EVER since the advent of test tube, the fertility industry across the world has hit a boom. People, especially in cultures where infertility is a taboo, have found new solace, a reliable one at that. Indeed, for many couples who cannot conceive, a process known as In Vitro Fertilisation, IVF, is often their only hope. Though the financial cost is astronomical and hitherto far beyond the reach of the common needy person, many have resorted to the fertility industry for relief. And relief they have got! Fertility industry has created an entirely new business hub where megabuck is the name of the game, still men and women desirous of becoming parents and weaning children have been willing to explore to the fullest. The fertility industry is big business but just what are the emotional, physical and financial costs? National Health Service, NHS, figures from the United Kingdom show that one in six couples is classified as infertile, and it is the same in the US. Figures from Qatar suggest that 16 percent of couples are infertile, and in India 30 million couples, which accounts for 10 percent of the population. The result is a booming fertility business. And with a range of expensive assisted reproductive technologies on offer, for many, the cost of a human life is priceless.
Dina Salam, for example. A successful Palestinian businesswoman in her 40s, Dina married her American husband, Hisham, six years ago. The newlyweds – then in their late 30s – were full of hope. Living and working in Qatar, they had a beautiful home, home-help, individual cars and frequent holidays abroad. “I was 38, and my husband and I were very keen to have kids and raise a family, so six months into our marriage I visited a doctor here in Qatar to find out why I hadn’t conceived. The doctor referred us both to a fertility specialist who suggested we try IUI – artificial insemination. So we did. Three attempts later, and still nothing,” Dina explains. “My doctor advised us to go for IVF, and I was totally convinced that this would be our solution.” In the Salams’ case, Hisham has weak sperm. The doctor suggested the only way they could conceive would be to remove Dina’s eggs from her ovaries and fertilise them with Hisham’s sperm before transferring the embryo back into Dina’s uterus – a process known as in-vitro fertilisation, or more commonly as IVF. “That’s when we started our IVF journey – first to Florida, then Doha, Jordan, Bahrain, and lastly New York. Each attempt failed.” Like most women undergoing IVF, Dina had to have several rounds. On average, a patient falls pregnant only one out of three times, so IVF often has to be done repeatedly, and it is a costly business. “We’ve spent close to $100,000,” she says. Fertility clinics in the US alone are thought to be part of a $4.5bn industry – which is still largely unregulated. And that figure is set to rise to $4.8bn within the next four years. It is a simple supply-and-demand model, but the product on offer is a baby – something many seem willing to spend their last penny on. World-renowned IVF expert Professor Lord Robert Winston says couples are often exploited. “The combination of desperation … [at] being infertile and the fact some couples are prepared to pay large sums of money … for fertility treatment leads to exploitation. “It didn’t use to be like this. When I first started in the field of IVF, clinics would only charge what was felt appropriate. We need reasonable ethical standards applied, but the problem is that private medicine is very expensive, and medicine in the commercial market is at risk of being treated as a commercial commodity.” It is exactly because patients such as Dina and Hisham are willing to invest thousands of dollars in treatments that fertility programmes continue to compete fiercely for patients, advertising high pregnancy rates and sometimes even offering patients financial incentives. The competition for patients worries those who fear that doctors will use risky medical practices to try to boost pregnancy rates, or that clinics will mislead patients about their chances of conceiving, let alone carrying to term.
So, if infertility rates have remained largely the same for the past 20 years, why is the business of treating infertility booming? Stevens from the WHO says: “I would guess that if treatment centres are increasing, it’s due to improved treatment technologies and infertile couples’ increased ability to pay for these treatments.” But Jain proffers a different explanation: “Many people are committed to a genetic idea of reproduction: that their own biological child will better reflect their values, goals and biology. With doctors underplaying the dangers of fertility treatments and adoption being a difficult process, especially for gays and lesbians or older people, fertility clinics will prosper. “We live in a society that values reproduction for its own sake, and so many people need that, they need to have children to feel ‘whole’.” “Most couples will go to any extent to have a baby,” adds Rezai. “Reproduction and child rearing is an instinctive mechanism within all of us. It is up to the medical community to discuss the risks of conventional methods and perhaps some information about alternatives.” In the UK, the average first birth is at 31 but fertility rates don’t start dropping until after 40 and 42. There is a long way to go before they are seriously doomed.”
Sarah Howard has been trying to conceive for five years and says hospitals benefit from couples’ infertility issues: “They prey on couples who are desperate to have children. They often give you a small amount of hope. I can tell you firsthand that the small amount of hope is enough to hand over large amounts of money. “I will guarantee that people will continue to give them money because we put all our hope and faith in them as professionals. We let ourselves believe that they have our best interests at heart.” It is a costly business, both financially and emotionally, but Hannah Walker, a 39-year-old American designer, believes the time and money she has spent on trying to conceive a child has been worth it. “It was part of my life experience and led me to where I am today. The issue I had is that I was undiagnosed for so long. I wish I had done more research before going to these people. I counted on them to diagnose me or send me to someone who could, and they didn’t. “Fertility doctors have a one-track mind and whether that’s right or wrong, that’s the way it is. I kept every lab report, ultrasound, and carried my own file with me to these different doctors. I made sure that I was informed and even suggested to doctors the therapy I needed – after doing my own research. They didn’t take well to that and really have a God complex about them … They’re pretty arrogant.” When all ‘facts’ are not created equal It is a widely reported “fact” that many women now wait too long to start a family. Dina was told by doctors in the US that her inability to conceive was due to her age. But Dr Jean Twenge, a professor of psychology at San Diego State University, says all may not be as it seems. She says that we are told that women’s fertility levels take a significant drop once they hit 35 and that one in three women between the ages of 35 and 39 will not fall pregnant after a year of trying. But Twenge says this data is based on research that was conducted in France between 1670 and 1830. A time, as she puts it, “before electricity, antibiotics or fertility treatment”. She says that while fertility does decline with age, many women in their late 30s do have children. And in July’s edition of The Atlantic magazine, Twenge reminds us that most fertility problems are not because of a woman’s age. She cites blocked Fallopian tubes and endometriosis as key factors that can affect a woman at any age, while stressing that in half of all infertile couples, it is the man who has fertility problems. Professor Lord Winston, Emeritus Professor of Fertility Studies at Imperial College London, says the media is responsible for presenting an inaccurate picture of current levels of fertility: “Newspapers do not give a fair reaction; they tend to write what they think people want to read. British national statistics for 2011 show there were 905,000 pregnancies in Britain. That has never been surpassed since the 1950s. Figures show fertility levels are not decreasing nor remaining static; they are higher than ever before. The number of actual births – not pregnancies – was around 760,000 much more than in the 1990s.” The World Health Organization (WHO) concurs, saying that despite media hype suggesting growing infertility rates, figures have stayed pretty much constant since 1990. A study led by WHO looked at infertility levels in 190 countries between 1990 and 2010. The study found that in 2010, 1.9 percent of women aged 20 who wanted to have children were unable to have their first live birth (referred to as primary infertility), and 10.5 percent of women who had previously given birth were unable to have another baby (referred to as secondary infertility) – a total of 48.5 million couples. Gretchen Stevens, the lead author of that study, says: “Unfortunately, there are not many studies that directly measure infertility in general populations; those studies that exist often use inconsistent definitions of infertility and are not comparable – so they don’t tell us anything about trends in infertility. “The only country which carries out repeated studies to determine infertility prevalence is the US, and the data from the US do not show any significant change in infertility prevalence.” Stevens and her team used widely collected demographic data to infer the prevalence of infertility in different countries over time. They used the demographic definition of infertility, which differs from the standard clinical definition of infertility, which is failing to conceive after a year of trying. “In the definition we used, a couple was considered infertile if they did not have a child after five years of trying – so a couple that quickly goes for infertility treatment might be considered fertile. We do not think this had a large effect, though, since the US data would not consider such a couple fertile and also did not show any change in infertility prevalence,” she explains. “We concluded that globally, infertility prevalence is unchanged; some types of infertility may be increasing in high-income countries; and infertility is clearly decreasing in sub-Saharan Africa. We did not determine the reason for these changes – or lack of change.” MEDICAL APPROACHES Although the fertility industry is big business worldwide, approaches differ from clinic to clinic and country to country. “In Ireland I was happily given my drugs without follow-up appointments. In Doha I was given fertility drugs straight away but was closely monitored,” says Sarah. “When we were in England we tried the local health service to see if it would be different. We were put on a six-month waiting list for our first appointment, then had six months of investigations before IVF would even be considered. We found out that one round of IVF would be free on the NHS but the wait was so long.”

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