What IVF Does Not Heal

The Nobel Prize given to Robert Edwards last Friday is unfortunate, because it valorizes a practice that does not serve larger social goods.

In its press release regarding the award, the Nobel Committee wrote, "Robert Edwards is awarded the 2010 Nobel Prize for the development of human in vitro fertilization (IVF) therapy.  His achievements have made it possible to treat infertility, a medical condition afflicting a large proportion of humanity including more than 10 percent of all couples worldwide."  These statements are misleading.

First, describing IVF as a "therapy" is misleading, because it does not treat whatever pathologies are at the root of couples' infertility.  Second, infertility is not a medical condition, but rather the result of other medical conditions.   A man or woman (or both) who have medical conditions that make conception difficult or impossible will experience no healing of those conditions through appeals to IVF.  One might argue that IVF has allowed the medical community to ignore these underlying pathologies and focus instead on achieving successful pregnancies.

A case in point is endometriosis, a condition that is little understood but which affects 176 million women worldwide.  The logic behind calling IVF a therapy seems to be this: "women with endometriosis have difficulty conceiving.  IVF helps them conceive; therefore it solves their problem."  But it does not solve their problem: they still experience the disease, which may cause many years of pain and suffering.  An analogous situation, for men, can be seen in problems in sperm production, which can be caused by any number of factors, none of which are addressed by appeal to IVF.  The common practice of IVF and other reproductive technologies shifts attention away from whatever underlying causes lead to infertility.

One larger issue is that IVF is a lucrative industry, whereas research into endometriosis (and other ailments) is comparatively marginal.  Medical practices using reproductive technologies like IVF appear to provide answers for couples who struggle through infertility, and their wide appeal, of course, is that reproductive technologies have been successful -- though only about 30% of the time.

Looking at the problem differently, let us observe that the IVF industry is driven by the desire of couples to conceive a child.  That desire leads many through a landscape of heartbreak and broken dreams, and so it is not hard to imagine why many couples have seen IVF as nothing less than a medical miracle.  And to be sure, we rightly give thanks for those people that have come into the world through IVF.  But the macroscopic view yields other observations which we must also consider. 

Most significant is what we know about the practice of adoption: those who experience infertility are up to ten times as likely to adopt as those who have not.  To put it differently: the experience of infertility leads many from that landscape of heartbreak to the hope of adoption.  The promise of IVF, I would argue, interrupts that painful yet transformative process.  For some 70 percent of couples who attempt it, it represents a money-swallowing hole and therefore another painful detour en route to parenthood.  The other 30 percent achieve pregnancy and birth, but in most of those cases they do not experience the basic joy of having struggled together toward the decision to welcome an orphan into their home.

It is the global picture of adoption that makes IVF a troubling practice.  Adoption is very often a difficult decision; it takes a great deal of soul-searching and hard conversations for people to come to the decision to adopt, particularly when the adoptable children have special needs.  Most often, the evidence tells us, people undertake that difficult adoption process because they have been forced to consider it after dealing with infertility. 

From this macroscopic view, IVF represents an attempt to respond to people's desires for children without attending to the larger global picture.  IVF does not serve the common good -- that is, the good of countries and states providing loving homes to all their children.  It interrupts the transformative process -- the conversion, if you will -- experienced by many families who ultimately are led to seriously consider adoption.  It feeds the natural desire of parents to be genetically related to their children, but it does not raise the question of whether this desire serves a larger good.