When Did Normal Aging Become an Infertility Condition?

age-related infertility

Come again? Did I read that wrong? Hasn’t aging always been synonymous with losing fertility?
Menopause, anyone?

Seems odd to call out normal aging as though it’s a disease (infertility) or a condition that needs to be treated with procedures. In fact, the bigger question is why are women waiting until the age of menopause to try to have children? The belief (hubris even) that humans can outsmart mother nature is fostering a volatile environment with lots of money being exchanged — all for magical thinking.

To make a play on the adage “when you have a hammer everything looks like nail,” you could say the latest law of the instrument is that when you have a fertility clinic every biological function becomes the basis for a fertility treatment. Why don’t we just start harvesting ovarian tissue and egg cells when girl babies are born — you could get the youngest eggs on the shelf, no need to wait for those 20- or 30-something eggs.

It’s been a dizzying week of headlines and reporting in the reproductive world — and we’re still days away from the annual meeting of the American Society for Reproductive Medicine (ASRM) which is taking place in hallowed halls of …. Hawaii???

Talk about bad optics … not to mention the awkwardness of conversations in the exam rooms of the reproductive endocrinology units all across America.

Patient: Doctor, it appears I’ll be ovulating in mid-October.  Can we plan for the fertility treatment later this month?

Doctor: Um, ah, well, I know you’re not getting any younger, but we’ll need to push that procedure back on the schedule. I’ll be in Hawaii knocking back Mai Tais while I attend the session about re-engineering my practice for the (lucrative) fertility preservation market.

I kid you not. This ASRM conference has a session or two dedicated to going after what’s now seen as the latest growth market: women without any specific infertility condition — other than living and growing older with each day on the planet. It’s titled:

Fertility Preservation Patients: How to Re-engineer your Practice to Accommodate Them
Marybeth Gerrity, M.B.A.
University of Connecticut Health Center

ASRM.CoverThe conference brochure meeting cover (as you’ll see here) shows a silhouette of a woman surfing. Does that strike anyone else as off? A tad too whimsical for the vast majority of those shelling out thousands of dollars for invasive treatments that may end in miscarriage or loss of some kind?

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I can tell you that when I was fighting nausea coming out of my laparoscopy to address aggressive endometriosis I was not thinking, “yeah, I sure hope my endometrial surgery doesn’t conflict with my doctor surfing the waves of change in reproductive medicine.” Nor did I want my reproductive endocrinologist or embryologist lost in thought in my surgical follow up wondering how they were going to spend their time on the beach. Missing from the conference? Any sessions on how to manage the emotional trauma of failed treatments now well documented as part of the process for many who undergo IVF cycles.

There is a “medicalization” and with it a dehumanizing aspect of the industry that has been growing more troubling in recent years. No longer are people at the center of the equation. It’s now profits. Have we reached a point where hawking reproduction “services” is now taking a page out of time-share pitches or worse, stooped to botox cocktail parties or auto dealer tactics of “come kick the tire” and get some popcorn and snacks?

Predatory and exploitative

Apparently we have. Though to find the answer to the question:  Should You Freeze Your Eggs? journalist Robin Marantz Henig points out in this week’s Slate, “an egg freezing party is not a great place to find answers to this or other questions.”

What might have been a comprehensive, serious discussion about the realities of biological function, instead became an egg freezing event, hyping a technique held up by one enthusiastic reproductive endocrinologist on hand as being “part of technology that exists to help us all, just like the iPad, just like Skype.”

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A witness to the breezy, confident recitals and testimonials, Ms. Henig, wrote:

“Despite the positive vibe, egg freezing doesn’t necessarily stop the biological clock, not when the average age of egg freezing in the United States is 37.4. By that time, the eggs being frozen have already suffered a lot of the chromosomal breakage and genetic replication errors that make later childbearing iffy to begin with. Yet if the women at the cocktail party had their suspicions, they weren’t being addressed at the information session that followed. After all, EggBanxx had billed the event as an evening of “The Three F’s: Fun, Fertility, and Freezing”—no F’s left over for “Failure Rates.”

According to the UK’s Human Fertilisation and Embryology Authority (HFEA) only 20 babies have yet been born from frozen eggs to date in the United Kingdom — hardly enough to make it a safe investment in what’s billed via marketing materials as an insurance policy for a future family.

On the other end of the spectrum and across the pond, Professor Robert Winston, one of the doctors who pioneered IVF has a decidedly different take.  You can bet he was not on the list of ASRM potential keynotes in Hawaii after being on the record with warnings like “too much focus is placed on referring people for IVF rather than investigating the causes of infertility.”

World reknowned fertility expert Professor Robert Winston has said thousands of women are being exploited by doctors pedaling expensive IVF treatments.

Beyond thinking that clinics rush couples into IVF and charge too much, he is “kicking it old school” and launched a free advice service with Genesis Research Trust, a charity that funds research into women’s and babies’ health. He’s answering questions about fertility via the charity’s website in his spare time, “as he’s concerned people aren’t being given enough information.”

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Sharing medical information. What a novel idea. Rather than the ASRM offering sessions on how to grow fertility clinic practices they might be better served policing startups offering intros to fertility clinics and financing deals on a procedure that is still in its infancy. This latest startup created by women for women would be better served taking a page from Dr. Winston’s book. Or at a minimum they could share the fine print. As Ms. Henig noted, even the juggernaut ASRM when lifting its experimental label on egg freezing in 2013 “most emphatically did not recommend using the procedure in the way it’s currently being promoted”:

 Egg freezing ‘for the sole purpose of circumventing reproductive aging in healthy women’ could not yet be endorsed, the ASRM committee wrote, because there was still not enough known about the procedure’s ‘safety, efficacy, cost-effectiveness, and emotional risks’ to offer it as a way to stop the biological clock.

Seems the only thing being birthed these days is an enormous experiment. The next chapter in this story, I fear, will involve tremendous disappointment and likely litigation. Perhaps I should have titled this post: Fertility Procedures Spawns a Growth Market for Attorneys.

Mai Tai, anyone?

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17 thoughts on “When Did Normal Aging Become an Infertility Condition?

  1. The choice of the location for their meeting tells it all. I guess Hawaii is one of the most expensive locations to organize the event. But I am more then sure that Reproductive Medicine can easily afford it.

    Age related infertility? My mum entered menopause at 42 so I guess I will be entering it next year. That’s why this topic is interesting for me.

    I loved the quote:
    “as he’s concerned people aren’t being given enough information.” Exactly. Women worldwide aren’t given enough information.

    Thinking back, after each failed IVF my chosen doctor at the clinic had max 5 minutes available time to prescribe me another set of the drugs for the next IVF try.

    In my country, there are 6 IVFs covered by state health insurance company. But still, doctors are very interested in having lots of patients and lots of IVF treatments – because only this insures the growth of their departments and their budgets.

  2. hoping my comment will be posted this time (yay for mobile devices!).

    Yeah, my stomach is still turning about the fact the ASRM is putting so much focus on egg freezing and very little at understanding the causes of infertility. I firmly believe this is both politically motivated (environmental changes are linked with the rise in infertility) and the fact that egg freezing is a potential money maker.

    The thing is, there is still so much resistance to the truth that humans have a finite window to reproduce. In a society where women are told they can do anything, this is seen as “quitter” talk. But that doesn’t make it any less true. Nor is ignoring this knowledge helping anyone in the ALI community.

    We need to stop investing in the cheap tricks that ultimately don’t resolve this issue and start digging in to fund research that will. At the end of the day, despite it not being popular, the truth needs to come out.

  3. Hawaii…. My conferences for 2014 were in Philadelphia (in March) and will be in Indianapolis (in November). I would love go to Hawaii to drink some Mai Tais, go surfing, oh, and attend a few sessions too.

    Seriously though, I think that some of us in our community should write a proposal for ARSM’s conference next year. Something along the lines of “Managing the emotional fallout of failed fertility treatments: The consumer’s perspective.” I have the whole thing designed in my head (qualitative methodology, plan for triangulation, etc.). I doubt they would touch this proposal with a 10 foot pole, but it could be a really meaningful and needed study.

    1. Pamela Tsigdinos

      You are so on to something here, Kinsey! Would love to see your proposal pick up steam and get significant traction.
      Let’s get others on board.

      1. I might or might not have put a little too much thought into this. I read the call for proposals and proposal evaluation rubrics from the past two years and there doesn’t seem to be anything prohibiting non ASRM members from submitting proposals (the only restrictions seem to be that all proposals must be original research and must not be published or presented anywhere else). The only potential “ding” would be that this won’t be (and can’t be) a randomized controlled trial.

        Realistically we would be looking at submitting to the 2016 annual meeting as opposed to the 2015 meeting, because we would have to account for plenty of time to collect data and we would want our study to have sufficient rigor to have them take us seriously. We would need someone with a university affiliation, probably in a social science (e.g., psychology, sociology, or even women’s studies) who could get a proposal through IRB (this is one thing that the call for proposals was clear about). I couldn’t get it through my IRB because I can’t come remotely close to spinning this as applicable to my field. That being said, I would LOVE to actually make this study a reality! I’m thinking something along the lines of a large-scale survey, focus groups, and individual interviews. Regardless of the ASRM conference, I think a study of this nature is really needed.

        Ok, I’ll stop before I bore anyone with my nerd-ness. :)

        1. Kinsey, I love your idea of proposing a paper from the consumer’s perspective. If you need any help putting something together, let me know!

  4. Yeah, OF COURSE I surfed in Hawaii throughout my one surgery and ten failed fertility treatments……isn’t that what everyone does during their two week waits?

    I’ll take 3 Mai Tais please, (thanks for offering, Pamela!), I’ll need about that much to recover from looking at that picture.

    Oh, and will the workshop on re-engineering your practice to accommodate fertility preservation patients take place before or after the lectures on how to create a waiting room environment that does not re-traumatize patients, helpful resources to offer patients needing to stop treatment, and how NOT to sell false hope?

    Seriously, GREAT idea Kinsey. I’m totally on board. Feel free to contact me.

    1. Pamela Tsigdinos

      Mai Tais definitely on me if you and Kinsey are on the panel program organizing team.

      I continue to be astounded by how out of touch those in the industry are. HELLOOO – you’re tinkering with humans here. This is not the plastic surgery or toy industry, for Pete’s sake.

      It’s as if the ASRM (and members) are thumbing their nose at all the people who have had the misfortune to walk through their doors.

  5. bubli

    Kinsey, I would join you in running that study tomorrow. I keep thinking of what it would look like as well.

  6. Sigh.

    I read that this and the links and thought SIGH.

    As a marketer, I know businesses and industries are constantly looking for new angles – new ways to sell fear and greed. But it’s pretty amazing that they are trying to sell “aging” as a new medical condition.

    It’s disappointing to say the least.

  7. I read this several days ago, but have been waiting until I got back to my laptop to respond. Some posts deserve thought, and can’t be responded to on a mobile device!

    “Surfing the Waves of Change” – complete with illustration of a female surfing – is tacky in the extreme! These conferences are all about big business, not about medical (or psychological) advances that might benefit the consumer. No, they are – as you point out – purely and unashamedly focused on reproductive medicine as big business. Would they do this for cancer? For heart disease? I doubt it. Would they talk about beefing up the market for knee surgery and hip replacements? I can’t imagine it. This is so mercenary it makes my blood boil.

    Mind you, I do have to say that doctors have been selling ageing as a medical condition for a long time. Both in terms of general health issues (and I guess I can’t argue with that), and particularly with appearance medicine/cosmetic surgery. So reproductive medicine is now in on the game. Argh. And once again, vulnerable women are their targets.

    I’ve always found age issues around infertility and assisted reproduction to be disturbing. This is more than removing a few wrinkles – it’s bringing another life into the world. There’s always the question – “we might be able to do it, but should we?” That question is then so much more difficult to answer when profit is thrown into the mix.

  8. Did you see that Facebook is adding an employee benefit of egg freezing, up to $20,000? This is another way humans are trying to outsmart mother nature and companies are working to keep employees instead of having them leave to be mothers.

    http://www.nytimes.com/2014/10/15/upshot/egg-freezing-as-a-work-benefit-some-women-see-darker-message.html

    1. Pamela Tsigdinos

      I did indeed…among the most clear-headed perspectives I’ve seen comes from Miriam Zoll: What Apple and Facebook Don’t Know About Egg Freezing … who was also tapped to contribute to The New York Times Room for Debate discussion.

      Will share more in the coming days.

  9. […] purveyers of pain masquerading as helpers. Well said! As I first mentioned in an op-ed and blog post two years ago — and often since — objective, independent advice from health […]

  10. […] cows. We have explored thorny societal biases. We have elevated bioethics concerns. We have raised important questions about the safety and health implications of artificial reproductive technologies. We have built a […]

  11. […] more recent years, infertility clinics have turned their attention to otherwise healthy women. Using all forms of media, new reprotech providers are boldly advertising egg freezing services […]

  12. […] the years since, the reprotech industry — including RESOLVE and the American Society for Reproductive Medicine (ASRM) — have surreptitiously turned the biological clock, the natural aging of a […]

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