Reproductive tourism and the regulatory map.

Consider the case of Sharon Saarinen. In 2002, the 38-year-old hairdresser traveled to Beirut in desperate pursuit of a baby. Four years earlier, she and her husband had had their first high-tech child, a daughter conceived through cytoplasmic transfer. In this process, fertility specialists remove a single egg from the mother-to-be and inject it with cytoplasm from the egg of another (usually younger) woman. The rejuvenated egg is inseminated with the father’s sperm and inserted into the mother’s uterus. The daughter that resulted in the Saarinens’ case was apparently perfectly normal. Yet like any child conceived through cytoplasmic transfer, she carried within her the genes of three people — the typical sets from her mother and father, plus mitochondrial DNA from the donated cytoplasm. To the Saarinens, their child was a godsend. But the Food and Drug Administration was less sure. In 2001, worried about the long-term prospects of creating genetic hybrids, the agency asserted regulatory authority over cytoplasmic transfer, making even its U.S. inventors wary of continuing their work in the United States. So when Saarinen wanted to conceive again, she left the United States for Beirut, where her Lebanese-born doctor ran a fertility clinic. She underwent the procedure but did not conceive a child. The Saarinens are hardly alone. Indeed, they are at the forefront of a quiet but burgeoning market in reproductive tourism, one that stretches around the globe and already encompasses thousands of people. These people are not ill in the usual sense, and they generally don’t view themselves as engaged in commercial activity. What binds them together are three shared characteristics: the desire for a child who is genetically “theirs,” the inability to produce this child through natural means, and a willingness to do whatever is necessary to produce one. And thus there are dozens of stories like Saarinen’s: Americans travel to Mexico for an immunologic treatment banned in the United States; Germans acquire donor eggs in Spain; Australian lesbians secure sperm abroad. At a personal level, such stories are tragic and touching. They reveal a longing so intense that people will do anything to fulfill it. They speak as well to several decades of remarkable scientific progress — from artificial insemination to in vitro fertilization (IVF) and egg donation — that has enabled once-infertile couples to produce children. In the United States, roughly 40,000 babies are born each year as a result of assisted reproduction. Surely, this is a desirable outcome — a fine example of medical science enhancing life. At the same time, though, the explosive growth of high-tech reproduction has led to a lopsided market in baby making and to critical public policy questions: Do parents have the right to procure children by any available means? Should society treat reproductive medicine as a luxury good (like Botox) or a fundamental right (like emergency health care)? And who, most critically, gets to decide? To understand these issues, we must understand the role governments play in regulating reproduction. Historically, reproduction has been largely a private affair — occurring out of view of any authority and beyond government’s reach. Yet time and again, governments have extended their power into the reproductive realm, determining, for example, the illegitimacy of certain births or the illegality of certain modes of birth control. Even in the United States, where privacy ostensibly reigns supreme, state governments have traditionally wielded authority over such intimate issues as marriage, contraception, and abortion. Meanwhile, state and federal governments have played a steadily expanding role in allocating and providing health care servicDr. Spar is a professor of business administration at Harvard Business School, Boston.