Why the History of IVF Matters in the Fertility Choices We Make Today
Despite over a century of fascination with artificial insemination and reproduction (starting as far back as 1881), the first successful human birth from IVF was achieved in 1978: Louise Brown, who turns 42 this year.
Four years after Louise was born, her sister, Natalie Brown, came into the world. Natalie is also an IVF baby, and at the time of her birth, was the world’s fortieth IVF baby.
Yes, you did the math right. IVF started out slowly, with only forty babies in the first four years. This sedate pace did not last long…
8 Million IVF Babies
In 2018, when Louise Brown turned 40, the world hit a milestone: 8 million babies born through IVF. The pace of progression in the sector began with the discovery and use of stimulated cycles: clomiphene citrate, and the use of human chorionic gonadotropin (hCG) allowed scientists to control and time egg maturation.
Basically, science could control the menstrual cycle.
This marked an important shift in IVF — when scientists can control the reproductive cycle, assisted reproduction goes from interesting research to viable, commercial, clinical treatment. And the clinical world embraced it.
As soon as IVF became a clinical treatment, the race was on. Embryo freezing and thawing (1983), egg donation (1984), egg freezing (1986), intracytoplasmic sperm injection (ICSI) (1992): nothing is off the table when it comes to starting a family.
Fertility clinics use advances in research to sell prospective parents ever-increasing chances at achieving a dream: the family they always wanted.
What Happened to the Law?
Throughout all of this, one thing that is curiously off the pace is regulatory oversight and legislation. Assisted reproduction is an ethical and moral hotbed. By merging exploratory research on stem cells and embryos (dubious or revolutionary, depending on your outlook) in the name of helping people create their dream family (a very moral endeavour), you open the door to strong opinions and hot debate.
Medically assisted reproduction (MAR) sits at the intersection of religion, culture, tradition, medicine, society and legislation: people’s views of MAR are rather like people’s views of Brexit, Marmite, or Donald Trump: polarised.
This has created a curious legislative landscape in the world of MAR: wild inconsistency, prohibitive policy and discriminatory laws.
The Wild West That Is Assisted Reproduction Law
Austria’s IVF laws prohibit IVF except in the case of married heterosexual, cis-gendered couples using their own gametes (sperm cells). Subsequent legal challenges — still making their way through the European Court of Human Rights — may yet change these laws.
For now, Austria defends the law as protecting us from the “exploitation and humiliation of women”. A curious stance, given that the legislation was drafted and passed by an overwhelmingly male cohort.
Legislation, oversight and regulation in MAR varies by country. Many laws are by now out of date, out of touch with a world in which every family looks different, where binary gender norms and rigid relationship structures become less relevant with the passing of generations.
Heterosexuality and ‘Human Sense’
In Hungary, MAR is permitted only for married and ‘stable’ heterosexual couples. Lesbian couples can pursue MAR but are considered as ‘single women’ when they do so, to stay within the confines of the law
Luxembourg and Malta have no laws, instead deferring to ‘human sense’. In Cyprus, a committee was formed in 2007 to begin ‘preparation of an opinion’ (there have since been no laws, or for that matter, opinions).
In 2006, Denmark introduced a law allowing for the evaluation of ‘parental incompatibility’ when seeking IVF. In Croatia, surrogacy is prohibited. In Spain, the law does not recognise surrogacy at all.
Even in Sweden, the law states that “insemination may be carried out only if the woman is married or cohabiting. Written consent for insemination is required from the spouse or cohabitee.”
You get the idea.
In short, MAR is one of the most highly privatised, inconsistently regulated, and wildly legislated sectors of medicine that exists today. Why? Because merging science and reproduction resonates with peoples’ moral compasses, in a big way.
A Pope, A Conjugal Act and ‘Illegitimate Children’
Creating babies in a lab is futuristic, the stuff of dreams and moral quandaries. Lawmakers, politicians, philosophers and scientists alike feel compelled to weigh in.
In 1951, Pope Pius (in an address to a college of midwives), famously said, “To reduce the cohabitation of married persons and the conjugal act to a mere organic function for the transmission of the germ of life would be to convert the domestic hearth, sanctuary of the family, into nothing more than a biological laboratory.” Needless to say, some inconsistencies there in attitudes towards the purpose of marriage.
Has artificial insemination turned our homes into biological laboratories? No.
Has Pope Pius influenced the opinions of an entire generation of Catholics? Yes. And this is what is damaging.
In 1963, in the case of Gursky v. Gursky, a New York judge ruled a child born of donor insemination (consented to by the husband) to be illegitimate. A similar case a year later had the same ruling: child illegitimate (husband still liable for support).
These opinions and rulings happened not that long ago. Modern clinical techniques and attitudes were being shaped and developed in this time, and we can still see the effects of these attitudes today in the laws and regulations surrounding MAR.
The themes we see emerging in legislation and religious opinion are concerning: Consent. Marriage. Heterosexuality. And at the centre of this complex, discriminatory, emotionally-charged environment, we find the fertility clinics.
When is it ok to Sell a Fantasy?
Fertility Clinics sell hope — they sell the chance at a family. For would-be parents, desperate to conceive and not sure why they can’t, the fertility clinic represents a way forward. Caveat: as long as you have the cash.
Clinics are prohibitively expensive, with intrauterine insemination starting at £1500 in some London clinics. If it’s IVF you’re after, be prepared to part with £5000.
In fact, the average spend per couple in the UK is £12,000.
The average spend per couple in the US is $61,000.
Fertility clinics are privatised, commercially-driven entities. Yes, they exist to help people create families; and they are highly motivated to make a profit whilst doing so. The result of this is a plethora of treatment ‘add-ons’; additional services provided by clinics that can double the cost of treatment.
In 2019, the Human Fertilisation and Embryo Authority (HFEA, the UK Government’s regulator, responsible for ensuring that clinics and research centres comply with the law) created a traffic light system for ranking efficacy of treatment ‘add-ons’ in fertility clinics (essentially, the additional services sold by clinics in support of achieving pregnancy).
A Green light indicates that there is sufficient evidence to show the procedure to be effective; Amber indicates inconclusive evidence; Red indicates very little or no evidence. Of the 11 popular add-ons, not a single one received the green light.
We Need More Choice — and More Power — When it Comes to Our Fertility
Lack of clarity in the law, rapid advances in research and inconsistencies in regulation, combined with the commercial drivers in the fertility sector paradoxically results in one thing: less choice.
When fertility treatment costs £5000, suddenly only a small group of people can afford to choose it. When the law prohibits IVF for LGBTQ+ people, we take away people’s ability to choose what’s right for them. When leading religious figures and courts of law weigh in on what is right and what is wrong, we influence (read: undermine) people’s confidence to make choices that are right for them.
This is not ok.
It’s Time to Shake it up
We need more choices when it comes to our fertility. We need better sex education as teens. We need to have access to fertility education as adults.
We need to be able to have our choices presented to us early on in our fertility journey, so as to make better choices for ourselves and our families later on.
The fertility sector as it is today allows those who can, to ‘have’ choices. It blocks those who cannot from ‘making’ choices. To quote Kerry Washington’s character in Little Fires Everywhere, “you didn’t make good choices, you had good choices.”
This is no longer acceptable. It’s time to crack open the fertility sector. It’s time to democratise access, improve access to choice and empower people to make those choices.
Advocating for (and driving access to) fertility treatment for all families is our mission at Béa Fertility, and that’s what you’ll find me musing about here.
Sources:
https://via.library.depaul.edu/cgi/viewcontent.cgi?article=3081&context=law-review
