Richard and Meredith Gladu once found the resurrection of their life's dream in a six-story office building just off Route 9 in Brookline. A few years later, Meredith wanted to find it again. So she returned to the high-tech lab there for a series of treatments to increase the likelihood that an embryo created from her husband's sperm and an anonymous donor's egg would attach to her uterus and grow into a baby. ¶ The couple had used the same process two years earlier to produce by science what they could not by themselves: a child of their own. This second procedure was, as these things go, fairly straightforward. The clinic had two embryos left over from the couple's previous pregnancy, as well as all the original paperwork, including the consent forms signed by both the Gladus. On December 28, 1995, Dr. Merle Berger, a cofounder of the in-vitro fertilization clinic Boston IVF and a leading expert in reproductive medicine, placed the two embryos in Meredith's body. At some point during the next 72 hours, one of them attached to her uterus and she became officially expectant. Some time later, she called the Wayland Fire Department, where her husband worked as a firefighter and emergency medical technician. Richard Gladu himself answered. Receiving the call did not surprise him, as his wife phoned often. But he was stunned by what he heard.
“Guess what?” he recalls her saying. “I'm pregnant.”
He couldn't think of a thing to say. He says he had no idea his wife had gone for a second IVF procedure. She'd never mentioned it, he claims, and no one at the clinic had ever asked him whether he wanted another child. If they had, they might have discovered that Gladu, now 50, had filed for divorce more than two months earlier, that he was struggling with alcoholism, that the couple was nearly finished. Another child with his wife was about the last thing in the world Gladu wanted.
Meredith, 46, who now goes by her maiden name, McLeod, laughs at that account. It's true the clinic never notified her husband before the second procedure, she says, but she insists he knew about the pregnancy all along. Their conversations about it “were too numerous to count.” Even if she had withheld that information, she says, she certainly wouldn't have delivered such news over the telephone.
Their private family dispute would, in time, erupt into a painfully public battle involving a $3 million lawsuit, two of the city's most prominent IVF doctors, and unsettling questions about the nature of parental obligation and medical accountability in this unfolding era of reproductive science.
Dr. Selwyn Oskowitz sits in his small Brookline office, surrounded by paintings rich in reds, yellows, and greens. It's an unusually bright afternoon, and the room is warm and comfortable. The 58-year-old fertility doctor is talking in a soft voice about the worst time, only recently ended, in his distinguished career.
In 1984, just three years after the first “test-tube baby” was born, Oskowitz delivered the first newborn conceived in Massachusetts by in vitro fertilization. Oskowitz had moved to the United States from his native South Africa in 1975, anxious to work in the emerging, still-controversial field of reproductive medicine. By the mid 1980s, he had delivered thousands of naturally conceived babies, had witnessed again and again the transcendent joy a newborn, with its very first breath, injects into the lives of its parents. But it was something he saw less often that moved him even more: the anguish of parents who could not conceive. Their despair forged in him the conviction that every child is a miracle. Fertility, in truth, was all.
“Birth is one of the most pleasant-sounding words,” Oskowitz says, smiling from behind his desk. “Doesn't it make you happy when you hear that word?”
Oskowitz and three other fertility doctors formed Boston IVF in 1986.
The clinic grew rapidly, along with the field as a whole, as scientific advances improved success rates. In 1985, when there were only about 30 fertility clinics across the country, 260 babies were born using “assisted reproductive technology.” By 2001, there were roughly 400 clinics that reported producing 40,687 babies. In all, more than a quarter-million Americans have been born using reproductive medicine; 10,000 of them can trace their existence to Boston IVF. Today, the clinic has six offices throughout New England and performs about 3,000 IVF cycles per year at an average cost of $7,500 each. It also conducts as many as 3,000 cycles per year of another reproductive technique known as IUI, which costs $2,500 to $3,000 per cycle. In general, a reproductive cycle results in a pregnancy about 25 percent of the time.
Oskowitz is a disarmingly articulate man, a student of philosophy who crosses his arms and stares down at his desk or out the window for long moments while contemplating a response. This tends to imbue with a grand sweep and utmost import just about anything he happens to say, such as, “The intrigues of life and why we're here — why we feel so big at times and our contribution by necessity is so minuscule — make every individual's contribution meaningful, and how much more meaningful when one has a child of one's own.” Or, “It is perfectly understandable that if an individual does not wish to parent any additional children and is responsible about that wish by telling all those involved, then, yes, his decision is absolutely inviolate. I would sympathize with any person in a situation where that was violated.”
This last part has to do with the lawsuit Richard Gladu filed in 1998 against Boston IVF and both Oskowitz and Berger. Gladu claimed the two doctors were negligent because they helped his wife get pregnant that second time without asking his permission. The lawsuit dragged on for more than five years before finally making it to trial this year in a dimly lit courtroom in Cambridge.
The doctors, both on the faculty at Harvard Medical School and accustomed to lives of quiet affluence and influence, suddenly found themselves on the evening news and in the papers. They listened in court as Gladu and his lawyer insisted they had ruined a family and driven a man into depression and counseling. It was an unnerving experience for two men who, as far as they were concerned, had simply done their jobs: They had helped produce a healthy child. Weeks after the verdict, sitting in his office, Oskowitz still appears shaken. He says Boston IVF always believed the wife had the full consent of her husband.
Oskowitz recalls the biblical story of Lot, whose daughters tricked him into having sex with them. They got him drunk and lay with him in order to become pregnant. Oskowitz glances up from his desk. “That type of behavior goes back to [the beginning of] recorded history,” he says.
A friend introduced Richard Gladu to Meredith McLeod on July 4, 1987. They married the following year and spent the next year or two enjoying themselves, traveling, taking cruises to the Caribbean, and spending weekends at their home on Cape Cod. As McLeod entered her thirties, the couple began to consider having children. They had a good life, and it was a happy time. But they soon learned they could not conceive. So they contacted Boston IVF in the fall of 1989 for help. The possibilities were thrilling to contemplate. “This was brand-new technology,” McLeod recalls. “This was like Star Wars of the medical world. This was unbelievable stuff. And 14 years ago, I was a part of that.”
Or should have been. Despite two tries the couple couldn't produce a child.
Natural birth, it became clear, was not an option, so the Gladus looked elsewhere. They adopted a baby girl in 1992. At eight months of age, she was diagnosed with cerebral palsy. When she was two, the couple decided again to try Boston IVF. “I wanted a son,” Gladu says.
Five embryos were created using Gladu's sperm. Berger transferred three into McLeod and the other two were placed in frozen storage. This time one of the embryos attached and McLeod became pregnant with a boy. Gladu was excited. He attended far more of the IVF treatments than most fathers, and when his son was born, he was there to cut the umbilical cord. Still, he remembers the entire IVF process leaving him with a certain trepidation. “It was very uncomfortable and unnatural,” he says. “It's not the normal way to conceive a child. In some respects, it brought us closer. But in some respects, it drove us apart. The spiritual side was always on my mind: Maybe this new science has gotten beyond what it should have. She never looked at that.”
Gladu was an attentive father in those early years, McLeod acknowledges. He helped with childcare and shuttled their daughter to and from physical therapy. But McLeod also says Gladu never overcame his discomfort with the nature of their son's conception. “We were handed a beautiful, healthy infant,” she says. “Those doctors did so much for us. And all these years later he doesn't get it.”
The stress of raising two young children began to affect the marriage. McLeod says Gladu was embarrassed by their daughter's cerebral palsy and his commitment began to waver.
Gladu calls those claims absurd: “I dedicated myself to this for the success of the older girl. They said early intervention was the key. It was hard, but I did it. I was a very big part of the caregiving for those kids.” He admits, however, that the pressure got to him. He was working full-time, helping with the kids, and drinking too much.
Around that time, he says, he and his wife had a discussion that left him incredulous. “She said, 'Let's have another baby,'” he recalls. “I said, 'Are you out of your mind? I don't want any more children.'”
Things continued to deteriorate and, finally, in October 1995, Gladu filed for divorce. He left the family and headed to the house on the Cape. Eventually he changed his mind, however, and returned home. He joined Alcoholics Anonymous, and the couple entered marriage counseling.
What he never knew, he later testified in court, was that his wife had already begun fertility treatments. When she called him to announce she was pregnant, he asked how that was possible. “She said, 'It's a natural pregnancy.'” He recalls her repeating that claim to their marriage counselor. “This woman has very deep issues,” he says. “I'm not sure what motivated her. I think keeping me in the marriage was one of [her motivations].”
McLeod insists she never said the pregnancy was natural. She says Gladu admitted in court that he suspected she wanted another baby but never relayed his objections to the clinic. “I believed he wanted another child,” she says.
That may be, but why did she? She was married to a man who was battling an alcohol addiction, had sued her for divorce, and, she believed, was ashamed of their daughter. Why would she want a third child with him? “We had it all,” she explains. “We had two homes, a beautiful family. He had a drinking problem. Do you walk away from someone with a problem, or do you try to help them?”
Gladu left for good when his wife was four and a half months pregnant. She gave birth in 1996 to a healthy baby girl. The divorce was finalized the following year. In 1998, when the little girl was 2, Gladu filed his lawsuit. Though he loves his daughter, he says, their relationship has been complicated by his disgust with the circumstances of her birth. He says he has suffered from depression.
“My daughter and I have a very strong bond; there's nothing but love,” he says. “It's just how she came into this world that's different than the other two children. It's not my fault. This is humanity and human beings we're talking about. These children are not growing up in a lab.”The dull brown walls in courtroom 7B at the Middlesex Superior Court seem to swallow any brightness or vibrancy. Yellowish light meekly illuminates the oval room, and Dr. Selwyn Oskowitz looked glum sitting in the witness box. Wasn't it true, Richard Gladu's lawyer demanded, that Boston IVF had never asked Gladu's permission before helping his wife get pregnant again?
“I do what my patients instruct me to do,” Oskowitz responded.
“In this case, in 1995, Mr. Gladu did not give you any instructions,” attorney Lisa Arrowood said.
Oskowitz replied that the consent form Gladu signed for the first pregnancy, the one in 1993 that led to a son, gave the clinic the needed authorization.
Her voice rising in apparent disbelief, Arrowood said the consent form was for a single pregnancy; it was not meant to grant carte blanche to create as many children as possible. Wasn't it “lay knowledge,” she asked, that a woman will sometimes seek to get pregnant in order to prolong a relationship?
Oskowitz conceded that it was.
Dr. Merle Berger took the stand next. He claimed it was up to Gladu to alert the clinic that he wanted no more children.
“You are creating human life with this man's genetic material,” Arrowood said, “and you don't think you should assume the burden of making sure he agreed with that?”
“Not at the time, no,” Berger replied.
Before leaving the stand, he looked straight at Arrowood and shook his head. “All of us believed we were doing a very good thing for that family, or we wouldn't have done it,” he said.
That's exactly the problem, Arrowood says later in an interview. Some fertility doctors have spent too much time with couples who can't conceive; they've seen too much heartache. “They definitely come at this with the attitude that every child is a blessing. But we all know that not every child is a blessing at [every] particular time in life.” Adding to the problem, she says, is that fertility doctors refuse to acknowledge that “they are not doing just medicine. This is different. What they do creates human life and enormous emotional, legal, and financial responsibility for two people. That's what they don't want to accept. They like the power and the extremely lucrative business, but they don't want to acknowledge that they're creating life.”
Indeed, the doctors leave little doubt about how they view their job: They do not create life; they help abnormal fertility systems function properly.
“I shudder when one uses the term 'create babies,'” Oskowitz says. “We help the body in creating conception, and babies are delivered nine months later. Our role is probably a billionth of what nature does.”
That's a fairly common view among fertility doctors, says George Annas, chairman of the Health Law, Bioethics, and Human Rights department at the Boston University School of Public Health. “They really have convinced themselves that as long as they're doing what the patient wants, they're doing their job. In their view, they're not marriage counselors. Their expertise is infertility.” The problem, Annas says, is that one invested party is without an advocate. “There's no one really there to represent the child.”
It's worth asking, Annas adds, whether the private market is the appropriate model for the fertility industry or whether, as with adoption, the profit motive should be removed.
“I don't see that it's any different than any other medical procedure,” counters John Robertson, a University of Texas law professor who chairs the ethics committee of the American Society for Reproductive Medicine, the industry's professional organization. “Most [fertility doctors], they're out there trying to help people.” Even Robertson agrees, however, that Boston IVF should have gotten Gladu's permission. “That was just an oversight for which they should be held responsible,” he says.
And, as it happens, they were.
At the trial's conclusion, the jury found Boston IVF liable for helping McLeod get pregnant without obtaining Gladu's written consent. But Gladu's victory was mixed. Of the $3 million he sought, the jury awarded him just $108,000, of which $98,000 was designated for child support for his daughter, who is now 7. In effect, the jury found that Gladu was not financially responsible for the pregnancy. Looked at another way, however, the jurors decided that Gladu's distress was worth only $10,000.
That's not much to show for five years of legal battles, but Gladu insists it was worth it. “It wasn't about the money,” he says. “It was about coming forward and defending my family.” He also notes that Boston IVF changed its consent policies as soon as he filed his suit.
McLeod sees it differently. “He rolled snake-eyes,” she says. “At first I was upset that he got anything, but then I thought $10,000 was a slap in the face.”
Though the jury delivered a verdict against Boston IVF, Oskowitz and Berger were personally cleared of any negligence or wrongdoing. McLeod says it's a shame they were dragged into court in the first place. “I love Dr. Oskowitz,” she says. “On my deathbed I will remember this man for what he did for me.”
Told of her words, Gladu laughs. The entire ordeal “drove a stake into my marriage, my hopes, and my dreams,” he says. “This IVF clinic broke this family up. Well, they contributed to it.”