Just a century ago, a shocking number of diseases that today can be cured – or even prevented by vaccines – were claiming lives or leaving people disabled. Thank goodness for science! It is a good thing that scientific progress in the medical field has led to diagnostic tools, chemical cures, advanced, computerised, and even robotic surgical equipment at times. Three cheers for science!
It is a good thing that science makes its presence felt in the field of childbirth too. Procedures to combat infertility, in vitro insemination, all those practises that fall under the name of assisted reproduction, have allowed millions of people around the world to become parents.
Putting ethical issues to one side – such as whether or not it is a appropriate for a physiologically menopausal 60+ woman to become pregnant – and without minimising certain risks such as multiple pregnancies, assisted reproductive procedures represent one of the breakthroughs of our time. Three cheers for science.
We mustn’t forget though that they are not a solution to the problem that lies at the heart of the Why Wait Agenda, namely that of the gap between the children we want and the children we have, and more generally of the steadily declining birth rate and, most of all, of the rising average age of mothers in the developed world when having their first child.
It is not a solution for several reasons. The first is that it only works in three to four cases out of ten. This is the average success rate of people who enter a fertility medical centre and leave, months or years later, with a baby in their arms. FIVNAT/SFSO data published on the official website of the Swiss Federal Office of Public Health (FOPH) report for 2019 an average of 25 per cent of pregnancies following IVF (in vitro fertilisation) treatments, but then only 19 per cent of subsequent births, because a considerable proportion of these pregnancies end in miscarriage..
The second is that the success rate, as with natural conception, is closely linked to a woman's age. So, a 29-year-old woman undergoing fertility treatment will be much more likely to become pregnant than a 39-year-old woman - let alone a 49-year-old woman. This means that medically assisted reproductive procedures can be much less effective in helping people who start trying to have children after the age of 35, and especially after the age of 40. Which are statistically the age group that most often turns to these centers, though.
The third is that in many cases these procedures are expensive; the differences between regulations in individual countries also give rise to so-called fertility tourism, which further increases costs for those who, for instance, would like access to heterologous fertilisation or pre-implantation diagnoses but live in countries where these are forbidden by law; or single people or people in same-sex relationships who live in countries where medically assisted reproduction procedures are only open to heterosexual couples.
The fourth reason is that these are nonetheless invasive procedures, involving the intake of considerable amounts of drugs and hormones and a medicalisation of ovulation phases, with close gynaecological monitoring and sometimes involving surgical procedures. The likelihood of twin or multiple births, and therefore higher-risk pregnancies, also increases hugely: in Switzerland in 2019 for instance the overall rate of multiple births was 1.7%; but if we only take into account pregnancies following IVF treatment, the rate rises to 6.11%, which is almost four times as much.
So, yes, three cheers for science. Three cheers for medically assisted reproduction, which can be a help for so many people to have the children they are unable to or cannot have naturally.
But the problem needs to be tackled at its root. All the women who go to infertility centers because they have waited too long and not because of their choosing, those women who suddenly realise that to start trying to get pregnant at 35 or 39 or 42 is not that easy; those women will certainly get their chance through medically assisted reproduction, if they decide to try, if they have the mental and financial resources to do so. But for a large proportion of those women, wouldn't it have been better to create a non-hostile environment and allow them to have children when they started wanting to have them? Instead of subjecting them to undue, severe pressure to postpone their choice to become mothers?
Three cheers for science. But for women over 40, not even science offers a great deal of success in trying for a child. What we need is a political, and cultural, paradigm shift, so that women who want children do not reach the age of 40 before they can afford to (try to) have them
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