Fertility crisis: why IVF isn't working

Demographic and Market Context

• Women begin life with over one million ovarian follicles, dropping to a few hundred by their late 40s, a decline compounded by reduced egg quality that significantly lowers conception chances from the mid-30s.
• In the rich world, one in six couples currently struggles to conceive, driven largely by the trend of delaying family planning until later ages.
• The global assisted reproductive technology (ART) market is estimated at $20 billion and expanding, characterized by high margins, strong private equity interest, and lighter regulation compared to other medical sectors.

Current Limitations of IVF

• While IVF success rates have improved over the last 30 years, progress has largely stalled regarding age-related infertility, with 38-year-old women in Britain still facing less than a 20% success rate per embryo transfer.
• IVF was originally designed to address mechanical infertility (e.g., blocked fallopian tubes) rather than improve ovarian reserve or egg quality, leaving the biological clock unaddressed by the technology.

Trends and Statistics on Egg Freezing

• Egg freezing has seen a tenfold increase in cycles in Britain between 2009 and 2019, with a sharp rise in 2021 following a pandemic dip.
• In the US, growth is fueled by employer benefits and increased awareness, with costs ranging from $30,000 to $40,000 for two cycles and storage.
• Large-scale US data indicates that 70% of women who froze eggs before age 38 and subsequently thawed at least 20 eggs went on to have a baby.
• Survival rates for frozen-thawed eggs in reputable labs are approximately 90%.

Industry Concerns and Risks

• There is growing concern that new clinics may oversell success rates; quality variation is a critical factor as laboratory expertise is often opaque to consumers.
• Patients risk facing unexpected outcomes after a decade, particularly if they freeze eggs at unknown entities with unproven track records.
• The process remains physically taxing and emotionally difficult due to side effects from hormone injections, such as mood instability and sadness.

Future Innovations: In Vitro Gametogenesis (IVG)

• Japanese researcher Dr. Katsuhiko Hayashi successfully generated viable baby mice using eggs grown entirely in a lab from skin cells via IVG, a process taking ten years to perfect.
• IVG has also been used to create mice with two male parents by growing eggs from male stem cells.
• Venture capitalist Matt Chrysalof, co-founder of OpenAI, established the company Conception to translate this technology for humans, with a goal to produce proof-of-concept human eggs within one year.
• Proponents argue IVG could benefit women over 50, same-sex couples, and cancer survivors who have lost fertility due to chemotherapy.

Safety and Ethical Hurdles for IVG

• Current lab-grown eggs have demonstrated very low success rates in producing viable offspring.
• Safety concerns persist regarding genetic stability, as the protracted period of out-of-body manipulation may cause minute changes not found in natural conception.
• Even without immediate clinical application, IVG offers significant value for basic reproductive research by providing a renewable stock of eggs for study.

Long-Term Research on Biological Aging

• Dr. Hayashi is investigating the protein cohesin, theorizing that its degradation contributes to egg aging.
• Theoretical future applications include a "fertility freeze" pill that halts the biological clock, allowing women to retain the quality of their 20s-era eggs for use later in life.
• These anti-aging interventions remain distant from clinical reality.