Tuesday, February 28, 2006

An Economist Looks at the Fertility Industry

Debora Spar, a professor of business administration and an associate dean at the Harvard business school, has recently published Baby Business: How Money, Science and Politics Drive the Commerce of Conception. She is interested in trends in economies and rules of exchange that come in the wake of new technologies, like satellite television, the Internet, and now, IVF. At first, she says, “people get all excited, where there are no rules, and which creates new markets. Over time, these technologies become regulated because people want and need rules.” And the infertility business is interesting to her because in the US is a 3-billion-dollar-a-year sector. According to the author, in this interview anyway, there is nothing more to this business but supply and demand: 15% of the population is infertile, and this represents a high constant demand, and the price of ova, especially those of Harvard grads, has remained high because there is short supply. The average cost of a baby is well over $50,000.

More messy questions include that of whether the therapies ought to be considered enhancements because most infertility is not a disease of the woman who undergoes the treatment. For example, a couple’s infertility may be attributed to male factor infertility, in a heterosexual couple; and, a single woman or a woman in a same sex partnership desiring to be pregnant requires assisted reproduction, IVF being the most common, in order to conceive . Thus a woman who undergoes IVF treatment may herself be reproductively healthy. One could also hold the view that most female infertility may be a social construct; a position that gains support in light of the billion dollar IVF industry in the US, that most women in heterosexual infertile couples would be willing to adopt a child, and the message that having a biological child is considered necessary in order for a woman to realize her "true" potential as a woman.

In the end, even if one considers women’s infertility a disease of the woman who undergoes the treatment, therapy for IVF is time consuming, invasive, and potentially harmful, costly, and most likely is will not be successful. Maybe economists haven't been looking at what supports the billion dollar infertility industry and IVF, but ethicists have.


Anonymous said...

"that most women in heterosexual infertile couples would be willing to adopt a child"...

Curiosity--could you cite your source for this statement?

Eleanor Milligan said...

This article reminds me of a recent case in Queensland, Australia,(reported 05 June 2005, The Courier Mail) where a couple , already parents to 5 children under 3 (incl. one set of quads through IVF & Anon donor sperm, 13 weeks premature) , accessed more fertility treatment through a private IVF clinic and became pregnant with a second set of Quads within 6 months of the first set being born. Apart from the logistical issues of coping with potentially 9 children under 4y.o., and the physical impact on the mother of producing 8 babies in 18 months, this case raises other economic issues. In Queensland, there is a public health system to support members of the public who have no health insurance. Both sets of quads were conceived through a private IVF clinic (QFG), where the parents paid for access to this technology. This family then presented to a public hospital (free) for antenatal care for this extremely high risk pregnancy and subsequent care of the 4 babies who were 13 weeks premature that required lengthy specialist intensive care, a cost borne by the public system. To do this once could be considered an unintended outcome of a very 'successful' IVF cycle, but to do it twice is gross irresponsibility on the behalf of the IVF doctors who assisted this couple. The public health system would not sanction such use of IVF technology, but living as we do, under the consumer driven business model of medical service delivery, i find it absurd that this couples demands were not tempered by common sense or good obstetrics practice in the private system. Apparently if you can pay you can buy whatever you want regardless of the ongoing consequence or burden that you create (and have no intention or capacity to pay for). The second set of quads would have been born by now but the couple and their doctors media have been very quiet on this- given the furore that erupted when the second pregnancy was announced -