(In)fertility and 21st Century Baby Markets
11.05.21
When Aldous Huxley released Brave New World in 1932, he was mocked or dismissed by most of his contemporaries. Literary critic Granville Hix judged his subject matter — class-based reproductive engineering — as a ludicrous departure from more pressing matters. “With war in Asia, bankruptcy in Europe and starvation everywhere, what do you suppose Aldous Huxley is now worrying about?” he asked.
Who could imagine such a technologically intensive, state-run baby market, when there seemed to be no end in sight to naturally produced babies?
In the late 19th century, few people would pay to obtain a child. The only avenue for profit was, as the New York Times described it, the “business of getting rid of other people’s [unwelcome] babies.” In 1890, an agent of the New York Society for the prevention of Cruelty to Children went undercover to buy a two-week-old baby. The baby farmer initially asked for two dollars but quickly downgraded to one. “She… urged [the agent] to take the infant at once and at his own price,” reports economic sociologist Viviana Zelizer in her study of baby markets, Economic Lives.
Today, at a time when young women are increasingly willing to pay up to $20,000 for the mere possibility of having a child in the distant future, much less obtaining a live one today, the scales have tipped in the seller’s favor. Fertility startups abound, and rising demand may push the global fertility market to reach $33.9 billion by 2028 (expanding at a CAGR of 6.5% per year, according to Grand View Research.) Barry Behr, a Stanford University reproductive endocrinologist, aptly describes the reproductive craze: “These days if you write ‘fertility’ on a piece of cardboard and take it to Sand Hill Road, you can get funded.”
Whatever happened to bargain babies? This week, as we mark the passage of World Fertility Day, we discuss (in)fertility and the many forms of 21st century baby markets.
Infertility: An Equal Opportunity Provider
One factor behind the growing demand for fertility services is the increasingly barren population of developed countries. We all know the usual media culprits for shrinking family size: women’s liberation, women’s careers, women’s ill-timed reproductive primes, etc. (Many fertility startups explicitly advertise themselves as an antidote to such conflicting timelines: “Find that right person,” says one market player. “Pursue your career. Finish your education. When you bank your eggs, you take the pressure off.”) Yet, there is increasing consensus among the scientific community that more subtle environmental factors may be at play.
Shanna Swan, an environmental and reproductive epidemiologist at the Icahn School of Medicine at Mount Sinai in New York, sounded the alarm in 2017 when she released a meta-analysis of 185 fertility studies from the past 40 years. It traced a profound drop in male fertility, with sperm counts in the Western world declining by 59.3%, while sperm concentration dropped by 52.4%. On average, sperm count is dropping 1% per year, with no sign of tapering off. The cause? Fetal exposure to modern chemicals, particularly endocrine disruptors such as BPA (found in water bottles, food containers, and sales receipts) and phthalates (found in pill coatings, tubing, medical devices, detergents and packaging, nail polish, liquid soap, hair spray, the list goes on…).
“Contrary to popular belief,” writes Swan, “the womb does not protect the fetus against chemical assault.” Nature’s “default” form is female: it will not develop into a healthy male fetus unless exposed to the correct level of testosterone. This leaves male fetuses particularly vulnerable to chemical exposures, which can detrimentally effect sperm count and sexual development.
“There has been a chemical revolution going on starting from the beginning of the 19th century, maybe even a bit before,” said one biologist, “and upwards and exploding after the Second World War, when hundreds of new chemicals came onto the market within a very short time frame.” At the going rate, according to Swan, half of men in Western countries would have no sperm by 2045, while many others would be categorized as sub-fertile.
But women have not been spared from the chemical revolution. According to the CDC, miscarriage rates also increased by 1% per year among pregnant women of all ages in the United States from 1990 to 2011. Another more startingly effect is the early onset of puberty, now increasingly linked to “chemicals of concern.” “The age of puberty, especially female puberty, has been decreasing in Western cultures for decades now,” said one researcher. “For example, at the turn of the 20th century, the average age for an American girl to get her period was 16 or 17. Today, that number has decreased to 12 or 13 years.”
Logistically, this means that women’s biological clock, already at odds with our modern educational and career trajectories, may be even more askew. “There’s compelling evidence that diminished ovarian reserve (DOR) — a condition in which the number and quality of a woman’s eggs is lower than expected for her biological age — is occurring more frequently than in previous generations,” said Swan.
Shrinking Adoption Opportunities
To exacerbate the situation, adoption, once a celebrated solution for infertile couples, has become an increasingly rarified and expensive enterprise: adoption rates have fallen from a peak of 89,000 in 1970 to 66,000 in 2019. This decline, when accounting for population growth, indicates a 50 percent per capita decrease, and some estimates now place average costs at $60,000-$70,000 when adopting an infant through a private agency.
One reason for the shortage is that international markets are no longer filling the gap. Gone are the days when it was acceptable (or possible) for Madonna to adopt four children from Malawi, or Angelina Jolie to adopt three children from three different countries (Cambodia, Vietnam, and Ethiopia). “Claims of cultural imperialism, wounded national pride, and rare, sad horror stories of exploitation or abuse soured foreign nations against American families,” writes David French, an evangelical Christian who has faced increasing backlash for adopting his daughter from Ethiopia.
Intercountry adoptions, once all the rage, are increasingly banned by previously popular source countries. Russia, Guatemala, and Ethiopia all shut down their adoption programs years ago due to tensions with the U.S. government. China, once the top sending country thanks to its one-child policy, has since reversed course and expanded its own domestic-adoption program, reducing international adoptions by 86%. In total, the number of international adoptions has declined from a peak of 23,000 children in 2004 to less than 3,000 today.
Another cultural shift contributing to the decline of adoption is the growing acceptability of single motherhood. For decades, the pool of adoption candidates was almost entirely supplied by poor, unwed mothers. Gabrielle Glaser, an investigative reporter who documented the practices of early adoption agencies in her book, American Baby, contends that, in the post-war decades, over 3 million young pregnant women were “funneled into an often-coercive system they could neither understand nor resist,” where they were shamed or threatened into surrendering their children.
Today, teens are too preoccupied with TikTok to procreate much to begin with (the teen pregnancy rate hit a new all-time low in 2019), and just 1% of unmarried women go through with adoption (as opposed to 9% in 1970). All in all, adoption has transformed from a system for redistributing healthy babies to “a way to provide families for older, special needs children.”
Financing Fertility Services
Who will finance the new demand for assisted fertility services? “I live in New York, and I can’t even afford a place to store my clothes, much less my eggs,” says one thirty-two-year-old who recently went in for a fertility check-up. Doctors, in some cases, suggest that aspiring grandparents fill the gap: “I tell my patients who are parents to older children: finance them,” said one doctor. “You want to have grandchildren, your kids can’t afford this stuff, but you’ve got the bucks, so go ahead and freeze the eggs.”
Some of the major new female fertility startups offer financial products in addition to clinical services. Future Family, which received $114 million in venture capital and debt financing in 2019, offers loans and subscription plans (starting at $300 — $475/month with interest rates ranging from 7.99% — 15.99%) for fertility treatments.
Progyny, the leader in fertility insurance benefits, secured nearly $100 million in equity to expand its corporate fertility benefit business. Patients are increasingly able to subsidize the cost of treatments through employers: among large companies, IVF coverage has increased from 24% in 2015 to 27% (and among companies with 20,000 or more employees, it has risen to 42%).
And, as fertility rates become an increasing geopolitical concern for countries with dwindling populations, more governments may intervene to offset the cost directly. Most European countries fully fund or subsidize assisted reproduction for qualifying individuals. Denmark, once ground zero for the male fertility crisis (more than 20% of Danish men do not father children), has now become a haven for other European patients, and an estimated 8 to 10% of all Danish babies are born via assisted reproduction today.
The End of Natural Reproduction
Some fear that declining sperm counts may threaten entire nation-states, if not the human species. As infertility and technology continue to progress, however, it seems more likely that reproduction will be increasingly removed from the private lives of individuals and into a laboratory-based setting. ICIS, a particular form of IVF that individually injects a singular sperm, is already widely used to combat male factor infertility (but it remains expensive and arduous). On the larger reproductive horizon, however, is the pursuit of in vitro gametogenesis (IVG), the ability to turn adult cells into egg or sperm cells.
In 2016, a pair of Japanese scientists, Katsuhiko Hayashi and Mitinori Saitou, successfully converted skin cells from a mouse’s tail clipping into fertile mice eggs, marking a “key achievement in reproductive biology and regenerative medicine.” As GQ glumly observed, “The stem cells in question were taken from female mice. There was no need for any males.”
This misses the larger objective, however, to make reproduction independent of any individual male or female. IVG, if successfully replicated in humans, paves the way for any number of reproductive milestones, including multiplex parenting (reproduction from 2+ individuals), gay parenting (with biological contributions from both individuals), singular parenting (the ultimate form of narcissism), and dead parenting (could we revive JFK?), etc.
The timeline, however, according to the most optimistic estimates, is at least ten to fifteen years out. Mice, after all, took four years (“Better than nothing,” says Hayashi.) In the meantime, Dr. Swan warns of the day when natural conception becomes so exceptional that we truly buy into the Monty Python classic, “Every Sperm is Sacred,” and find ourselves bursting into song: “Every sperm is sacred / every sperm is great / if a sperm gets wasted / God gets quite irate.”
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