News reports say the television advertisement “sparked an uproar.” It chronicles a couple failing to conceive before getting a bank loan for IVF. The ad has been called “disgusting” and “exploitive of people in a desperate situation,” and apparently led to complaints to New Zealand’s Advertising Standards Authority. I have one major gripe with the ad. Otherwise, I love it.
The ad is beautiful, moving and in important ways quite accurate. In 60 seconds, it conveys the sharp sadness of infertility, the helplessness, the late-night, Web-surfing loneliness. Much of this emotional pain is caused by the condition itself. Infertility is not a trivial problem – wanting to have a baby, but being unable to conceive isn’t like wanting a Maserati but not being able to afford it or wanting but failing to drop ten pounds, before Christmas. It is the inability of one or two bodies to perform basic biological functions, functions that are both highly socially valued and, for some people, essential to a good life.
While not everyone wants to procreate (and I think it is great that voluntary childlessness is becoming a socially acceptable choice), children lend profound meaning to the lives of many people. Those who want to have children, but cannot, may try for years, never once getting pregnant. Or they may succeed only to miscarry, sometimes over and over, sometimes late in the pregnancy. The ad successfully portrays this long, painful struggle, whose psychological toll resembles that of other major medical conditions in its first 15 seconds of blue and grey tinted film.
Then it draws attention to another part of the infertility struggle: difficulty paying for treatments. Although New Zealand has universal health care, with two rounds of IVF publicly funded for women meeting eligibility criteria, waiting lists can be 12 to 18 months long (precious months if you’re in your mid to late 30s). About 40% of IVF treatments in New Zealand are privately funded, costing just under NZ$10,000 ($7,600) per cycle. In the U.S., where a cycle costs around $12,000, many health insurance plans exclude IVF altogether, so it is in large part an out-of-pocket affair.
It isn’t easy for ordinary people in New Zealand or the U.S. to come up with this kind of money – and, yes, ordinary people in both countries suffer from infertility and seek access to IVF. But having a child is important enough for them to raid their savings or borrow from family or take out loans from banks (the same goes for people seeking adoptions). I am sick and tired of seeing fertility medicine, particularly IVF, portrayed as a luxury good consumed primarily by the rich and famous (a low point: the New York Times Magazinecover story about a bazillionaire who hires a surrogate). So I was gratified to find a sympathetic portrayal, albeit in an advertisement, of a couple struggling to find the money for IVF.
Finally, the bank rescues them with the cash. At this point, the narrative reverts to an advertisement. This is, after all, an ad for a bank, not a public service announcement. Still, I don’t think the sales pitch should make us loathe the message – we can hate the fact that people have to pay out of pocket for IVF or that such a large proportion of fertility medicine is a for-profit enterprise – but those are different problems from the one addressed. Namely, sometimes people need financial assistance to have children and some banks are actually willing to lend money for that purpose.
The real trouble with the ad comes at the end. The treatment succeeds, which is satisfying and actually pretty realistic. While average success rates hover around 30 percent per IVF cycle, one study found the cumulative live-birth rates after six cycles to be 72 percent (and higher for women under 35). This means that many people who don’t succeed on their first try do get pregnant eventually. The problem is, this couple ends up having triplets.
Fertility specialists have agreed for a while now that triplets are not a good outcome for IVF. Rates of pregnancy complications, miscarriage, pre-term delivery, infant death, and lifelong neurological and other impairments are markedly higher for triplets than for singleton births. “Compared with singleton births, perinatal mortality rates are at least four-fold higher for twins and at least six-fold higher for triplets,” said the authors of a review article published in the Lancet. “Moreover, in twin and higher order multiple births, the risks of prematurity are enhanced 7–40 fold and of low birthweight 10–75 fold. Prevalence of child disabilities can be 50% higher in twins and 100% in triplets.” Studies also report higher rates of stress and depression among mothers of multiples, as well as marital tension and economic hardship following the birth.
These data are sinking in. Fertility clinics have changed their practices to reduce the number of triplets and higher. The Centers for Disease Control and Prevention reports that U.S. providers now transfer an average of two embryos at a time, and that triplets make up fewer than 2 percent of live births following IVF (twin births, however, remain high). Octomom aside, it is very unlikely that women and couples undergoing IVF today will end up with triplets (or more). But if they do, it is even less likely that that they’ll leave the hospital with three plump and healthy babies in their arms.
I know the ad is an ad and that it’s selling a dream. But if you’re an infertile couple, an IVF cycle that works and gives you one healthy baby is a dream realized. It’s also the safest outcome for everyone. So I wish the ad had ended that way – with a happy family of three, not five, leaving the hospital, nervously buckling their brand new baby into the car seat before driving home to their blue and gray tinted house, and their nice little $10,000 bank loan.
Josephine Johnston is a research scholar at The Hastings Center.