There is something quite ironic in this week’s award of the Nobel Prize to Robert Edwards for the development of human in vitro fertilisation. During decades in which the whole thrust of reproductive medicine was to render fertile women infertile for 99 per cent of the time, Dr Edwards and later his colleague Patrick Steptoe were perfecting techniques for turning infertile women into mothers.
And yet these two grand projects are only apparently contradictory. Both pushed medicine away from its basic curative function and towards a social engineering role: efficient contraception would suppress bodily rhythms to make every child a wanted child; IVF would make wanted children appear even when the body was not fit to conceive.
In pursuing this path, both contraception and IVF gave birth to a new and arrogant attitude to human beings at the very beginning of their lives and in their dependent years.
Up until the 1960s it was generally considered a crime and a personal tragedy to put an end to the life of an unborn child, but with the advent of the contraceptive pill, abortion had to be excused or legalised to get rid of “mistakes” by individuals who did not use the new technology correctly, or neglected to use it at all. This was the first modern blow against new human life.
Then came fertilisation outside the body. What belonged by nature and culture to an act of love between spouses — the generation of a new person — was broken down into its components and manufactured in the laboratory, but no moral authority apart from the Catholic Church could see what was wrong with this. Today, most Catholics do not understand why the church teaches that the marital embrace is “the only cradle worthy of a human being”.
Cradle this being in a petri dish, however, and it turned out that everything was permitted.
If you could treat a foetus with a heartbeat, fingers and toes as a mis-timed product of conception, how much more the human embryo of only a few days who really did look like a “clump of cells” under the microscope. By the time a live baby was born from IVF in 1978, Dr Edwards had been fertilising human eggs for nearly 10 years, and the wastage of new human lives continues to be a necessary part of the technology. Those that do develop but are flawed are discarded.
Before long, embryos who passed muster but were surplus to requirements at the time were being stored in freezers, “waiting to be transferred in utero or, more likely, be used for research or to die, abandoned and forgotten by all,” as the head of the Pontifical Council for Life forthrightly commented on Monday, referring amongst other things to embryonic stem cell research. Monsignor Ignacio Carrasco de Paula also noted the “market for eggs” that IVF has spawned.
Donor eggs, donor sperm and IVF together have turned the “wanted child” into the “must-have” child wanted by anyone at all: sixty-year-old women, single women, same-sex partners. And, increasingly, it has to be exactly the “product” desired: the right sex, or the right genetic make-up. The rights and welfare of the child are no longer paramount; adult desires trump all other considerations.
For anyone who cares about the sanctity of human life, about children and the future of the family, all the above makes a damning list. Is there not something positive we can say about Dr Edwards’ work? Even the Vatican official said that he “has inaugurated a new and important chapter in the field of human reproduction, whose best results are evident to all.”
Certainly we have to rejoice that four million people have been born as a result of IVF, even though they represent only 20-30 per cent of the embryos brought into being. One also has to acknowledge the happiness that these children have brought their parents; infertility is undoubtedly the greatest sorrow that can afflict spouses, and, at a time when abortion was reducing the number of babies available for adoption, IVF offered hope, and sometimes a real baby.
But here we run into another deep irony: the hope IVF held out of a technical solution began to function as a reason to delay childbearing and thus became another cause of infertility.
The reproductive revolution unleashed by the contraceptive pill encouraged delayed marriage and child-bearing. Indeed, that was the whole point of it in the minds of those who produced the pill out of concern about the mid-twentieth century “population explosion”. Over the last four decades that delay has steadily increased, so that the median age of mothers giving birth (married or not) has risen from the mid-twenties to around 30 in some developed countries.
Many factors come into play in this cultural change, not least the increasing participation of women in the workforce and the boost that has given to the material aspirations of couples, who often desire not only an elegant home in which to begin family life, but also a hugely extravagant wedding as a prelude. They must have some inkling that their fertility will run out, but the idea that men in white coats will provide a baby if all else fails has taken such a hold that IVF experts themselves have begun issuing warnings against it.
Just a few days ago the leading practitioner in New Zealand said plainly that the leading cause of infertility now is delayed childbearing. In 20 years the number of women in the country having babies between their mid-30s and mid-40s has risen from around 5000 to more than 13,600, and Dr Richard Fisher said that one-third of women receiving IVF treatment were over 40 (when their chances of conceiving naturally are between 6 per cent and zero).
“And we treat most of them because they are over 40, not because of an underlying medical condition. The longer you delay, the less your chances of conceiving. If you have the opportunity to conceive younger you should take it.”
For all their misgivings, IVF doctors find it hard to say no to anybody.
A few years ago Dr Alan Alan Pacey of the British Fertility Society went so far as to admit: “Nature designed women to have children in probably their late teens and early twenties, and many women are now waiting until they are over 35.”
Delay can reduce fertility in other ways as well. The flip side of the reproductive revolution is the sexual revolution — the increase in sexual partners during the uncommitted twenties that raises the risk for sexually transmitted diseases, which in turn can lead to infertility from pelvic inflammatory disease and blocked fallopian tubes. Indirectly, IVF contributes to such lifestyle-related risks in a culture where marriage and child-bearing are delayed.
On balance, Dr Edwards’ great invention may have contributed more to infertility than it has appeared to solve. Strictly speaking it has not cured any type of infertility, it has only circumvented it, and in doing so has failed both medically and socially.
His was a clever scientific breakthrough which, however, was fundamentally unethical and a massive distraction from the quest for real solutions to infertility. That the Nobel Prize committee cannot see it devalues the prize and sends a misleading message to young adults, who already have more than enough incentives to squander their fertility in the — largely vain — hope that technology will rescue them.
Carolyn Moynihan is deputy editor of MercatorNet.