Truth in Medicine: Vast Majority of Assisted Reproductive Technologies Fail
By Miriam Zoll — May 16, 2013
In an essay recently published in the Wall Street Journal, Sarah Elizabeth Richards, author of the new book “Motherhood Rescheduled,” encourages women to ward off age-related infertility by simply freezing their eggs — like she did.
Between the ages of 36 and 38, Richards spent $50,000 to freeze 70 eggs that she plans to thaw, fertilize, and insert into her uterus when she is 44 or 46.
“Egg freezing,” she said, “stopped the sadness that I was feeling at losing my chance to have the child I had dreamed about my entire life.” Still looking for a mate at almost 40, Richards says she now goes onto Match.com and has the confidence to tell men that she can “have kids whenever I want.”
While Richards’ decision appears to have provided her with a sense of hope and temporary emotional equilibrium, it may prove to be illusory. Sadly, as millions of women, including me, can attest, the vast majority of assisted reproductive technologies fail.
In 2012, of the 1.5 million treatments performed globally, 1.1 million failed: a 77 percent failure rate. In the United States, the overall failure rate was 68 percent. Once optimistic and hopeful about the promise of reproductive science, I endured four failed in vitro fertilization (IVF) cycles, one miscarriage, and two donor egg attempts in which both donors were diagnosed as being infertile.
But it is no wonder that Richards believes she will be able to bear children with her frozen eggs whenever she wants to. A $4 billion industry is driving the public discourse about often unproven discoveries through a lens that focuses attention on the minority of successes rather than the whole messy, complicated story.
Related: What’s Wrong With Fertility Clinics and Online Advertising
Growing up in a culture that reveres science, she has been bombarded with overly optimistic and one-sided media stories touting the miracles of creating babies in laboratories. The truth is, 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.
The only current independent effort to track the health of all women going through treatments remains largely invisible to patients who might sign up to have their health — and that of their offspring — tracked over time.
The voluntary Infertility Family Research Registry is based at the Dartmouth Hitchcock Medical Center and is funded in part by the American Society for Reproductive Medicine (ASRM). To date, the vast majority of large fertility centers in the United States are not displaying the registry’s placard in their waiting rooms, greatly reducing the potential benefits such a long-term study would provide. [Ed note: Our Bodies Ourselves is actively encouraging infertility clinics and centers across the country to promote awareness of the Infertility Family Research Registry.]
Richards’ desire to protect her ability to bear a biological child is heartfelt, and her willingness to undergo egg freezing procedures that were considered experimental at the time speaks to her commitment — and her panic — to try anything to preserve that opportunity. But her statement that this decision was “the best investment” she ever made is premature, to say the least.
The general public knows virtually nothing about the failure and success rates of vitrification — a new flash-freezing technique that has been used to preserve the eggs of women younger than 30 who are facing life-threatening illnesses. While an estimated 1,000 babies have been born from this technology worldwide, there is virtually no data that tells us if these live births were the result of 3,000 or 10,000 trials.
We have no idea how many miscarriages or still births may have ensued, and there are few, if any, long-term infant health studies evaluating how flash freezing half of a child’s DNA might affect that child later in life. The one study Richards cites found that 900 babies exhibited no more risk of birth defects than babies conceived naturally by young mothers, but is one study really enough?
Apparently the ASRM believed it was proof enough for them to lift the “experimental” label from the still young procedure last fall. The ASRM Practice Committee said it was not yet ready to endorse widespread use of egg freezing for elective use. However, while randomized controlled studies were rare, the committee did find sufficient evidence to “demonstrate acceptable success rates in young, highly selected populations.”
Citing a lack of data on safety, efficacy, cost-effectiveness, and potential emotional risks, their report states, “Marketing this technology for the purpose of deferring childbearing may give women false hope and encourage them to delay childbearing. Patients who wish to pursue this technology should be carefully counseled.”
As would be expected, once the ASRM decision became public, their caution about women’s age and infant health was obscured and eventually obliterated by the dust kicked up by a stampede of panicked but hopeful 30- and 40-something women running to the nearest fertility clinic to have their eggs harvested for future use — for anywhere between $10,000 and $15,000 per harvest, or more.
One must wonder why the ASRM felt so compelled to provide a stamp of approval for a procedure still lacking in reliable safety and efficacy data. As legal scholars Debora Spar and Naomi Cahn have written in their books, “The Baby Business” and “Test Tube Babies,” respectively, in the context of an unregulated industry in the United States, it is virtually impossible to separate the medical and market forces at play when new techniques and procedures are advertised to potential clients.
The blurred boundaries between fertility clinics wanting to provide patients with safe, evidence-based procedures while also needing to generate business to meet their bottom lines puts that much more pressure on consumers to know what they are signing up for. But when evidence and information is scarce, biased, or non-existent, well-heeled consumers like Richards feel they have no choice but to close their eyes, write a check, and jump off that technological cliff called “hope.”
For Richards’ sake, I hope she succeeds. If not, she may well join the ranks of millions of men and women who, since the first IVF baby was born in Britain 35 years ago, have experienced involuntary biological childlessness as a result of delaying parenthood and relying on science for last-minute miracles.
Miriam Zoll is an award-winning writer and an international health and human rights advocate and educator. She is the author of “Cracked Open: Liberty, Fertility and the Pursuit of High Tech Babies” and is on the board of Our Bodies Ourselves. This article was originally published at RH Reality Check, and is reprinted with permission.
As an infertility patient, I think readers need to understand that infertility is not just caused by one thing- delayed childbearing. I am certainly not alone in having infertility foisted on me while still in my supposedly fertile 20s. While there are plenty of women, and their partners, who I feel do not quite grasp that women’s bodies really are unlikely to bear fruit in their early 40s, even with high-tech medical interventions, it is unfair to characterize infertility as a problem experienced by aging professional women.
Just like any medical illness, the success of treatment will depend upon the cause of the illness. My infertility, an unexplained ovulatory disorder, was easily resolved using oral medications. In fact, I am now pregnant with my third child. My partner had no issues. A friend with no tubes due to endometriosis, who had no sperm or egg issues, was able to conceive easily using IVF. A friend who had issues with unbalanced translocation that attempted IVF using PGD was discouraged from trying, as the success rate would have been dismal. Failure rates for women over 40 would naturally be very high for women using their own eggs, but would be much, much lower for someone like me, who was 27 when we first started out. Couples with both sperm and egg issues would naturally have much higher failure rates as well.
What Mrs. Spock said is very important. I would like to,add lesbians as another group availing themselves of treatments. That was the reason in my case when we began treatments at age 31. Unfortunately all of the treatments out there work on a variety of conditions except those involving bad eggs. After three ivfs i was diagnosed with diminished ovarian reserve and told that donor eggs or adoption were my options. We chose to live,without children. I think its important to have hope but to talk to as many peers as possible to get on the ground knowledge. I felt my clinic was very responsible and dud not push me on lost causes….I was in my early thirties so I wasn’t supposed to have old eggs; no,testing,indicated a problem until ivf two when doctor decided to,run tests reserved for older women
Hello, this is Miriam Zoll, the author of the blog post above. Thank you for your important comments about infertility not being caused only by advanced age. To be sure, there are many women in their 20s and 30s who face infertility for a wide variety of other reasons, and sometimes, assisted reproductive technologies (the manipulation of the egg and sperm outside of the body – NOT – IUI or hormone treatments alone) can help them. Unfortunately, the science is unable to help the majority of those who walk through clinic doors (77 percent globally; 68 percent in the U.S. in 2010 (most recent data available). This is not to say that some women might seek treatment and be helped by it, but it is very important that we begin to create a more balanced discussion about the ability of science to reverse a diagnosis of infertility–for whatever reason. Women and their partners who enter into treatments not knowing the full story can encounter serious emotional, physical and financial repercussions.
This is a very informative article. I never thought that egg freezing procedure is possible. Science is really changing everything. I think this is a great discovery but it’s unfortunate that those who undergo this procedure at this early stage will still be part of the experiment. I hope this will have a positive outcome in the future.
I think it is important to have better Ivf data. Many of the clinics manipulate their data making this technology appear more successful than it is. This leaves patients who are greiving the possible loss of their future family vulnerable to being scammed into treatment that will likely not work. We hear all the time about Ivf successes but rarely about all the failures. Women who have failed to have children despite undergoing the inhuman torture that is IVF are blamed for their infertilty. They and their stories are taboo. There is little consideration given in our society to how profoundly devastating infertility is to a woman. We still blame women for their infertilty and statements about waiting too long are really nothing more than another way of stigmatizing a woman for a physical disease that she has no control over. Would we accuse a woman in her 30’s who had lost her breasts due to cancer/mysectomy of having waited too long to do a mammogram?