Book Review

Technology and Infertility: Clinical, Psychosocial, Legal, and Ethical Aspects

N Engl J Med 1993; 329:1589-1590November 18, 1993

Article

Technology and Infertility: Clinical, Psychosocial, Legal, and Ethical Aspects
Edited by Machelle M. Seibel, Ann A. Kiessling, Judith Bernstein, and Susan R. Levin. 446 pp., illustrated. New York, Springer-Verlag, 1993. $59. ISBN: 0-387-97793-7

According to the preface, this book is based on the proceedings of a postgraduate course given in June 1990 that was sponsored by the Faulkner Center for Reproductive Medicine in Boston. Despite the obvious time lag, it contains a great deal of useful and current information.

The chapters may be roughly divided into the technical (medical, surgical, and laboratory) aspects of infertility and the psychosocial, legal, and ethical aspects of in vitro fertilization (IVF). The broad scope of the subject matter is commendable, but it also gives rise to problems in the organization and coherence of the book. Perhaps these difficulties reflect some of the problems inherent in the high-technology field of infertility, since patients undergoing IVF cycles become involved in such arcane issues as the potential responses to gonadotropin stimulation, the quality of the egg or embryo, and the cell division of the embryo. The application of so many high-technology procedures, often on a repetitive basis, frequently leads to heightened stress in the patient, who may then require intensive medical and psychological care.

The complexities of modern reproductive medicine are illustrated by the fact that there are 45 chapters in this book. The subjects range from a chapter on “New Animal Embryo Engineering Technology” to one on “The Adoptee's Search: Who Are the Real Parents of Adopted Children”?

The chapters are organized into subgroups of similar subject matter, providing an organizational framework that is helpful for the selection of topics for reading, since these topics differ so greatly from one section of the book to another. The treatment of male infertility receives only cursory consideration, limited to the aspect of surgical advances, although the two chapters devoted to this topic are very informative. The section on cellular and molecular advances consists of three chapters that provide particularly good reviews of their respective subject matters -- oncogenes and proto-oncogenes in mammalian gametes and embryos, in vitro coculture of mammalian embryos, and the intraovarian insulin-like growth factor system. The references in most of the chapters are comprehensive and recent. Some chapters include question-and-answer sections based directly on the actual postgraduate course, but I think their inclusion creates some lack of continuity overall.

This book will be of interest to many practitioners in the field of infertility. It is somewhat uneven in structure, but is well written, edited, and produced and certainly stimulates thought related to a wide variety of topics housed under the umbrella term “infertility.” The sections on legal and ethical aspects provide a fitting final exemplification of the subject matter, inasmuch as they succeed in provoking as many questions as they answer.

Irwin E. Thompson, M.D.
Boston IVF, Brookline, MA 02146