The real causes of infertility

There are now hundreds of women undergoing IVF treatment that is exclusively age-related

Another week, another breakthrough in IVF, as Professor Alan Handyside, the embryology pioneer and one-time colleague of Lord Winston, presented a paper on a new pre-implantation embryo screening technique. The procedure detects embryos unlikely to be viable. A particular risk, we are reminded, for embryos created with the eggs of women in their late thirties and early forties.

This development comes in the context of a steep rise in age-related IVF. The latest study by the Human Fertilisation and Embryology Authority showed a tenfold increase in fertility treatment for women aged 40 or more over the past 15 years. These women may be in the minority (the average age of IVF patients is 35, up from 34 in 2001) but they represent a growing trend.

They are also symptomatic of a society where a woman's biology is increasingly seen as a problem in need of a solution. Vast amounts of time and money are ploughed into advances in the infertility industry when the real problem is our failure to accommodate women as they are. If it were convenient for women to have their children at a younger age, we would not have had this tenfold increase in IVF among the over-forties.

I do not deny the value of fertility treatment. When IVF is used in cases where there is a medical cause of infertility and no other chance of conceiving, it is a godsend. It provides an opportunity for roughly 30,000 women a year and is successful for about a third of them. Nor do I intend to criticise older mothers: they just want a baby. It is simply about acknowledging that, depressingly, we live in a culture hostile to the female body, where growing numbers of women regard it as impossible to have a child at the peak of their fertility.

There are now hundreds of women undergoing IVF treatment that is exclusively age-related. This is coyly referred to as "infertility with no underlying reason". Simultaneously, huge resources are being poured into the new holy grail that allows conception up to the age of 50 and beyond: egg and embryo freezing. This is an on-demand, pre-planned IVF that claims to free women from their biology completely.

With every development comes a gradual acceptance of the idea that fertility is something to be defeated and controlled. The myth has grown up that the timing is every woman's choice to make - for professional, social or personal reasons. Worse, this has been sold falsely as a liberating option. Why not choose exactly when to have a baby? Sort out your career first, then take advantage of science and have your baby later on, if you like. It sounds empowering, but in fact it is witheringly limiting, because it paints the biological clock - and, by extension, women and their bodies - as an inconvenience.

Meanwhile the price women pay for IVF, both psychologically and physically, is rarely discussed. The odds are brutal for those past their late thirties. After 40, the success rate is 12 per cent, which plummets to 3 per cent at the age of 44. And, as with all medical interventions, there can be unforeseen side-effects. You may well be prepared to run such a risk if you have an underlying medical cause. But isn't there something uncomfortable about the normalisation of invasive medical procedures performed on women who might have conceived naturally and easily if they had had the chance when they were younger?

And so to the million-dollar question. Why didn't they? Contrary to myth, no one consciously "delays" having a child. There are deeper social mechanisms at work. First, the business of children is still the responsibility of women. Second, for some women, it is not so much about a career as about finding a suitable partner. It does not help that the average age for marriage has crept up by five years since the 1960s. By the time many women meet the man they want to father their child, they may well be in their late thirties or older - another social trend working at odds with the biological clock.

The more widespread age-related IVF becomes, the more obviously it betrays a social background that is anti-women. If you want to look for the real "underlying reason" for the rise in infertility treatment, there it is.

Wouldn't it make more sense to change social attitudes, especially in the world of work? Or shall we just continue down this route of solving the "problem" of women's supposedly inconvenient biology?

This article first appeared in the 09 July 2007 issue of the New Statesman, The new terror