Universities should not offer the false hope of ‘fertility’ benefits

Talented young women and men in both the academic and business worlds share a common dilemma: their career development timeline overlaps with their most fertile reproductive years.

Like many, I tried for more than a decade to both advance my career and get pregnant. I understand, deeply, the primal call to bear a child. But when relying on IVF, I felt like little more than an exhausted lab rat doomed to run on a treadmill that never stopped.

At least my career in the tech sectors allowed me a little leeway in terms of the timing of my treatment; I learned from my academic friends that the time crunch is even more severe when you factor in the university and research world’s rigid, longstanding system of advancement and funding.

For instance, the average age for a scientist to get their first RO1 grant from the National Institutes of Health is 43 for non-medical applicants and just over 45 years old for medics. Ron Daniels, president of Johns Hopkins University, lamented this distressing trend in 2014, stating: “Young scientists are discouraged in securing grants due to aspects of the grant process that tend to favor systematically incumbent scientists over new entrants”, while universities and research laboratories “have deterred recruitment of young scientists into faculty entry positions, thereby impairing their capacity to compete for research funds”. Consequently, it is hard to establish a flourishing independent career until academics are well past their prime childbearing years.

More and more women, across employment sectors, are delaying childbirth, wooed by the belief that science will come to their aid. And employers are only encouraging the trend. Johns Hopkins, for instance – like Apple, Facebook and Netflix – now offers “fertility” benefits to its staff – as do Vanderbilt University, the University of Maryland and my alma mater, the University of Michigan. Among other things, such programmes typically offer subsidised egg freezing and fertility treatments.

On the surface, this sounds like progress. Yet, based on the experience of an older generation (my IVF generation), I worry about the costs and consequences of luring young academics into believing they can put off their families while they chase academic mile markers. Let’s revisit some history.

Serendipitously for the multibillion dollar reproductive medicine industry, the acknowledgment that women in academia and business were severely penalised career-wise during their most fertile years coincided with a widely promoted guideline change by the American Society of Reproductive Medicine practice committee. It removed the experimental label on egg freezing. This led to a tidal wave of new business formation around “fertility” benefits providers.

A successful and well-funded PR campaign by the very industry that stands to gain the most in selling more egg freezing and IVF cycles hastened a surprisingly swift adoption of “fertility” benefits by recognised institutions seemingly eager to boost their recruiting efforts in a tight labour market.

Less well publicised, the ASRM committee also offered this warning: “There are not yet sufficient data to recommend oocyte cryopreservation for the sole purpose of circumventing reproductive aging in healthy women because there are no data to support the safety, efficacy, ethics, emotional risks, and cost-effectiveness.”

The lack of evidence-based application and safety validation is usually a showstopper for any emerging elective medical procedure or pharmaceutical. But reproductive medicine, particularly in the US, has excelled at side-stepping these requirements by appealing directly to the marketplace often with misleading claims.

The field of egg freezing is still a developing one and no long-term studies of children born as result of it have been undertaken. Not all eggs will survive the freezing and thawing processes, and it’s worth pointing out that of the estimated 2.4 million assisted reproduction technology cycles attempted worldwide each year there are only around 500,000 live births. This equates to a 79.2 per cent failure rate. This is partly why most traditional health insurance companies, steeped in decades of cost analysis, have stuck with the long-held requirement that a treatment be considered “medically necessary”.

Furthermore, while other countries have varying degrees of regulatory oversight of reproductive medical procedures, there is no single federal agency in the US with that remit. The US relies on professional self-regulation and guidelines instead.

So, is it realistic to think women in academia can put off families to age 45, or anything even close to that? It bears listening to those who came away from IVF treatment without the promised baby who are now speaking out about the false hope sold.

Universities should not unwittingly (or, worse, wittingly) play into false hope. They should not be incentivising their female faculty and staff to put themselves through the hellish experience of IVF. They should instead focus on structural workplace changes and offer more help with childcare earlier in people’s careers. That is much the more humane and effective remedy, and it is the one that female staff would most value.

Pamela Mahoney Tsigdinos is a writer and author.