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Editorial| Volume 214, P204-208, July 2017

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Ever growing demand for in vitro fertilization despite stable biological fertility—A European paradox

      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 [
      • Kupka M.S.
      • D’Hooge T.
      • Ferrarati A.P.
      • de Mouzon J.
      • Erb K.
      • Castilla J.A.
      • et al.
      Assisted reproductive technology in Europe 2011: results generated from European registers by ESHRE.
      ]. Worldwide over 5 million IVF babies were born by the end of 2013, mostly in high-income countries [
      • Kamphuis E.
      • Bhattacharya S.
      • van der Veen F.
      • Mol B.W.J.
      • Templeton A.
      Are we overusing ivf?.
      ]. 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 [

      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)

      ,
      • Rolland M.
      • Le Moal J.
      • Wagner V.
      • Royere D.
      • De Mouzon J.
      Decline in semen concentration and morphology in a sample of 26 609 men close to the general population between 1989 and 2005 in France.
      ]. 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 [
      • Kupka M.S.
      • D’Hooge T.
      • Ferrarati A.P.
      • de Mouzon J.
      • Erb K.
      • Castilla J.A.
      • et al.
      Assisted reproductive technology in Europe 2011: results generated from European registers by ESHRE.
      ].
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