether those who are born through infertility deserve to be born and live life. That is not the question at all. The question is where do we want to put the emphasis into society? Do we want to take the resources, limited that we have, put it into infertility treatment with a multi-fetal gestation, or do we want to put it into prenatal care for large numbers of women that got no prenatal care?

NARRATOR: In many leading fertility clinics, nearly 50 percent of all in vitro treatments of women under 35 result in multiple births like the Whitcomb twins.

Dr. MICHAEL KATZ: Maybe the infertility doctors would consider that we achieved pregnancy, we achieved a delivery, and maybe we'll have babies here. So that's- you know, in their statistics, it's considered a successful infertility therapy. For me, it was considered, you know, the worst outcome possible because 25-weekers or 24-weekers face tremendous odds against them.

And I'm very worried, and I'll be worried until the day they go home, and that'll be a few months from now, and that's the good outcome. And the bad outcome is, of course, if they are going to be handicapped, or will not make it.

MICHELLE WHITCOMB: You know, it's just hard. Wish everyone could remember the responsibility of any pregnancy, any pregnancy, you know? Sometimes you just feel selfish that you want children so bad that you don't think of a family being this way. So hopefully, maybe somebody will- you know, sometimes you feel you put yourself first. "I want children. I want children," but yeah- you know, so maybe somebody will realize that, you know, here you want children, but you want them healthy, you want them to be able to live, you want their quality of life just like anybody, to be good.

Dr. MARK SAUER, Infertility Specialist, Columbia University: I mean, I've said publicly, you know, when you come to guys like us, it is our mission to get you pregnant no matter what. And we, you know, have to be held accountable because otherwise that "no matter what" will lead to certain irresponsible practices, and you will see the sextuplets and the octuplets.

These are preventable complications. These are iatrogenic, doctor-induced complications. And they're always with a good intent. A woman wants to have a baby. But unfortunately, you don't always see such nice outcomes, and some people are injured, and some babies are injured, and some babies die as a result of this type of care.

NARRATOR: Dr. Mark Sauer runs the Columbia University fertility program in New York. He says that few couples are prepared for the stress of high-tech fertility medicine.

Dr. MARK SAUER: It makes this field very hard because you know with every case that you take on, there is at least as good a chance of failure as success. And you know that there's a heavy price, not just emotional, but also financial, that these couples have to pay to reach that point where they either walk away, pregnant or not. It's disturbing. You know, all these happy endings, there's at least another one not quite so happy on the other side that usually is not profiled.

NARRATOR: Sauer was one of the pioneers of getting older women pregnant using eggs from younger women.

NARRATOR: He now sees an alarming escalation in the price some clinics are willing to pay these young women.

Dr. MARK SAUER: It's like the old gas station wars when I was a kid, where, you know, one lowers their price, the other one does, and how low will it go? And this- except it's the opposite. How high will it go?

NARRATOR: Last year, one of the leading New York-area clinics doubled the price it was paying egg donors to $5,000. Some couples have offered up to 10 times that amount.

Dr. MARK SAUER: The question becomes, "When is the payment excessive? When is it more than just compensation for reasonable risk and time? When does it become an enticement? When does it become a solicitation?" Or as one of my patient- or one of my colleagues, actually, in the U.K. said, "Are you pimping for patients?"

NARRATOR: In San Rafael, California, Jacquelyne Gorton runs an agency that recruits egg donors.

JACQUELYNE GORTON: These women, you know, are doing this to help. It's not just to sell. I won't work with a woman if she's too focused on the money. That's not a candidate that we would want to work with.

NARRATOR: Like a talent agent, she represents young women willing to sell their eggs to desperate couples.

CATHERINE REYNOLDS: The money has actually enabled me to fulfill a few dreams of my own. I got a brand-new car, my very first and only one. And I was able to take a trip to Australia with my fiance. I've wanted to do that since I was about 3 years old. We went diving in the Great Barrier Reef, went exploring the tropical rain forest. As a biologist, it was paradise, so-

NARRATOR: Catherine Reynolds is 30 and has provided eggs for six infertile couples.

CATHERINE REYNOLDS: You know, it's not just about the money. It's something that- you know, I mean, are you going to be attached later? Are you going to feel like this is your child? And I feel, personally, I contributed building materials that I wasn't going to use.

NIGEL CAMERON, Bioethicist, Trinity International University: We're speaking about the reconstruction of our notion of childhood. What does it mean to be a child? What does it mean to be a parent?

NARRATOR: Nigel Cameron trained as a minister and now teaches bio- ethics at Trinity International University outside of Chicago. He argues that we are turning the miracle of conception into a commercial enterprise.

NIGEL CAMERON: You put these design elements in there, and whereas the children may be very much wanted and planned-for children, they're also controlled children, who have become not simply gifts to their parents, which is one of the ways in which children retain their dignity and cease to belong to us as creatures of their parents, in which these children also become manufactures. They become consumer products.

NARRATOR: Both Tyler and Spencer Madsen were born through in vitro fertilization.

NARRATOR: Spencer and Tyler's mother, Pam Madsen, runs the New York chapter of an organization for infertile couples called Resolve.

PAM MADSEN: I think that the media, and maybe the public at large, as well, they look at the high-tech in vitro fertilization - high-tech, as people call it, "baby making," which I'm not sure about that term - and they think that somehow it's very sci-fi and high-tech. It's "The children will be different." And we don't feel differently. The children might feel differently. And I think what's really interesting is how ordinary it really is.

NARRATOR: But each technology opens up new ways of having children. Susan and Deb figured out a unique way to have theirs.

SUSAN VAUGHAN: Deb has been an egg donor for me, and then I'm going to carry the baby. And hopefully, if we have other children in the future, then we'll reverse the process, and I'll donate an egg to her, and she'll carry it. And that's about as close as two women can come to having children together.

NARRATOR: Last November, Deb had her eggs removed and fertilized with the sperm from the Cryobank. After months of deliberation they had found their man. He is 6 foot 1, blond, musical, and a pre-med student.

DEB WASSER: Susan finally said, "Well, you know, you don't have to date this guy or have him be your husband. We just want somebody solid, good father material."

NARRATOR: Susan is now pregnant with Deb's egg.

SUSAN VAUGHAN: It's confusing. Deb actually has to adopt the baby, even though it's her egg. So it's sort of really messing around with, you know, how things usually work.

INTERVIEWER: Do you think that confusion could be difficult for the child?

SUSAN VAUGHAN: I think that the child, hopefully, will understand, particularly after seeing us filming the process and talking about it, that we really wanted to do this, and we really wanted to do it together, and this is the best solution we came up with. And you know, I think if I were that child, I would feel good that we put so much time and energy into making the decisions and planning and thinking about how we wanted to do it and why.

Dr. MARK SAUER: Certainly, the fabric of society gets changed by these types of paradigms, and taking, you know, the males out of reproduction, which we do actually these days when we're dealing with lesbian couples and inseminating them with donor sperm. I don't think that's that troubling because it's a small group of the population that we're servicing that way.

I think people would like to have this image that Americans are this Ward Cleaver and his wife type families, and they're not. There's all types of women and men wanting to have children.

SUSAN VAUGHAN: I think once the baby's born, the fact of the technology and what we did will become relatively less important. I think that's important for us in feeling bonded as a couple, and making- having a child and through a joint effort. I don't think that's going to come into play at PTA meetings. I think the fact that we're two women together may.

NARRATOR: Across America, the rapid advance of technology has led reproductive medicine deep into uncharted ethical terrain, a journey fueled by the desperation of infertile couples like Marie and Guy Arcuri of Winston Salem, North Carolina.

GUY ARCURI: It was difficult because we wanted to be friends with our friends, and we wanted to love their children. And when you do that- you know, we automatically became aunt and uncle, Uncle Guy, Aunt Marie. And all of our friends' children called us that, and it began to become pretty painful to be called Uncle Guy because, you know, I'd rather be called Daddy.

NARRATOR: After years of failure, Marie learned that she suffers from a rare genetic condition called Turner's syndrome.

MARIE ARCURI: I would never have known it if I hadn't gone through this infertility, so it was kind of fascinating to find out a few things, like that I had partial- that I have somewhat of a webbed neck, and I used to kid as a child that I had a terrible time doing somersaults. And he was a gymnast, and Guy was a gymnast in college, and you'd watch him do all this stuff, and, "God, I can't do a somersault. What is the deal?"

And now realizing that I had some- you know, I didn't know that I had it at that point, but it was kind of- you look back on stories of things that happened. And obviously, that's why I'm short.

Dr. JAMIE GRIFO, Infertility Specialist, NYU: Marie is a very unique person. She has Turner's, a form of Turner's syndrome, but the meaning of that for her was that she was unable to have a pregnancy. The embryos she was making were missing chromosomes, and she was unable to get pregnant.

MARIE ARCURI: I think that Dr. Grifo's always been a straight-shooter from the beginning. "These are the facts. Your chances are slim." You know, "This is what I have to offer, but I'm going to be factual with or you," and, "Try to separate your head from your heart," which is very difficult in fertility.

Dr. JAMIE GRIFO: And I even actually said to her, "You know, Marie, I think we should stop trying because I don't think this is going to work."

NARRATOR: Dr. Jamie Grifo runs a cutting-edge research program at New York University Medical Center which specializes in selecting embryos that are free of certain genetic diseases.

On day three after fertilization, the embryos are usually between five to eight cells. And using a micro-manipulator, which is just a fancy microscope that allows us to use these robotic instruments, little glass pipettes that we forge to do microsurgery on an embryo- and what we do is we take this eight-cell embryo and pluck one of the cells out it so that we can do a genetic analysis on that single cell.

GUY ARCURI: I think we all kind of have this assumption that you don't tamper with nature, you know? And to tamper with an eight-cell embryo and pull two out, you know, that's kind of violent almost, in a sense. But if it will give us information that we can use to have a child, you know, I'm for it. But some people, you know, kind of think there's a shock value there.

NIGEL CAMERON, Bioethicist, Trinity International University: This repels something deep inside us, the notion that- because early embryos really are members of the human family tree. I mean, here we have somebody who has uncles and cousins and grandparents. This is already a member of our species. I think it's extraordinary that we so glibly are moving into a situation in which the smallest members of our species become our own research objects.

Dr. JAMIE GRIFO: You know, it is a tough topic to talk about, embryo research, because what does that mean? And how do you do research on an embryo? There are people in society who think that an embryo is a baby. And certainly, I treat an embryo, every embryo, with respect that it is a potential human. But if you look in nature, and you know what I know, and have seen what I have seen, what you learn is that embryos are made all the time. We just don't see them. Most embryos don't make babies.

GUY ARCURI: We felt constantly that we were on the- we were making serious ethical decisions every step of the way. And we considered them always with the goal of the best interest of the child we would like to have.

NARRATOR: After three miscarriages and years of treatment, Hope Marie Arcuri was born in 1995. She does not have Turner's Syndrome.

GUY ARCURI: At our daughter's baptism, Marie got up and gave a little speech. And she said, you know, "We named our daughter Hope because we really believed and hoped that God would allow us to be parents." But some people think that she should be named Determination, and that- that truly fits my wife. She's a determined woman.

NARRATOR: Three months ago, Hope got a baby brother, Matthew, who is also free of Turner's.

MARIE ARCURI: What a miracle. I mean, what a miracle that I have two healthy children that I never, ever thought I'd have.

NARRATOR: While the science that created Hope and Matthew is still in its infancy, it holds both great promise and troubling implications. The next step will be to repair and improve the embryo's DNA.

LEE SILVER, Ph.D., Princeton University: Once the technology has been perfected, it's the same technology, no matter what genes you want to put in. So if you develop the technology for putting in genes that enhance health characteristics, then that very same technology can be put in to give a child other kinds of non-health characteristics, like increased talents, which we'll be able to figure out some day, or increased memory abilities or cognitive skills.

NIGEL CAMERON: We're looking here at something we put together as a project, and we've built this baby. And the more the biotech people advance in what they can do, the more we're going to build our babies, and they're going to control them. And we're going to design the next generation.

NARRATOR: Each year new, often experimental procedures are tried on patients. Last year Dr. Grifo announced that he was developing an astonishing new technique for older women.

As a woman ages, her eggs become less fertile. So what Grifo is attempting is to remove the nucleus with its genetic material from an older woman's egg and put it into a younger, healthier one- in effect, performing an organ transplant on a single cell.

Dr. JAMIE GRIFO: We tried it on two patients. We were able to reconstruct eggs. It's miraculous. We were able to get those eggs to fertilize - I mean, that was a scientific feat - and those embryos to develop. But we haven't made a baby from it yet.

NARRATOR: Grifo's announcement of this new experiment shocked the outside world because his technique was similar to the one used to create Dolly, the cloned sheep.

GEORGE ANNAS: In general, when you want to do a new procedure in assisted reproduction, you just do it. You could have a bad dream one night, and wake up the next day and say, "Well, I'm going to try that." You know, "Let me try that. Fuse two eggs. Let me try to take the cytoplasm from one egg and put it in," you know, "in the nucleus of another egg," you know, or "Let me try to clone a human being."

NARRATOR: The federal government has refused to fund any research on human embryos because of political opposition, and therefore it has all taken place in private laboratories with little oversight. Mention the word cloning, however, and the government is swift to react.

Last October, the surgeon general and the Food and Drug Administration stepped in, and Dr. Grifo stopped his research.

Dr. JAMIE GRIFO: They hear the word "clone," and the lights go off, and they don't try and really understand. They just hear the sound bite, and they don't understand the details, and they get confused. This has nothing to do with cloning except that it uses a nuclear transfer technique which cloning also uses. But the end result is very different.

NARRATOR: Dr. Grifo argues that the result of his nuclear transfer would only be a rejuvenated egg that must still be fertilized by sperm, whereas cloning would produce an embryo that could grow into an identical copy of just one person. But others fear that perfecting the technique of nuclear transfer will move us that much closer to cloning a human being.

Dr. MARK SAUER, Infertility Specialist, Columbia University: Whether or not any of us would take that bold step is, I think, hard to predict. My gut feeling is when there's a challenge, and you put it in front of people like us, someone will always take that challenge and take it to the next step.

NIGEL CAMERON: I'm sure these clinics, even the most responsible of them, will be happy to add this as an option if it satisfies others of their clients and enables them to increase their range of reproductive services.

LEE SILVER: The best example I can give you as to why physicians are not going to wait as they should is with ICSI. Physicians did not wait to prove that it wasn't going to cause birth defects before they embraced it wholly across the country. And I think that we can use that history to understand how cloning is going to go. I'm not advocating the use of cloning in this way. I think it is wrong, but I think that it's going to happen.

NARRATOR: After three tries, Kevin and Mina finally succeeded in having a baby last December. Her name is Kieran, and she has no signs of Kartagener's Syndrome. But all of the news has not been good.

MINA GATES: Seven months into our pregnancy, we found out that Kevin's lungs had deteriorated, and he had very short amount of time to live unless he got a double lung transplant. We are now exploring the lung transplant list at Stanford, and we do have some difficult times ahead of us. But having Kieran, it makes it all worth it for us. In the morning, every day is happy for us.

KEVIN GATES: When I'm holding Kieran, I don't think about the obstacles at all. I'm just smiling, looking my baby.

NARRATOR: Two weeks after her premature twins were born, Michelle Whitcomb finally got to touch her babies.

MICHELLE WHITCOMB: They're so fragile looking that you're afraid you're going to hurt them. Even when I pick them up the first time, I'm afraid I'll be a wreck.

NARRATOR: Dr. Katz is pleased that the twins seem to be doing well, but no one knows if there will be any lasting problems.

NARRATOR: Deb and Susan are expecting their baby next month. It's a girl, but they're still debating about the name. Susan wants Ella, and Deb wants Bella.

NARRATOR: Both women say they are planning to breast-feed.

SUSAN VAUGHAN: I have a feeling that by the time the kid is old enough to talk about this, it's actually going to be very commonplace. They're going to have kids on the playground going, "Yeah, well, I was in a petri dish, and then this happened and that happened." I mean, I can only imagine, like, you know, revealing stories about conception will be, you know, in the next century.

Dr. MARK SAUER: You know, I don't know how far we'll go because it's very hard when you look back. And I've been in this field now almost 20 years, and I just am amazed at where we are.

NARRATOR: Every day the California Cryobank ships out more than 100 vials of sperm, 24,000 a year. They are one of Federal Express's best customers.

LEE SILVER: I think that this is a revolutionary, evolutionary point in our history as a species. I really believe very, very strongly that our species will change.

We have taken control over our own evolution as a species. We have no idea of where we are going to end up, but we're going to control our evolution, not nature. So I am very ambivalent about this technology. I'm excited about it on the one hand, and I'm frightened to death on the other.

CREDITS DURING PREVIEW:

MAKING BABIES

DIRECTED BY

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WRITTEN AND

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