Aoife Stuart Madge investigates the future of fertility


The inventor of the pill has predicted that by 2050 we'll be choosing elective IVF on our own timeline,  and that sex will be purely for fun. Aoife Stuart-Madge asks leading fertility experts for their view.

Professor Carl Djerassi changed the world of reproduction completely when he invented the pill back in the 1950s, but he’s now foreseeing even bigger changes in family planning in the next decades. The Austrian-American scientist has predicted that by 2050, most babies in the Western world will be born via IVF because fertile women will elect to freeze their eggs and delay pregnancy. Speaking to The Telegraph in the UK, he said, “Women in their 20s will first choose this approach as insurance, providing them with freedom in the light of professional decisions or the absence of the right partner or the inexorably ticking of the biological clock. However, I predict that many of these women will in fact decide to be fertilised by IVF methods because of the advances in genetic screening. And once that happens, then IVF will start to become a normal non-coital method of having children.” The 91-year-old added, “Over the next few decades, say by the year 2050, more IVF fertilisations will occur among fertile women. For them, the separation between sex and reproduction will be 100 per cent.”

INSURANCE POLICY

The freedom to delay motherhood until we’re good and ready certainly sounds tempting (especially for those still hunting for Mr Right), and it would potentially put an end to unwanted pregnancies and the raging abortion debate, but is it messing with Mother Nature to separate sex and reproduction completely? According to Dr Marilyn Glenville PhD, a leading women’s health expert and author of Getting Pregnant Faster (Marilynglenville.com), we’ll always opt to conceive a child through conventional means, given a choice. “The technology is certainly out there to be able to separate sex and reproduction, but I would think that the majority of women would prefer to conceive a baby with the love and intimacy that is usually connected with reproduction rather than going down the ‘test tube’ route,” she says.

However, according to shock new statistics from the UK, many young heterosexual women are already separating sex and reproduction. Last month, four major British IVF firms said they had assisted with ‘virgin births’ where women who had never had sexual intercourse were seeking donor-assisted treatment. Doctors suggested there had been as many as 25 such births in the last five years. Following the news, this practice has come under fire from religious groups who have said it undermines the importance of bringing up children in a stable family.

But while there are few fertile women who would choose IVF as a first option to conceiving, there are already a growing number of women who are electing to freeze their eggs as an ‘insurance policy.’ Apple and Facebook both hit the headlines recently with the news that they would pay for their employees to freeze their eggs in a programme that will be rolling out across both tech companies next month. New York-based fertility expert and author Jill Blakeway, from the Yinova Centre, says she has already seen an increase in women opting to freeze their eggs. “I do think more and more people will freeze their eggs and sperm because it makes sense to have your younger gametes available when you choose to conceive. It’s like an insurance policy which, for women particularly, makes sure they don’t run out of time. However, I don’t think people will get sterilised after freezing their eggs because they will still want to preserve the option of conceiving naturally.”

NO GUARANTEES

However, Blakeway warns that elective IVF overlooks many aspects of fertility treatment, including the chances of success. “I see couples all the time who have viewed IVF as an insurance policy and are disappointed. The treatment has a relatively low success rate meaning that a couple may need to do several IVFs before being successful. The treatment itself is more gruelling than people think with daily injections, side effects such as headaches and hot flashes, daily monitoring and two invasive procedures when the eggs are retrieved and the embryos transferred.”

And far from gravitating towards medical intervention, Blakeway says social trends are actually moving towards a more natural approach, not away from it. “From my own experience, my patients are worried about taking unnecessary medications and want to conceive naturally if they are able to. We are seeing more and more people moving towards choosing organic foods and non-toxic household cleaners because they are concerned about toxicity and I think this applies to pharmaceuticals too. I think we’re all grateful that IVF exists to help infertile couples conceive but I don’t see people choosing to take fertility drugs unless they need to.”

There is also the added concern that by delaying parenthood, we’ll have a generation of ageing mothers. “I have treated a number of women who have conceived later in their 40s using donor eggs and often their pregnancies are difficult because their bodies are older. So it’s not just getting pregnant that’s the issue but staying pregnant and having a healthy, well-nourished baby.”

SCIENCE VS NATURE

However, Mr Michael Dooley, a consultant gynaecologist at the Poundbury Clinic in the UK (Thepoundburyclinic.co.uk) believes the argument against delaying parenthood is no more valid now than it was when the pill became available in the 1950s. “That concern over ageing parents could have been raised when the pill came out. The pill has also helped delay parenthood, and you could also argue that the pill has allowed us to separate sex and reproduction.” He adds, “The big change which will revolutionise fertility is ‘social’ egg freezing for women. We are all totally signed up to equality between man and woman, but sadly there is not biological equality. Men can reproduce until their 70s and 80s, whereas women cannot reproduce past their mid to late 40s. Therefore we can use the science of egg freezing as an insurance.”

But, he warns, like any insurance, you should hope you never have to use it. “I see a lot of people opting for social egg freezing, but you have to understand the implications of the insurance policy. It’s not guaranteed at all. To date only 2,000- 3,000 babies in the world have been born through egg freezing.”

While Dooley can see a future where more women opt to freeze eggs, he believes that retaining and maintaining natural fertility will always and should always be the number one priority. “Medicine is not just about the science, there is ethics, emotions, legalities and finances involved as well. The goal for clinics like ours will always be to maintain natural fertility and use world class techniques developed in laboratories appropriately once you’ve gathered the relevant information. At the same time, you should make sure you are doing everything to retain natural fertility.”

SOCIAL ISSUE

The real problem, Mr Dooley argues, is that women are having to delay families because of their career. Many view Apple and Facebook’s egg freezing policy as antifamily, claiming it’s encouraging women not to have children, despite their position claiming that they are enabling women.

Whatever your viewpoint, Mr Dooley says the fertility dialogue has to work in tandem with scientific advances. “Egg freezing is just another way of using science to address a social problem. We have got to look at better social structures, better career structures and a better working environment for women.”

It’s a conversation that women need to be having from school age, he argues. “Every woman needs to think about her fertility. It starts with education in the teenage years, looking at lifestyle, smoking, being overweight, prevention of chlamydia, looking at prevention of unwanted pregnancies and terminations. All these have a potentially huge impact on fertility,” he says. Food for thought, particularly during this hectic party season when most of us are guilty of consuming our weekly alcohol quota in one night.

Mr Dooley adds, “We’ve got to be very careful not to let science dominate nature because then you’ve got a kitten that could potentially turn into a wild animal. Science will let you have a contraception, and science will allow you to have a fertility insurance, which may not be guaranteed. But we should be looking at maintaining natural fertility, and use diagnostic fertility treatments to help people get pregnant who can’t get pregnant naturally.”

SOCIAL EGG FREEZING IN IRELAND

Dr John Waterstone, Medical Director at Cork Fertility Centre (Corkfertilitycentre. com) says: “Sex and reproduction have been separated since the dawn of contraception. Where contraception was once illegal in Ireland, now the government is advising people to use it. It is bizarre that Irish women were once clambering for the right to have sex without reproduction, now they are clambering for the right to have reproduction without sex. It’s a complete sea change.

“Undoubtedly, the whole idea of social egg freezing is becoming more popular, particularly in the United States, where women are freezing their eggs now because they don’t have a partner in mind or they don’t want to have a baby straight away. However, I think social egg freezing is quite some time away in Ireland.

“The problem is that it is new technology and it hasn’t been proven. There are already a lot of fertility units around the world – including in Ireland – who are offering social egg freezing as a service but they have never proven that they can make it work. Nobody in Ireland has frozen an unfertilised egg, thawed it and produced a baby afterwards. Meanwhile there are units who are selling this as a service. You have to be slightly worried about the ethics of that situation.

“I would not be backing the approach by companies like Apple and Facebook who pay for female employees to freeze their eggs. It would be much more effective to have family-friendly practices in the workplace. In other words, to allow women time off work to have their kids and offer job share and part-time options.

“If and when egg freezing is proven to be effective, more and more people will go for it in future. However, it will always be as an insurance policy. The majority of people in Ireland in the foreseeable future will aim to do what people have always done: Settle down with a partner and try to have a baby normally.”