Australasian Science Magazine

By Michael Cook

Talk of IVF as a solution for declining birth rates is a sign that governments are clutching at straws.

With nations around the world failing to reproduce themselves, policy wonks now realise that too few children could be worse than too many. Without children, populations age rapidly; there are too few workers paying taxes to support the disabled and the elderly; an economic and social crisis looms.

A stable population requires a birth rate of 2.1. Many countries in Asia, Europe and Latin America have sunk far below this.

Conventional strategies for boosting the number of births include baby bonuses, family benefits, extended maternity and paternity leave, and more flexible working schedules for mothers. But even these fail to make much impact.

What else can be done?

The brain waves of desperate bureaucrats range from barmy to loopy. In 2012 Singapore (with a birth rate of only 0.78) declared that 9 August would be a national night of pro­creation. A syrupy rapper sang on a YouTube video: “I’m a patriotic husband, you’re my patriotic wife, let’s do our civic duty and manufacture life.” In Japan, local governments subsidise speed dating to help time-poor office workers find spouses.

Alas none of these gimmicks works, so it’s hardly surprising that countries with extinction on the horizon also consider subsidising IVF. Demographers say that no country’s birth rate has ever recovered after dropping below 1.5. Singapore’s is about 0.8; Taiwan’s is 1.1; South Korea’s is 1.2.

At stake is the very survival of a number of small countries with distinctive cultures. Do more IVF clinics make sense?

While helping childless couples have children seems like a obvious solution, there is precious little research to support the idea that free IVF will boost birth rates. One of the few studies was published in 2006 by the Rand Europe think-tank. Its conclusions were rather pessimistic.

When IVF is heavily subsidised, the Rand analysis showed that it boosts the birth rate slightly. When it is not, the availability of IVF actually depresses the fertility rate.

What happens is this. Many women in their fertile years balance the cost of having a child against the extra income they could earn at work, and defer having their children. In the back of their minds, IVF is their fertility safety net.

The years tick on, and in their mid-30s the alarm on their biological clock goes off. They begin trying for a child, but many of these older women fail. If IVF is heavily subsidised, many of them will clutch at their safety net. Some lucky ones will have children, giving a small fillip to the birth rate.

But if IVF is not subsidised, women discover to their dismay that it’s horrendously expensive. They cannot afford it and they have to give up their dream of having children.

So the availability of IVF is a will ‘o the wisp, a flickering beacon of hope enticing women to invest so heavily in their careers that they are unprepared for the inexorable fading of their precious fertility.

The report cast even more cold water on IVF as a way of rejuvenating dying countries. The health of babies born to older women and from IVF is poorer than children born to younger mothers and through natural conception. Older women have more Down syndrome children. There are far more multiple births for women with IVF treatment, which is associated with poor child health.

IVF is also associated with low birth weight and prematurity and a higher risk of birth defects. “These health effects and other unintended consequences should be taken into account when assessing the impact of [assisted reproductive technology] as part of a population policy mix,” the report said.

Talk of IVF as a solution for declining birth rates is a sign that clueless governments are clutching at straws. Low fertility is a complex issue with social, economic, medical and environmental factors. IVF is just a band-aid.

Ultimately a low fertility rate is the sign of a cultural crisis – having children is simply not a fulfilling life project. Perhaps the solution is more ethical than medical. Only when couples think that babies are their best investment will birth rates begin to climb back to replacement levels and beyond.

Michael Cook is editor of BioEdge, an online bioethics newsletter.