Ellie* had her first child easily at 38, and then tried to get pregnant with a second child at 41. But after nearly a year of trying and a miscarriage, she is still not pregnant. Despondent, she choked back sobs when she saw other women with babies.
Natalie and David tried IVF to get pregnant, but it didn’t work even though they transferred two embryos. They tried again and were thrilled when the first ultrasound showed twins. But at 26 weeks, one of the twins died, and as a result the other was born severely premature.
Jennifer loved her two boys, but she longed for a little girl. She and her husband decided to try one last time. A year later, Jennifer had another boy.
Karen and Rick were devastated when they learned that their infant daughter, Kiley, had cystic fibrosis, a disorder affecting the lungs that can lead to death before age 30. Before Kiley was born, they did not realize they were both silent carriers of the gene that causes the condition.
Will we reach a time when only poor women have to worry about miscarriage? When rich couples will never have to receive the devastating news that their fetus or baby has a chromosomal or genetic abnormality?
Reproduction is a messy business. Having children is one of life’s most important and momentous tasks, yet it is also one of the most unpredictable and uncontrollable. Miscarriage, infertility, and genetic diseases cause pain and suffering to many, and others are disappointed when they wished for a child of the other gender. What if we didn't have to worry about any of these issues? That sounds like a nice future to live in.
That future is now, if you have enough money. For the fortunate, nearly every aspect of conception can now be carefully controlled using cutting-edge reproductive technologies introduced in just the last few years.
These technologies are not those you may have seen in recent headlines. In last Sunday’s New York Times Magazine article on three-parent IVF, many feared that the procedure would lead to “designer babies.” However, so-called three-parent IVF uses mitochondrial DNA from a third party, not the nuclear DNA that determines all of the child’s characteristics. Three-parent IVF distracts attention from the procedures that actually do make it possible for women to have an extraordinary amount of reproductive control.
I first became interested in these new technologies after I had my last child—the third of three girls—at age 40. I’d just finished a book on natural conception based on medical journal articles, and returned to the journals for the most recent updates. What I read both shocked and thrilled me: Apparently, if I could afford to go through a few IVF egg retrieval procedures, I had a good chance of having a healthy boy with little risk of miscarriage and no risk of twins. If I’d frozen my eggs when I was younger, that would have been even better.
To illustrate how the new technology allows people to control their reproduction in unprecedented ways, consider a 30-year-old woman (we’ll call her Sophia) from an upper-class family. Sophia pays the $20,000 or more necessary to extract and freeze a large number of her eggs. Over two retrievals, fertility doctors obtain 30 of Sophia’s eggs and freeze them using the current “flash-freeze” technique called vitrification, which boasts a nearly 100 percent survival rate.
Ten years later, Sophia and her husband decide to start a family. They thaw some of her eggs, which are fertilized with her husband’s sperm in the IVF lab. After five days, screening reveals which embryos are free of chromosomal abnormalities such as Down syndrome and single-gene disorders such as cystic fibrosis, as well as the embryo’s gender. The doctor transfers a single, normal embryo to Sophia’s uterus—just one, because transferring one screened embryo leads to pregnancy rates just as high as two unscreened embryos, and without any risk of twins. If she gets pregnant, Sophia’s risk of miscarriage is 10 percent or less, giving her one less thing to worry about. This procedure will require another $10,000 to $15,000.
Sophia gives birth to a healthy baby boy—not a surprise, as she and her husband asked the doctor to transfer a male embryo because they decided they wanted a boy first. Three years later Sophia goes back to the clinic, where they repeat the IVF process and transfer a single normal female embryo. This time it doesn’t take; the success rate is between 50 and 70 percent, so that happens sometimes. They go through everything a third time, and welcome a healthy baby girl nine months later.
Even with one IVF failure, Sophia’s story is a charmed one. Through reproductive technology, she had two children after 40 with little worry of miscarriage, twins, or chromosomal or genetic disease, and chose the gender of her children. The downside? That outcome cost around $50,000, about what the average U.S. family makes in a year.
Right now, Sophia’s story is still a rare one. The vast majority of couples use IVF because they have no other choice. Most would have rather conceived the old-fashioned way, which is free and rarely involves needles. These new technologies help infertile women avoid the risks of miscarriage and the possible obstetrical (not to mention life) complications of twins. IVF costs around $15,000 a try and is rarely covered by insurance, so these techniques bring much-needed financial benefits as well.
But these brand-new technologies also allow fertile women to exert extraordinary control in creating their families. I expect the next decade will find many more people drawn to this greater control, giving them the ability to have children later in life, screen for abnormalities, and choose their children’s gender. Readers of The Impatient Woman’s Guide often write to tell me that the uncertainty around conception and pregnancy drive them crazy. True “designer babies”—choosing for attributes such as appearance, intelligence, or sports ability—are still far in the future given current knowledge of genetics. But designer families are already reality.
Is this a good thing or a bad thing? Either way, it’s happening. In my view, the under-examined implications are around income inequality. Will we reach a time when only poor women have to worry about miscarriage? When rich couples will never have to receive the devastating news that their fetus or baby has a chromosomal or genetic abnormality? When lower and middle-class women will have their children in their 20s and 30s, while rich women wait until after 40? And will families like mine, with children all of the same gender, someday signal poverty?
Only time will tell. I can’t decide if reducing the risk of miscarriage and abnormalities—plus guaranteeing a boy to “complete” our family—is worth $50,000 (or more). Isn’t that priceless? Or is even considering that crazy? I don’t know. If we do have another child the old-fashioned way, at least we’ll have more money for her college fund.
And maybe we should set aside some for egg freezing, too.
* Names and identifying details have been changed.