IVF at 35: Science Still Hasn’t Outsmarted Mother Nature
The recent death of Robert Edwards, one of the British doctors who perfected in-vitro fertilization (IVF) thirty-five years ago and spawned a reproductive technology revolution, provides an important opportunity to reflect on the state of the fertility industry today.
Since Edwards and his colleague, Patrick Steptoe, achieved fame as the first doctors in the world to create life outside the womb, assisted reproductive technologies (ART) have spread rapidly across the globe. According to an October 2012 report from Transparency Market Research, the world market for infertility drugs and devices will reach nearly $4.8 billion in 2017, with the industry expected to grow at a compound annual rate of 4.3 percent over the next five years.
Since 1978, an estimated five million babies have come into the world as a result of a wide range of ARTs, the vast majority of those through IVF. Often overlooked and rarely discussed in the popular culture or by the industry itself, however, are the significantly higher numbers of failed treatments associated with these invasive technologies. In 2012, according to the European Society of Embryology and Reproduction, 1.5 million ART cycles were conducted globally and 1.1 million failed (76.7 percent). In 2010 in the United States, data from the Centers for Disease Control indicate that 150,000 cycles were performed and 103,000 failed (68.6 percent). While the minority of grateful patients who do become parents celebrate Edwards’ legacy, the severe trauma of those fragile-hearted millions who experienced failed treatments, miscarriages, still births or emptied ovaries too often slip unnoticed into the mists of unrecorded history.
Reproductive medicine is still a young science. Many women signing up for treatments do not realize until later the extent to which they are participating in a vast experiment, where evidence-based medicine has yet to establish a reasonable foothold. Few, if any, longitudinal studies have been conducted to determine the health risks of women undergoing treatments and the babies born from them.
Despite that gap, there is an extensive body of studies associating certain procedures with increased vulnerabilities. Risks for women include elevated rates of preeclampsia and blood clotting as well as ovarian, endometrial and breast cancers. Mental health challenges are also often extremely debilitating: A study from the Journal of Counseling and Development found that women who endured failed treatments reported acute depression and said they felt they were treated like “guinea pigs” for the “testing” of relatively new treatment options, and were then “abandoned when they failed to become pregnant.” As for infants born through IVF, a 2012 pediatric study from UCLA Medical Center––the most comprehensive study conducted in the United States to date––revealed a 25 percent associated risk of birth defects, including increased rates of eye, heart, and genital and urinary organ malformations.
Research from multiple countries has demonstrated that many of the people who sign up for the treatments Edwards and Steptoe pioneered often do so without fully understanding the limitations of their own biological fertility––or that of the science. A recent review examining the demographic and medical consequences of delayed childbearing indicated that despite the widespread availability of high-quality ARTs for those who can afford them, treatments can rarely overcome the age-related decline in fertility––2010 CDC data reveals a 95 percent failure rate in patients older than 42.
Many women who delay motherhood are often depending on fertility treatments as a safety net for building a family later in life. Most wholeheartedly believe––and the mainstream media and popular culture confirm their beliefs with premature optimism––that they will easily become pregnant after their first IVF treatment, or that the eggs they freeze for $18,000 at age 35 will mingle with sperm at 45 and blossom into a healthy baby. The fact is, roughly only 1,000 babies have been born through the new egg freezing technology known as vitrification––and mostly to mothers younger than 30. There is virtually no medical evidence supporting the notion that women in their thirties and forties will have any success at all with this costly intervention, or that the babies born from it will be healthy.
The absence of a much needed balanced public discourse about the success and failures of the science, coupled with pervasive misinformation circulating in cyberspace, in the airwaves and even in doctors’ offices, is perpetuating dangerous myths about the wonders of modern reproductive science.
Like many facets of medicine, the fertility industry relies on its failures to learn from and perfect future interventions. This is a bitter pill to swallow for those who banked on fertility treatments because they were raised to believe that science had finally outsmarted Mother Nature. Sadly, the notion that the miracle of IVF has finally enabled women to “have it all” turns out to be an illusion for the 68 percent of American women whose treatments fail annually.
Miriam Zoll is the author of the new book, Cracked Open: Liberty, Fertility and the Pursuit of High Tech Babies (Interlink Books-May 2013). She is the founding co-producer of the Ms. Foundation for Women’s original Take Our Daughters To Work Day and a member of the boards of Our Bodies Ourselves and Voice Male Magazine.