Making babies against the odds

Infertility treatment has come a long way but the authors of a new book outline its harsh realities, writes FIONOLA MEREDITH

SINCE THE FIRST test-tube baby was born in 1978, the treatment of infertility by assisted reproduction has expanded to become a booming global industry. In the EU, one in 25 babies born is now the result of some kind of IVF, and the numbers are still rising.

Experts believe that within the next two years, the global total of babies conceived through IVF will reach five million. Yet for people seeking fertility treatment, the range of possibilities – IVF, sperm injection, egg donation, fertility preservation, embryo transfer – are bewildering, and wider than ever. That’s where a new book by European fertility doctors Paul Devroey and Bert Fauser comes in. In Baby-Making: What the New Reproductive Treatments Mean for Families and Society, the men offer a straightforward and up-to-date guide to the rapidly-developing treatments, including the varying guidelines and regulations that apply in different countries. The book is designed for people entering the challenging and emotionally fraught process of IVF for the first time. As the authors say, “what we see is not what the public and the policy-makers see, which is why we wrote the book”.

Paul Devroey, clinical director of the Centre for Reproductive Medicine at the Dutch-speaking Free University of Brussels, is part of a group which pioneered the first male infertility treatment of intracytoplasmic sperm injection (ICSI), the world’s most widely used IVF technique.

In ICSI, a single sperm is injected into an egg to guarantee fertilisation. Devroey says the book is designed to educate women about patterns of their own fertility: “So few women are aware of their own bodies. Too many think that being 38, , is the same as being 25, but there’s a world of difference. The technology was not made for older women. It was made for younger women with reproductive problems.”

Devroey and Fauser say that whatever assisted reproduction technique a couple chooses, the chance of success is mainly down to the age of the woman. The pregnancy rate in women under the age of 25 is significantly higher than in women over 40; younger women have a pregnancy rate of around 50 per cent per cycle, while it’s no more than 10 per cent in the over-40s.

One chapter is called “How to design a baby” – and even raises the prospect of future prenuptial agreements requiring a comprehensive genomic profile of each partner, to rule out inheritable diseases – but Devroey is emphatic that fertility doctors do not exist to create designer babies. “There is a lot of fear and fantasy out there about designing babies. But most people we see have had infertility problems for at least five years: they have only one thing in mind, and that’s to have a healthy baby of their own.”

The authors acknowledge that many couples, desperate for a child, end up spending much more than they can afford in trying to realise this dream: “what they – and we as doctors – are designing is not so much a tailor-made baby with its own ‘designer’ traits, but more the ‘happy family’ which life has so far denied them.”

Devroey says that couples also tend to underestimate the psychological demands the treatment will bring. A recent study found that emotional distress, rather than a poor prognosis, was the main reason for women dropping out of IVF programmes.

But there are times when doctors and patients are at odds over how to proceed. The two doctors say that the high stress and costs involved mean that most couples coming to a first consultation for IVF would be quite happy to have twins: “A ready-made family in one go: two bundles of fun at only half the price and with only half the worry.”

Many couples are not keen on transferring just one embryo, fearing it will lower their chances of success. And many IVF doctors are happy to go along with their patients’ wishes of transferring two or even three embryos, despite the risks to mothers and babies posed by multiple pregnancies.

Yet Devroey and Fauser strongly believe that the ultimate objective of fertility treatment should be a healthy ‘singleton’ live birth, delivered to term, conceived without risk and at reasonable cost. “Multiple pregnancies are our biggest enemy,” says Devroey, shaking his head in despair at the case of Nadya Suleman, the American woman who gave birth to octuplets in January 2009, after IVF: “So many risks”. He says that with the advanced state of modern assisted reproductive technologies, “there is no need for more than one embryo be put back”.

Of course, fertility treatments are much more than a personal issue. As the authors explain, IVF and ICSI are performed within a social, political and economic context which has an enormous effect on how the treatments are applied, how much they cost, how safe they are and who can have them. In fact, as Devroey acknowledges, some may question the very idea of reproductive medicine in an overpopulated world of seven billion people. But he believes that infertile couples deserve the chance to overcome their childlessness through medical therapy. And for him, the ethical dimension of assisted fertility comes down to personal autonomy: quite simply, “If you’re against it, don’t do it.”