July marked the 33rd birthday of the world's first 'test-tube' baby: Louise Joy Brown arrived on July 25, 1978. Since then, four million babies have been born thanks to IVF. Many more have not. The treatment does not guarantee pregnancy and the side effects remain severe.
Yet there is a brutal dishonesty in IVF today. It's considered almost routine. Because women - and men — don't talk frankly about their fertility struggles, we continue to get a skewed message about the ease and success of treatment. Presuming we can have a baby whenever we're ready, with the help of scientific technology - if needed, we wait.
The mean age of women walking through the doors of the Colorado Centre for Reproductive Medicine, one of the world's premiere IVF clinics, has gone up in the last two decades from 32 to 39. I was 39 when I walked in 2.5 years ago.
Ever since, I've been through the wringer: eight times under general anaesthesia plus countless injections, pills, capsules, ultrasounds and blood tests. IVF brings you to your knees and dares you to stagger to your feet again. It forces you, even as you steel yourself for more shots and setbacks, to remember the gentleness in you and the reasons you want to bring another human into this world.
TURN SOFT AND LOVELY ANY TIME YOU HAVE THE CHANCE is my favourite Jenny Holzer slogan. It's hard to do that when you're preparing for yet another disappointment. I have a small, glossy black-and-white ultrasound photo - like the ones couples are given after they see their fetus for the first time - but taken during one of my IVF cycles. There's an empty space with seven small black circles scattered about - my pre-people - follicles with eggs that never became babies.
The chance of a woman my age having a baby through IVF is six to 10 percent. (Overall, success rates sit at 30 percent, a two percent improvement on when the technology started.) Sadly, the more times IVF fails, the more likely it is to fail. So my chances are even lower now. The Great Delay takes an unbearably high toll. I am 42 today, still undergoing treatment, and without a baby. Here's what I've learned the hard way:
This is a numbers game
If you're a woman, get an FSH (Follicle-Stimulating Hormone) and AMH (Anti-Mullerian Hormone) blood test. These can reveal 'diminished ovarian reserve', which can happen at any age and seriously affect your plans. Ask your mother and grandmother about their reproductive history. Don't wait until your mid- to late-thirties to do this.
If you're a man, get your sperm tested: one third of infertility is male-related, one third female-related, and one third both or unexplained. Over the last half-century, sperm counts have sharply decreased. Recent studies have connected advanced paternal age with - among others - Marfan and Apert syndromes, and autism.
Money matters too
Know the real numbers: in America, one IVF cycle can cost approximately $20,000 (some $14,500 for treatment and $4,500 for drugs), much of it uncovered by insurance. US senator Kirsten Gillibrand's Family Act - which would give a credit of 50 percent of infertility expenses, up to $13,360 a year - needs support.
Consider Egg Donation
There's a lot of talk about sperm donors, but egg donation is the business that's about to boom - though it's still a taboo subject. At the last count (2009) one in ten IVF cycles in America used donor eggs. Older women, particularly, are choosing this option. You haven't heard about it yet because no one's talking.
If you decide to delay, do it right. Just five years ago, you could freeze sperm, and embryos, but not eggs alone. It failed 90 percent of the time. Now it succeeds 80 percent of the time. This is the greatest recent reproductive development and the opening bell for the era of egg banking for women.
This is still a frontier science
Know that IVF doesn't always work. A healthy woman's chance of getting pregnant naturally is 20 - 25 percent if she's in her twenties, 10 - 15 percent in her thirties and five percent in her forties. IVF gives you better chances, thanks to game-changing new techniques like PGD of embryos. But there are no guarantees.
The World Health Organisation terms infertility as 'a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse'. (That number's closer to three months if you're over 40). And infertility feels like a disease. In 1993, Harvard Medical School published a study showing that patients diagnosed with infertility feel the same stress as patients diagnosed with cancer. I happened upon this Facebook post last week: 'I have one, and only one, friend who really 'got' what I went through with advanced cancer. She was a friend whose repeated attempts at IVF had failed'.
Still, IVF can be a miracle-maker when everything from endometriosis (women) to phimosis (men) affects childbearing. And in coming decades science will surely advance exponentially. PGD is a promising new technology that is spreading across the world - its use was approved by the German parliament last month: it can help determine which embryos are viable before they are transferred to the patient.
For doctors, PGD helps with embryo selection and reduces the rate of failure and of multiple births. For many patients, this earlier knowledge about embryo viability - or its opposite - makes infertility treatment vastly less psychologically taxing. For many other patients, of course, it is possible that infertility and its agonies could be averted altogether by changing our policies and perspectives.
Male and female age remains a prime major factor in this disease. So to really honour the first 'test-tube' baby's birthday let's urge young people to learn from her example: Louise Brown had her son Cameron, naturally, when she was 28.