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Everything Conceivable: How Assisted Reproduction Is Changing Men, Women, and the World
By Liza Mundy
Knopf, 406 pp., $26.95

" 'Ninety-six identical twins working ninety-six identical machines!' The voice was almost tremulous with enthusiasm. . . . 'Community, Identity, Stability.' . . . Millions of identical twins. The principle of mass production at last applied to biology.' "

-- Aldous Huxley, "Brave New World"

One rarely hears references to Huxley's classic dystopian novel of genetic engineering anymore. Otherwise, Liza Mundy might have incorporated it into her engaging and, at times, terrifying "Everything Conceivable: How Assisted Reproduction Is Changing Men, Women, and the World." Perhaps she thought it a cliché, but this might just be the time for a revival. The insights of Mundy's book, particularly in its darker passages, stand as illuminating cautionary tales to a society as much in love with technology as with genetically reproducing itself.

Mundy presents her story with admirable accessibility. She relies primarily on personal interviews with numerous individuals involved in assisted reproduction. For the most part, she seems excited by her findings and moved by the people she meets. These men and women try with the best of intentions to bring joy into their lives through children, and they struggle honorably to make sense of the incomprehensible menu of new choices that accompany those efforts.

Mundy gets rid of the "why not adopt?" question fairly perfunctorily by pointing out that only 2 percent of unmarried American women relinquish their babies for adoption. Supply simply will not meet demand. She does not explore in any depth the foreign-adoption controversy but accepts as an inescapable reality that most people who struggle to have children want some version of their own genetic offspring.

Mundy opens with the new human relationships created by a universe where eggs and sperm are custom-ordered commodities. Heterosexual couples incorporate egg donors into their family holidays; gay men build bonds with young Christian women who act as surrogate mothers; lesbian couples link up with gay male sperm donors to produce new family constellations. Mundy provides a richly textured vision of the far-reaching complexities that have begun to emerge.

She gives considerable attention to gay and lesbian couples who have propelled both this technology and the new relationships created by it. Mundy approvingly relates the groundbreaking history of the Sperm Bank of California -- founded in 1983 in Berkeley -- that opened its doors to single women and lesbian couples at a time when traditional sperm banks denied such women access. As Mundy notes, "It showed how a relatively simple fertility technology could catalyze massive social change . . . . It showed how having children -- maybe even more than not having children -- can be a radical , cataclysmic act."

Increasing consumer pressure and scientific advances blasted the fertility market doors open. At this point, the issue is not who you are but whether you can afford the technology. And therein, of course, lies another conundrum.

Curiously, it is not one in which Mundy has much interest. She notes that infertility most commonly affects poor, younger women of color. Yet these women are obviously not the ones fully participating in the expensive and extremely profitable assisted-reproduction industry. As a result, they don't play a big part in this book, either.

That's a pity because, by Mundy's own tepid account, there is probably a lot to be said. The author herself, in a surprisingly insensitive passage, describes an "ingenious" new company that sends frozen American sperm to Bucharest, where it is used to fertilize eggs in Romania. "The resulting human embryos -- half - American, half - Romanian -- are then frozen and shipped back to the United States, where they are thawed and transferred into the prospective American mother, all for much , much cheaper than can be done with a U.S. donor, in part because Romanian egg donors are paid so much less than U.S. donors are. And you don't even need a passport for the embryos!" Well, there you go , then.

Yet the chipper tour guide introducing us to happy new families built by successful technology also more grimly confronts the enterprise's dark underbelly. Here she provides an important, if exceptionally painful, service. Most women using reproductive technology carry multiple fetuses. Mundy sensitively explores the various crises that can occur as a result.

In one chapter, she looks at the decision to selectively reduce from four implanted embryos to two to produce a better chance at survival. This "deletion," as it is called, provokes a heartbreaking discussion made comprehensible by the even more painful chapter addressing the horrifying medical complications faced by many parents -- those whose fetuses are carried as long as possible but ultimately born prematurely and profoundly medically compromised. It is long past time that someone laid out publicly not only the joyous pictures of cute IVF babies but also the significant health risks faced by everyone involved in the process. Mundy's insistence that this hard truth not be swept under the rug is bracing and valuable. But she does not judge -- she wants us to see what's going on out there. She is a reporter, not a moral philosopher.

For many, however, there are profound moral challenges here. In her chapter "Souls on Ice," Mundy addresses those "extra" fertilized embryos sitting in freezers -- numbering over a half-million right now, their numbers growing daily. Do we toss them out with the medical waste? Can they be used for stem cell research? Should they be implanted into somebody's womb and allowed to become fetuses? What happens to the "products" of our limitless technology? Desperate people simply wanting a child to love paid good money to create those embryos, but their fate has become a dilemma for us all.

Sharon Ullman is an associate professor of history at Bryn Mawr College and author of "Sex Seen: The Emergence of Modern Sexuality in America."