Shopping for Fertility Markets

When it comes to reproductive technology, Americans are more tolerant than the French.

"In a world without AIDS," says Bernard Lejeune of the Edith Cavell Clinic in Brussels, "women would probably go to Club Med and get laid, and the problem would be solved."

But not only does the world have AIDS, the French world in particular has restrictions and cultural mores that force single women like me to cross borders to seek out the few clinics that offer assisted reproductive technology (ART) to nontraditional clients. Two thirds of Lejeune's patients come from France. In Spain there are fertility clinics where almost the entire staff speaks French.

I first became fascinated by the reproductive differences between countries when I was living in New York and researching the world of sperm banks for my own use. There are huge variations not only in what is legally possible but also in what is perceived as morally right or wrong.

The European geography of the authorized and the taboo is hard to interpret. There is no north-south line, no east-west Europe, no Catholic-Protestant frontier. ART is available for single women in Denmark but not in Germany or Switzerland. Egg donations are compensated and available for single women in Spain but not in Italy.

Americans might think of the French as more permissive on moral issues. But in France, gamete donation, sperm insemination, and in vitro fertilization (IVF) are available only to married couples or common-law spouses. During every public sex scandal in the U.S., my French friends like to make fun of Amerique puritaine, but then I tell them that in America the only thing required from a single woman who wants to get pregnant is a credit card.

"Well, I doubt that would be possible in Texas," replied one French researcher who studies donor-conceived children. Why Texas? It's the old French shortcut: Texas = George W. Bush = the Christian right. Yes, I replied, even in Texas. Assisted reproductive technology for single women has never been much of a political hot potato in the U.S.

The cultural stereotypes go in both directions. I remember one dinner party where an American single woman confessed how uncomfortable she would feel if she had to live with her boyfriend under one roof without eventually getting married. "You French are more open about that," she said. But while the French are not nearly as obsessed with marriage, they have a much more traditional vision of family. When I told her that in France reproductive technology is strictly reserved to infertile couples, she was shocked. "A Harvard graduate who had to take care of her career first and can afford it--she can't decide to have a child on her own?!" she asked. I got the impression that what seems morally wrong in the U.S. is not deciding to have a child on your own but doing so when you can't afford it.

Back in France, when I told friends about my eventually unsuccessful visits to American fertility clinics, they pushed for a more homemade solution. Why didn't I trick an ex-boyfriend? Why couldn't I find a good-looking guy in a bar?

I had trouble understanding why it seemed more acceptable to use someone's sperm without his knowledge or consent rather than use some that was deliberately provided by an informed donor. For my French friends, anything organic, even if it implied lies or risks of diseases, seemed better than something produced in a clinic.

France's restrictions spring from medical rationalization. Assisted reproduction was developed as a solution to fertility trouble, and being single is not a disease. A French reproductive endocrinologist told me that even if the French law changed she would still refuse to practice IVF on single women. She became a doctor to cure people, she explained.

The reluctance is even more pronounced because of France's universal health care system. Sperm and egg banks are state-owned. Insemination and IVF costs are paid by the French health care system. Should French citizens, through their taxes, subsidize single women who want children?

These concerns do not really apply when reproductive medicine is market driven. In the U.S., when the infertility-based market for sperm banks declined (because male fertility problems became less important due to new IVF technologies such as intracytoplasmic sperm injection), banks started marketing their services to single women and same-sex couples.

Since gametes and sperm have a more or less fixed value, American sperm banks make money with an unlimited resource: information, for which women seeking to conceive have an unlimited appetite. In the U.S., everything can be bought for a premium: a "profile" of the donor with his tastes (the color blue, Tarantino movies, fried chicken), an essay, childhood pictures, a recording of his voice. All this would be impossible in Belgium or Spain, where doctors, not women, pick donors, and recipients get no information on donors aside from their Rhesus blood group. "What we offer is a spermatozoide, not a husband," says Lejeune. For the American women I've met, not being able to choose their donors is inconceivable. Why would a doctor make a better decision?

In France sperm and egg donation is anonymous and uncompensated. As a consequence, there are only 250 donors in the country and a three-to-five-year waiting list for eggs. (I'm surprised the wait isn't even longer, considering that women donating eggs have to inject themselves with hormones and go through light anesthesia for free, whereas American women are paid thousands of dollars.) Success rates for eggs are lower in France than elsewhere, since doctors can't afford to select the best donors from such a limited pool.

"Luckily some women can go to Spain," my Parisian doctor told me. If nothing else, Europe at least has a lot of nearby countries to choose from. "Procreative tourism," a reproductive endocrinologist once said to me, "is not only a relief for women. It's also a relief for doctors."

Guillemette Faure is the author of Un bébé toute seule? (A Baby All Alone?), the story of her journey through fertility clinics in America and Europe. She now lives in Paris, where she hopes to raise a family.