Who Stole Fertility?

With a growing business in the medical field of fertility products, are Americans as infertile as they'd like to believe? Or is the industry a response to the new impatient nature of the nation?

By Virginia Rutter, Tom Arma, published on March 01, 1996 - last reviewed on October 01, 2009

Contrary to popular belief, there is no infertility crisis sweeping the nation. We've just lost all conception of what it takes to conceive. Reproductive technology has made us impatient with nature. So for increasing numbers of couples the creation of a new human being has become a strangely dehumanizing process.

My great-aunt Emily and great-uncle Harry never had kids, and nobody in our family talked about it. Growing up, I knew not to ask. It would have been impolite, as crass as asking about their income or their weight. The message was clear: If they didn't have kids, they couldn't have them, and talking about it would only be humiliating.

How times have changed. Today, a couple's reproductive prospects—or lack of them—are not only apt to be a conversation topic at your average dinner party, they're the subject of countless news stories illustrating our nationwide infertility "crisis."

In an infertility cover story last year, Newsweek reported that more than 3 million American couples would seek procreative help in 1995. Diagnostic tests, hormone treatments, fertility drugs, and assisted-reproduction techniques with names like in vitro fertilization (IVF), gamete intrafallopian transfers (GIFT), intrauterine insemination (IUI), zygote intrafallopian transfer (ZIFT), intracytoplasmic sperm injection (ICSI)—to name the top five procedures—have become as much a part of the reproductive process as the more poetic aspects of family making. While some of those 3 million-plus couples were legitimate candidates for the host of high-tech options now available to them, most wound up needing only low-tech assistance, such as boxer shorts instead of briefs.

In early 1996, in a four-part series, the New York Times reported on the fertility industry's growth and the increased competition among clinics.

And that's how an infertility crisis is created and perpetuated. For contrary to popular belief, infertility rates are not on the rise. Creighton University sociologist Shirley Scritchfield, Ph.D., says that American infertility rates have not increased during the past decades: In 1965, the infertility rate for the entire U.S. population was around 13.3 percent; in 1988, it was 13.7 percent. According to the U.S. Office of Technology Assessment, infertility rates for married women have actually decreased from 11.2 percent in 1965 to a little less than eight percent in 1988. These rates even include the "subfecund," the term used to describe people who have babies, just not as many as they want as quickly as they want. This means that more than 90 percent of couples have as many babies—or more than as many babies—as they want.

Letting Nature Take Its Course

Rather than an infertility crisis, what we have is a society that's allowed technology to displace biology in the reproductive process, in effect dehumanizing the most human of events. At the very least, this means stress replaces spontaneity as women become tied to thermometers—constantly checking to see when they're ovulating—while men stand by waiting to give command performances. At the most, it involves women and men subjecting themselves to invasive procedures with high price tags. Whatever happened to love and romance and the idea of letting nature take its course? Instead, we seem to have embraced the idea that science, not sex, provides the best chance for producing biological children. Technicians have stolen human reproduction. And there are some 300 fertility clinics—with annual revenues of $2 billion—to prove it.

Infertility has become big business, one that's virtually exempt from government regulation. And it's not for the faint of heart—or pocketbook. But all the hype has made us lose sight of what it really takes to make a baby. Conception takes time. Infertility is classically defined as the inability to conceive or carry a baby to term after one year of unprotected sex two to three times a week. On average, it takes less time for younger (in their 20s) would-be parents than older (in their 30s) ones; as couples move through their 30s, experts suggest staying on the course for two years. But even couples in their reproductive prime—mid- to late 20s—need around eight months of sex two to three times a week to make a baby (In December of 1995, the New England Journal of Medicine reported that healthy women are most fertile, and therefore most likely to conceive, when they have intercourse during the six-day period leading up to ovulation.)

The correlation between how often a couple has sex and the speed with which they succeed in conceiving may seem obvious. But psychologist and University of Rochester Medical School professor Susan McDaniel, Ph.D., says she counseled one infertile couple for six months before discovering they had only been having sex once or twice a month!

Of course, these days the one thing many prospective parents feel they don't have is time. During the baby boom, couples began having children at about age 20. But by 1980—when women were in the workforce in record numbers and putting off motherhood—10.5 percent of first births were to women age 30 and older. By 1990, 18 percent of first births were to women age 30 and up. Because more would-be parents are older and hear their biological clocks ticking, they're more likely to become impatient when they don't conceive instantly But how much of a factor is age in the conception game? Men have fewer age-related fertility problems than women do. The quality of their sperm may diminish with age; when they reach their 50s, men may experience low sperm motility (slow-moving sperm are less likely to inseminate).