The NYT ran an Op Ed titled “Selling the Fantasy of Fertility” by Miriam Zoll and Pamela Tsigdinos. I waited to write a blog about their

Do Infertility Clinics Sell a Fantasy
Does infertility clinic marketing encourage women to keep trying more and more treatment with little hope for success?

Op Ed because I wanted to really think through the points raised, and not be in auto-react mode. This well written and thought provoking article deserves that pause. I haven’t read Miriam’s book (Cracked Open: Liberty, Fertility and the Pursuit of High-Tech Babies), but I loved Pamela’s book (Silent Sorority: A Barren Woman Gets Busy, Angry, Lost and Found) and interviewed her on the Creating a Family show on Deciding to Live Child-Free (highlights here).

Where I Agree

Tsigdinos and Zoll are so right that “the refusal to accept physical limitations, when applied to infertility, can have disturbing consequences.” I have written before about my concerns for women who go through cycle after cycle of in vitro fertilization with the hope that somehow the next one will work. Infertility medications are powerful drugs, and I suspect that we will someday find there are health consequences for those who overuse them.

While there is no magic number of IVF procedures a woman should go through before she moves to a different option, doctors on many Creating a Family shows have said that chances of success after 3-4 cycles are slim. Unfortunately, as this article points out, it is sometimes hard to stop.

It’s no wonder that, fueled by magical thinking, the glorification of parenthood and a cultural narrative that relentlessly endorses assisted reproductive technology, those of us going through treatments often turn into “fertility junkies.” Even among the patient-led infertility community, the prevailing belief is that those who walk away from treatments without a baby are simply not strong enough to run the gantlet of artificial conception. Those who quit are, in a word, weak.

Ending our treatments was one of the bravest decisions we ever made, and we did it to preserve what little remained of our shattered selves, our strained relationships and our depleted bank accounts. No longer under the spell of the industry’s seductive powers, we study its marketing tactics with eagle eyes, and understand how, like McDonald’s, the fertility industry works to keep people coming back for more.

Where I Disagree

If parenting a biological child is important to a couple, or if they crave the experience of pregnancy or breastfeeding, why shouldn’t they seek treatment for their disease? There are downsides to most medical treatments, but we balance the risk and rewards and most often decide in favor of treatment. The key is knowing continued treatment is futile and it’s time to stop.

Who’s to Blame

Zoll and Tsigdinos’s blames the infertility industry’s seductive marketing tactics for making it hard for women to quit fertility treatment. Infertility clinics provide treatment for a disease, but they are also a business and as with most businesses, they market. But even with this “seductive” marketing,  from my perspective, not many women become “addicted” to fertility treatment. Most women try a reasonable number of cycles and then start considering other options. The Creating a Family Facebook Support Group is full of these women.

In my experience, the women who go back for IVF process after IVF process well past the recommended three to four cycles share certain characteristics–they are successful, competent, and fairly wealthy Type-A people who are usually able to conquer any obstacle with enough work and money.

I really like this type of woman. They are movers and shakers. They get things done. When they hit a wall, they look for ways around, over, or through regardless if the wall is a business challenge or infertility. Defeat is not an option. I don’t know Tsigdinos or Zoll personally, but I have to wonder if they fall into this category. They seem like women I’d like, so I’m guessing they are.

Is the infertility industry to blame for supporting their obsession? Well, maybe, but don’t they also share the blame? No doubt some infertility clinics and doctors gladly keep feeding the fire and make a pretty penny doing so, but I talk with plenty of infertility doctors who are frustrated by some women’s inability to stop treatment. They encourage counseling, they are happy to provide resources on other options such as adoption. In fact, they support nonprofits such as Creating a Family because they want to support all family building options.

Chances of Success

Unlike in many industries, success rates for infertility clinics are readily and publicly available for all to see. While these statistics aren’t perfect (we did a recent show on How to Interpret IVF Clinic Success Statistics) they exist for anyone to see. They are even broken down by age and type of treatment to help women assess their personal chances of success.

I don’t think it is lack of information that keeps the IVF junkies going. Infertility industry hype doesn’t help, but honestly, even without the marketing and the pictures of adorable babies and besotted parents, some women will keep trying because that’s who they are and how they approach life.

A Time to Pause

I agree with Tsigdinos and Zoll  that “[o]nce inside the surreal world of reproductive medicine, there is no obvious off-ramp.”  Creating a Family has long advocated for a time to pause in fertility treatment. This pause needs to happen, in my opinion, before pursuing in vitro round 5, 6, or 7. It also needs to happen before a patient moves to non-genetic parenting through donor egg or sperm. I’d love to see every clinic require a break at these times with counseling with a qualified therapist.

Now, it’s your turn–do you think infertility clinics are selling a fantasy?