Will IVF Keep Us Young?
Talk of IVF as a solution for declining birth
rates is a sign that governments are clutching
at straws.With nations around the world failing to reproduce them-
selves, policy wonks now realise that too few children could be
worse than too many. Without children, populations age rapidly;
there are too few workers paying taxes to support the disabled
and the elderly; an economic and social crisis looms.
A stable population requires a birth rate of 2.1. Many coun-
tries in Asia, Europe and Latin America have sunk far below this.Conventional strategies for boosting the number of births
include baby bonuses, family benefits, extended maternity and
paternity leave, and more flexible working schedules for mothers.
But even these fail to make much impact.
What else can be done?
The brain waves of desperate bureaucrats range from barmy
to loopy. In 2012 Singapore (with a birth rate of only 0.78)
declared that 9 August would be a national night of pro creation.
A syrupy rapper sang on a YouTube video: “I’m a patriotic
husband, you’re my patriotic wife, let’s do our civic duty and
manufacture life.” In Japan, local governments subsidise speed
dating to help time-poor office workers find spouses.
Alas none of these gimmicks works, so it’s hardly surprising
that countries with extinction on the horizon also consider
subsidising IVF. Demographers say that no country’s birth ratehas ever recovered after dropping below 1.5. Singapore’s is
about 0.8; Taiwan’s is 1.1; South Korea’s is 1.2.
At stake is the very survival of a number of small countries
with distinctive cultures. Do more IVF clinics make sense?
While helping childless couples have children seems like a
obvious solution, there is precious little research to support
the idea that free IVF will boost birth rates. One of the few
studies was published in 2006 by the Rand Europe think-tank.
Its conclusions were rather pessimistic.
When IVF is heavily subsidised, the Rand analysis showed
that it boosts the birth rate slightly. When it is not, the avail-
ability of IVF actually depresses the fertility rate.
What happens is this. Many women in their fertile years
balance the cost of having a child against the extra income they
could earn at work, and defer having their children. In the back
of their minds, IVF is their fertility safety net.
The years tick on, and in their mid-30s the alarm on their
biological clock goes off. They begin trying for a child, but
many of these older women fail. If IVF is heavily subsidised,
many of them will clutch at their safety net. Some lucky ones
will have children, giving a small fillip to the birth rate.
But if IVF is not subsidised, women discover to their dismay
that it’s horrendously expensive. They cannot afford it and
they have to give up their dream of having children.
So the availability of IVF is a will ‘o the wisp, a flickering
beacon of hope enticing women to invest so heavily in their
careers that they are unprepared for the inexorable fading of
their precious fertility.
The report cast even more cold water on IVF as a way of
rejuvenating dying countries. The health of babies born to older
women and from IVF is poorer than children born to younger
mothers and through natural conception. Older women have
more Down syndrome children. There are far more multiple
births for women with IVF treatment, which is associated with
poor child health.
IVF is also associated with low birth weight and prematu-
rity and a higher risk of birth defects. “These health effects and
other unintended consequences should be taken into account
when assessing the impact of [assisted reproductive technology]
as part of a population policy mix,” the report said.
Talk of IVF as a solution for declining birth rates is a sign that
clueless governments are clutching at straws. Low fertility is a
complex issue with social, economic, medical and environ-
mental factors. IVF is just a band-aid.
Ultimately a low fertility rate is the sign of a cultural crisis –
having children is simply not a fulfilling life project. Perhaps the
solution is more ethical than medical. Only when couples think
that babies are their best investment will birth rates begin to
climb back to replacement levels and beyond.
Michael Cook is editor of BioEdge,an online bioethics newsletter.50 | JAN/FEB 2016
QUANDARY Michael Cook
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