Since the landmark discoveries of in vitro fertilization (IVF) in 1978 and its main
variant intra cytoplasmic sperm injection (ICSI) in 1992–jointly called ‘IVF’ unless
mentioned separately – the use of IVF has grown tremendously in high-income countries;
in this study we mainly focus on Europe. Between 1997 and 2011 almost 900,000 IVF-infants
were born in Europe and this number must have surpassed over 1,4 million by now [
[1]
]. Worldwide over 5 million IVF babies were born by the end of 2013, mostly in high-income
countries [
[2]
]. IVF is by far the most used medically assisted reproduction (MAR) technique, which
also includes intra-uterine insemination (IUI) and ovulation induction (OI). The enormous
increase of IVF suggests that there might be something wrong with the biological fertility
of humans e.g. the ability of couples to have naturally-conceived children. Indeed,
the declining number of children born and the spectacular growth of IVF, especially
of ICSI, have been interpreted as evidence of an infertility epidemic due to deteriorating
male reproductive health [
3
,
ESF Science Policy Briefing 40; 2010. Male Reproductive Health—its impacts in relation to general wellbeing and low European fertility rates. http://archives.esf.org/fileadmin/Public_documents/Publications/SPB40_MaleReproductiveHealth.pdf (accessed 7 April 2017)
4
]. In the first section, we will explore whether human fertility has been declining.
We were surprised to find out this was not the case and concluded that the existence
of an “infertility epidemic” is not supported by the available data. In the second
section, we try to understand why, nonetheless, the use of IVF has grown rapidly in
the last two decades. In the third section, we argue that this trend has serious drawbacks
because of the risks for the health of women and children. In the last part we make
some concluding reflections. Our aim is to stimulate critical discussion about rising
IVF use and its justification [
[1]
].To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Obstetrics and Gynecology and Reproductive BiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Assisted reproductive technology in Europe 2011: results generated from European registers by ESHRE.Hum Reprod. 2016; 31: 233-248
- Are we overusing ivf?.Brit Med J. 2014; 348: g252https://doi.org/10.1136/bmj.g252
ESF Science Policy Briefing 40; 2010. Male Reproductive Health—its impacts in relation to general wellbeing and low European fertility rates. http://archives.esf.org/fileadmin/Public_documents/Publications/SPB40_MaleReproductiveHealth.pdf (accessed 7 April 2017)
- Decline in semen concentration and morphology in a sample of 26 609 men close to the general population between 1989 and 2005 in France.Hum Reprod. 2013; 28: 462-470
- Time to pregnancy: a measure of reproductive function in either sex. Asclepios Project.Occup Environ Med. 1997; 54: 289-295
- Time trends in biological fertility in Britain.Lancet. 2000; 355: 1961-1965
- Time trends in human fecundability in Sweden.Epidemiology. 2008; 19: 191-196
A Chandra, CE Copen, EH Stephen, Infertility and impaired fecundity in the USA 1982–2008. Data from the National Survey of Family Growth. National Health Statistics Reports Number 67, August 2013.
- Time trends in waiting time to pregnancy among Danish twins.Hum Reprod. 2005; 20: 955-964
- The epidemiology of infertility in the North East of Scotland.Hum Reprod. 2009; 24: 3096-3107
- National, regional and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys.PLoS Med. 2012; 9: e1001356
- Lifetime prevalence of infertility and infertility treatment in the UK: results from a population-based survey of reproduction.Hum Reprod. 2008; 23: 447-450
- Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends.The Lancet. 2016; 388: 258-267
- The variability of female reproductive ageing.Hum Reprod Update. 2002; 8: 141-154
- The quiet revolution that transformed women's employment, education, and family.Am Econ Rev. 2006; 96: 1-21
- The debate over low fertility in the popular press: a cross-national comparison, 1998–1999.Popul Res Policy Rev. 2002; 21: 535-574
- Why do people postpone parenthood? Reasons and social policy incentives.Hum Reprod Update. 2011; 17: 848-860
- European Fertility Datasheet 2015.Vienna Institute of Demography/Wittgenstein Centre for Demography and Global Human Capital, 2015www.fertilitydatasheet.org
- The effect of postponement of first motherhood on permanent involuntarily childlessness in six European countries since the 1970.Hum Reprod. 2012; 27: 1179-1183
- Realizing a desired family size: when should couples start.Hum Reprod. 2015; 30: 2215-2221
- The role of biological fertility in predicting family size.Hum Reprod. 2009; 24: 1999-2006
- A persistent misperception: assisted reproductive technology can reverse the aged biological clock.Fertil Steril. 2012; 97: 1044-1047
- Demographic age shift toward later conception results in an increased age in the subfertile population and an increased demand for medical care.Fertil Steril. 2010; 95: 61-63
- Towards less confusing terminology: a proposal.Hum Reprod. 2004; 19: 1497-1502
- The epidemiology of infertility. Report of WHO Scientific Group on the Epidemiology of Infertility. Technical Reports Series No. 582.World Health Organization, Geneva1975
- Reproductive health indicators for global monitoring: Report of the second interagency meeting, 2001.World Health Organization, Geneva2001 (WHO/RHR 01.19)
- Definitions of infertility and recurrent pregnancy loss.Fertil Steril. 2008; 90: S60
- International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminology.Fertil Steril. 2009; 92: 1520-1524
- Variation in couple fecundity and time to pregnancy; an essential concept in human reproduction.Lancet. 2000; 355: 1928-1929
- Too old to have children? Lessons from natural fertility populations.2016
- Evidence for decreasing quality of semen during past 50 years.Brit Med J. 1992; 305: 609-613
- Sperm crisis: what crisis?.Asian J Androl. 2013; 15: 184
- Declining worldwide sperm counts: disproving a myth.Urol Clin North Am. 2008; 35: 137-146
- Human semen quality in the new millennium: a prospective cross-sectional population-based study of 4867 men.BMJ Open. 2012; 2 (pii: e000990. 10.1136)
- Business is booming.Focus Reprod. 2014; : 24-32
- Can assisted reproductive technologies help to offset population ageing? An assessment of the demographic and economic impact of ART in Denmark and UK.Hum Reprod. 2007; 22: 2471-2475
- Pregnancy outcomes after assisted reproductive technology.J Obst Gynaelcol Can. 2006; 28: 220-250
- Perinatal outcome of singletons and twins after assisted conception.Brit Med J. 2004; 328 (epub2004 Jan 23)
- Multiple births resulting from ovarian stimulation for subfertility treatment.Lancet. 2005; 365: 1807-1816
- Ass Reprod Techn Surveillance—USA 2004.MMWR Surveill Sum. 2007; 56: 1-22
- Profiling the preterm or VLBW born adolescent; implications of the Dutch POPS cohort studies.Early Hum Dev. 2015; 91: 97-102
- Multiplicity and early gestational age contribute to an increased risk of cerebral palsy from assisted conception: a population-based study.Hum Reprod Update. 2010; 8: 2115-2123
- The longer term health outcomes for children born as a result of IVF: Part 1: General health outcomes.Hum Reprod Update. 2013; 19: 232-242
- Autism and mental retardation among offspring born after in vitro fertilization.JAMA. 2013; 310: 75-84
Michael J. Davies, Vivienne M. Moore, Kristyn J. Willson, Phillipa Van Essen, Kevin Priest, Heather Scott, Eric A. Haan, and Annabelle Chan. Reproductive technologies and the risk of birth defects. N Engl J Med 2012; 366:1803-13.
- The risk of female malignancies after fertility treatment: a cohort study with 25year follow-up.J Cancer Res Clin Oncol. 2016; 142: 282-293
- A multicenter randomized controlled trial of expectant management versus IVF in women with patent Fallopian tubes.Hum Reprod. 2004; 19: 1105-1109
- Can assisted reproductive technology compensate for the decline in infertility with age? A model assessment.Hum Reprod. 2004; 19: 1548-1553
- Tailored expectant management in couples with unexplained infertility does not influence their experience with the quality of infertility care.Hum Reprod. 2016; 31: 108-116
- Prospective validation of two new prediction rules for spontaneous pregnancy leading to live birth among subfertile couples.Hum Reprod. 2004; 19: 2019-2026
Article info
Publication history
Published online: April 17, 2017
Received:
October 9,
2016
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
