6. Treatments Costs a Fortune. Be Prepared to Confront Your Privilege. One average I.V.F. cycle in the United States costs between $12K and $15K; a donor-egg cycle, $30K; and surrogacy anywhere from $75K to $150K. Around the globe, the greatest cause of infertility is untreated sexually transmitted diseases; these hit poor women the hardest. Needless to say, fertility treatments are largely unavailable to them.

Only 15 U.S. states offer insurance policies that cover fertility procedures, compared to Britain, Israel and many countries in Europe that subsidize some citizens’ fertility treatments. In Sweden, France and Italy, single women, and lesbians and gay men, are often barred from accessing them at all.

7. Fertility Clinics Are Big Business. Most clinic staff wear two incompatible hats: a medical one and a business one, so this means their advice might include steering you towards trying new technologies and drugs. Our reproductive endocrinologist told us honestly that our chances of I.V.F. success were low, but he also said, “It only takes one good egg to make a baby.” Michael and I were awash in yearning and denial; the doctor knew that. “New techniques and protocols are constantly being developed,” he said. “You just never know what can happen.”

The world’s first fertility company, Virtus Health, went public this year to the tune of almost half a billion dollars. Its CEO is quelling investors’ fears that improvements in A.R.T. might mean fewer cycles for clients. Uh-oh — dwindling revenues.

8. Fertility Clinics Are a “Wild West.” There is only one piece of U.S. federal legislation, loosely enforced, that requires clinics to self-report their annual success rates: the 1992 Fertility Clinic Success Rate and Certification Act. Apart from this, the industry operates below the public radar.

Activities that are stunningly unregulated include: implanting multiple embryos that may increase rates of success but also endanger women’s and infants’ health; engineering and selling anonymous embryos in the marketplace; prescribing off-label drugs that have not been approved by the F.D.A. for fertility use; marketing donor embryos or donor egg treatments to post-menopausal women; and offering expensive procedures––such as egg freezing — that have no proven track record in efficacy or safety.

The hype around egg freezing is a good example of the clinics going rogue. This newest technology is being marketed as though it’s as revolutionary and reliable as the Pill. I know older women who view it as a kind of magical insurance policy that will ensure their chances to birth babies safely when they are older. But there is virtually no long-term, evidence-based research to back up these claims.

9. Your Treatment Options May Exploit Poor Women. Patients wrestling with the pain of infertility and considering options like surrogacy and egg donation need to understand and connect the dots between their treatment choices and these women’s lives. Take a look at the recent documentaries Made in India and Show Me the Baby Bump, Please. Many surrogates, in India and elsewhere, are illiterate, extremely poor, and often not informed about what they’ve consented to. They can be separated from their children for up to a year, relegated to “surrogacy dormitories,” and, if their pregnancy fails, compensation and follow-up health care may be withheld. As health consumers, patients can plan an important role promoting greater health and human rights protections for all parties involved in reproductive technology treatments.

Commercial surrogacy and egg vending are booming businesses. As someone who has studied the link between poverty and gender, I would much rather see women and girls acquire economic security through better access to educational, constitutional human rights protections, and sustainable employment opportunities, not by a singular focus on their gonads and wombs.

10. You Will Dislike Yourself. Entering the world of A.R.T. will challenge you to reassess much of what you thought you knew about yourself. Long-held beliefs about right and wrong begin to flake off your psyche like old paint on a windblown house. Moral dilemmas about eugenics and cloning invade your dreams.

For me, deciding to use donor eggs was much more difficult than choosing I.V.F. I was averse to how unnatural it was, and I felt deep shame for my conspicuous conception, paying another woman to risk her health and possibly deplete her own egg reserves on my behalf. How and why do these young women decide to sell their eggs to someone like me? How does a donor agency determine that one woman’s eggs are worth $8,000, but another’s only $5,000? Blonde, svelte donors seem to get paid more than brunette, overweight ones. And Caucasian, Asian, and African-American eggs carry very different price tags. Ivy League egg donors with high S.A.T. scores and 36-24-26 body measurements have been paid as much as $100,000 for their eggs.

While searching for a donor, Michael and I were aghast at how judgmental we became. This one’s eyes are too close together. I don’t like her teeth. She looks bi-polar. She looks uneducated.

Like any protective parent, you want to be discriminating when choosing the genetic code and physical traits of someone whose egg will form half the D.N.A. structure of your potential offspring; that’s understandable. Still, it did not sit well. And even though we are now the proud and grateful parents of the most delicious little four-year-old ever, our A.R.T. ordeal may have scarred us for life.

 —-

What’s redemptive for me now is my mission to reveal the hidden side of treatments, and to caution women intent on birthing babies to avoid making the same irrevocable decisions so many educated, middle-class women in Gen-I.V.F. made when we delayed childbearing. Since infertility often correlates with higher educational levels, Jewish women are the group that has been hardest hit. If you’re reading this, you doubtless know some of us. You may be one of us.

There’s a global epidemic of misinformation about the age when women’s fertility naturally declines and about the power of modern medicine to reverse this. If you have experienced treatments, or know someone who has, I invite you to cast off your silence and contribute to expanding an open and honest consumer-driven discussion about these life-altering technologies. 

Miriam Zoll is an award-winning writer and author of Cracked Open: Liberty, Fertility and the Pursuit of High-Tech Babies, founding co-producer of the Ms. Foundation for Women’s original “Take Our Daughters To Work Day,” and a board  member of Our Bodies Ourselves and Voice Male Magazine.

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