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Waking Up From the Pill

Many women try IVF four or five times, hoping for a successful cycle; even when it is unlikely, getting pregnant becomes an obsession. Insurance companies rarely cover the costs, which run up to about $15,000 per cycle including medication—a shortsighted policy, as they are on the hook for covering any preterm costs for multiple births, which are much more likely when financially struggling patients transfer three or more embryos in hopes of finally achieving success. Patients also need to factor in possible costs for donor eggs, surrogates, or adoption, which usually runs into the tens of thousands. Adoption is also a more difficult prospect now than it has ever been in American history, with far fewer infants available to adopt these days, since China, Vietnam, and Guatemala are effectively closing their borders (like Angie and Brad, many parents are turning to Ethiopia).

All of these decisions involve heartbreak and stress, and it’s easier to pretend that the clock isn’t ticking. “I’ve got 44-year-olds who show up in my office after trying two months and say, ‘I don’t understand, my gynecologist told me I was fine,’ ” says Grifo. “Now, he didn’t say, ‘You’re going to be fertile forever.’ But they didn’t hear that part—they heard the part where he said they’re healthy. And for these women, if IVF doesn’t work, it’s very hard to recover. They have to grieve and mourn and make a life. These women, the 44-year-olds, are the ones that struggle the most, because they are so angry. And they’re angry at one person, but they won’t admit it. They’re angry at themselves.”

Sexual freedom is a fantastic thing, worth paying a lot for. But it’s not anti-feminist to want to be clearer about exactly what is being paid. Anger, regret, repeated miscarriages, the financial strain of assisted reproductive technologies, and the inevitable damage to careers and relationships in one’s thirties and forties that all this involve deserve to be weighed and discussed. The next stage in feminism, in fact, may be to come to terms, without guilt trips or defensiveness, with issues like this.

Choice is a more accurate word when the chooser—us—is aware of all the possible consequences of taking different possible paths. But reality has a hard time getting into these areas, let alone the Brave New World of infertility medicine. Women have certainly come a long way—and this, a sense of reality about these most fundamental of issues, may be the next stage. “The fear of reproductive-rights groups is that if you regulate or say no to procedures like reducing a twin to a singleton after IVF, or whether extra embryos should be thawed, it will chip away at the fundamental concept of choice when it comes to abortion,” says Liza Mundy, the author. “These groups might want to say no to some of these, like sex selection of embryos, because that might privilege boy babies or girl babies. But if they say no to sex selection, does that mean they’re not pro-choice?” She sighs. “The easiest thing for them to do is not engage with any of this.”

The Pill may seem to promise eternal youth, but doctors have only middling odds of recapturing fertility when a woman has crossed into early middle age. There’s an easy answer to this conundrum, even though it’s a little weird: freezing eggs in one’s twenties. The technology has come a long way in the past five years, and women with frozen eggs now have a very good shot at successfully thawing and implanting them later in life. In 2009, NYU had a baby born from a woman who froze her eggs at 38, and it’s now posting the same rates of success with frozen eggs as it does with embryos frozen during IVF.

That may be the world to which many are heading—even more medicalized and technologized, where all women freeze their eggs and submit to assisted reproductive technologies, and with it, more complicated choices and questions that bioethecists love to hash over. Even Carl Djerassi, one of the inventors of the Pill (before he became a Stanford professor, playwright, and sci-fi novelist), has suggested that all forms of birth control will eventually become obsolete and the Pill “will end up in a museum.” In his imaginings, girls and boys will deposit their eggs and sperm in a reproductive bank to be frozen at 20 or so and then get sterilized. They’ll want to do this because genetic diagnoses of embryos will become increasingly sophisticated, and no one will want to risk having a child with birth defects, let alone a child of an unpreferred gender or one predisposed to a hairy back. When these people want to have children, either one or six, at 30 or 60 years old, they’ll make a withdrawal from the bank.

But that’s a long-term vision, a place that few of us will ever see—even if we want to. In the shorter term, Djerassi once wrote, “many a woman in our affluent society may conclude that the determination of when and whether she is ovulating should be a routine matter of personal information to which she is entitled as a matter of course.”

Now he tells us.