article

11.13.08

The Global Infertility Crisis

Women around the world are finding it more and more difficult to conceive, creating what one expert calls an "infertility time bomb."

Business recently took me to Taipei. My escort, a young feminist scholar, urged me to have my fortune told. “Taiwanese women love to visit fortune tellers,” she said. So, overdressed in pumps and a suit, I followed her into a subway station near Dragon Mountain Temple. In brightly lit stalls, behind desks outfitted with computers and caged birds, sat a dozen soothsayers from which to choose.

I selected a middle-aged woman. She asked and I told her the year of my birth. “You are a snake,” she concluded, after calculating something on her computer. Then, fingering the space between my nose and upper lip, she ventured an observation of uncanny accuracy: “You have not been able to bear children.”

I met a middle-aged lawyer in Taipei who said she went through fifteen years of emotionally and physically painful state-subsidized fertility treatments because her in-laws insisted.

Okay, it was a lucky guess; but it was a very good lucky guess. There is a global infertility crisis, particularly among women 35 to 55. According to Family Planning International, about 10 percent of all couples worldwide are or have been infertile. A recent Centers for Disease Control report says 6.1 million U.S. women between the ages 15 and 44 had trouble conceiving; 2.1 million married couples experienced infertility, and 9.2 million women had made use of infertility services.

Globally speaking, women in developed countries are having fewer babies, later in life. These days, first babies tend to be born after the 25th birthday. The decreased birthrate in Taiwan is, along with an increase in infertility, often attributed to marriage delays. The total fertility rate in Taiwan was 1.3 children per woman in 2007, compared to more than 6 children per woman in 1957. The rate of children per woman has also decreased in Germany -- a recent study documents that a growing number of Germans are deliberately forgoing parenthood.

But 21st century childlessness isn’t fully intentional. Increasingly, educated career women are facing the tragedy of wanting to get pregnant but not being able to—empty bellies, no bumps. They are simply too old.

Sheffield University Professor Bill Ledger began warning years ago of an “infertility time bomb” ticking in Europe and the UK. Women with economic and career aspirations are working inflexible hours and putting off childbearing until they are in their late thirties and early forties.

Since the early 1980s, infertile women in most developed regions have not had to settle. Thanks to the availability of infertility treatments the birth rate for women over 30 has risen a bit in recent years. In fact the mean age for childbirth in the UK was 29.3 years in 2007, up from 28.6 years in 2001. In Israel, IVF is free for the first two children, and there are ten times more IVF procedures performed there than in the U.S. Since 1995, in Israel fertility services have been provided for both married and single women under the country’s universal health insurance law. Israel’s health ministry now limits access to some services to only women under 45. Still, there are more fertility clinics in Israel than any other nation in the world and plenty of fertility tourism. The median age of woman seeking fertility treatments is about 34 in Germany, where infertility services are heavily regulated.

But fertility services are priced high. They constitute billion-dollar pharmaceutical and service industries. Only the wealthy can afford to pay full price out of pocket. And no matter who pays, infertility treatments are not a panacea for the global infertility crisis. Fertility care is expensive and sometimes not paid for by government or private insurance, and it usually doesn’t work for older women.

There are other concerns. The availability of affordable treatments can cause conflict within families. I met a middle-aged lawyer in Taipei who said she went through fifteen years of emotionally and physically painful state-subsidized fertility treatments because her in-laws insisted. “I almost wish there weren’t any such thing as fertility treatments,” she said.

The use of reproductive technology has also led to bioethical concerns about the handling of the earliest beginnings of human life. And ethical concerns surround exposing women to the uncertain health risks of repeated rounds of fertility drugs and high-risk pregnancies with twins and triplets.

And then there are the underpublicized family law nightmares. In one U.S. case, a married couple who hired a surrogate mother to carry a child for them using donated egg and sperm changed their mind after the child was conceived – they’d gotten divorced. The divorcing couple didn’t want the child, the surrogate and her husband didn’t want the child, and the sperm and egg donors and their spouses didn’t want the child. A federal appeals court had to force the divorcing couple to accept responsibility.

The realm of reproductive technology is unusually laissez-faire in the U.S. Some constitutional lawyers argue that the right to bear and begat children enshrined by the Supreme Court in Fourteenth Amendment jurisprudence is a right to bear and begat by virtually any consensual means necessary. But there have been calls for government regulation of reproductive technology, as there is regulation of abortion.

Great Britain, for its part, has enacted a special statute and created a special governing body to deal with policy and ethical questions raised by the growing popularity of artificial reproductive technologies. The Human Fertilisation and Embryology Act 1990 created the HFEA, an agency charged to license and monitor IVF, donor insemination, human embryo research, and the storage of gametes and embryos.

Based on the date and time of my birth, the fortune teller’s computer program told her that I was mother to a son and daughter; but my face told her I was infertile. She was puzzled. “Adoption,” I explained.

I don’t want my twelve-year-old to turn up pregnant anytime soon. But after a Ph.D., a law degree, and a year on Wall Street to pay off student loans, I was already 32, and sterile. I have begun telling the young professional women who seek my advice not to follow my example too exactly.

Anita L. Allen is the Henry R. Silverman Professor of Law and Professor of Philosophy at the University of Pennsylvania. She writes about everyday ethics, health, and the right to privacy for scholarly journals and the popular press.