It seems that the real problem is the actual monetary cost of IVF. If the cost itself wasn't so prohibitive that people look at it as an all-or-nothing shot, then it would be much easier to convince people to do single-embryo transfers. (Something that is mandated in many countries). Unfortunately the cost of IVF is so high (yet in most cases still less than the cost for adoption) that people are willing to risk a multiple embryo transfer because it will increase their chances of having even one child.

The use of fertility drugs is much more likely to result in twins then the use of IVF - maybe if IVF were covered by insurance, people would be more likely to use it, and the number of multiple births would decrease?

I think using "averages" tends to skew the graph a little bit as well. Twins born at 36 weeks are preterm, but will not cost close to what a child born at 30 weeks would cost.

I agree with the previous comment - lack of insurance coverage leaves couples feeling desperate and limits their options. States with mandated infertility coverage fare better in most of these statistics, because couples are more likely to pursue single embryo transfer.

As for whether having a biological child is "worth" it... this seems like an underhanded, poorly worded challenge to those who face the emotional, physical, financial, and spiritual crisis of trying to build their families despite infertility. Are assisted reproductive technologies perfect? Of course not, and the system through which they are structured is even more flawed. However, blaming individuals and diminishing the pursuit of biological parenthood is missing the point.

How about adoption? The very need for fertility drugs indicates that the woman's body cannot support a healthy pregnancy. Why would anyone risk having a baby with heath and development problems when they could be giving a homeless child a better life? I think it's selfish to put one's own wants and needs ahead of the future health and welfare of one's offspring.

Just to comment on the graphic: Since the two sets of bar graphs are making very different comparisons, where the grey (orange) in one graph does not correspond to the grey (orange) in the other, two different sets of colors should have been used for clarity.

"The very need for fertility drugs indicates that the woman's body cannot support a healthy pregnancy."

Absolutely false. The ability to conceive and the ability to carry a pregnancy are frequently independent. That is why many women who can conceive quite easily can experience miscarriage and pregnancy loss, just as many women who have difficulty conceiving have no trouble carrying a pregnancy once they successfully become pregnant. The reason that a child conceived through fertility drugs MAY have poorer health outcomes (which are largely eliminated once the child reaches a certain age) is largely accounted for by the fact that they're more likely to be multiples.

People chose to build their families in different ways for a multitude of personal reasons. I don't believe that pursuing biological parenthood is a mere vanity project, nor should it be dismissed as one.

Adoption is prohibitively expensive for many families - often topping $20k for a newborn, not to mention the fact that it can be very difficult for same sex couples or those pursuing single parenthood to adopt. Yes, adoption is a wonderful option, and it should be made more affordable and accessible. That doesn't mean that we can't also make IVF (and other assisted reproductive technologies) more safe, affordable, and accessible as well.

Every couple (or prospective parent) has the right to their vision of their family, and a medical condition (especially one that we have the ability to treat) shouldn't eliminate all possibility of biological parenthood. How about we let people have all the options, and let them choose how they would like to reproduce?

The only thing that bothers me about this topic is when people against abortion are all for science creating life. But there is a genetically ethically issue - are we changing or damaging our genetics by allowing science to bring humans into the world that otherwise would not have survived or been born at all. This is a hot button topic, but when you remove natural selection as the only way to create life it is one we must examine.

I hope I'm not straying too far off topic here, but I've noticed a rise of fraternal twins being born to Hollywood stars. People have always had a fascination with multiples--a friend whose siblings are twins once said "the twins are always special"--so is it a coincidence that media-hungry stars have been having twins left and right? Or is it that the women of Hollywood are too underweight to conceive without IVF? I also wonder how much the popularity of twins among the jet set influences other peoples' decision to be implanted with multiple embryos.

I don't know if vanity project is the right word. If it is so, it's a project DEEPLY seeded in biology. While yes, there are people who have decided they don't want children, humans are built to reproduce and built-in with the emotions for it. Sex isn't necessary for our lives either, is it? But who questions the human urge to have it? Of course sex is so necessary for humanity, and so is that biological urge to bear children.

I think adoption is a very honorable thing to do. But how can we judge those for whom IVF releives that painful urge to bear their own?

That being said, I will judge this: I'm pro-choice, but it is deeply troublesome to me that doctors in America plant multiple embryos with the intention about aborting down to the desired number of children. Abortion should be a last resort, not a form of birth control or a casual step in the journey to have other children.

And I find it horrifying that during Katrina, frozen embryos were saved while living breathing already born people drowned. That is wrong.

Pursuing an often amazingly expensive, often very sick child just so one can go "biological" over "adopted" is selfish, especially in a world where orphans exist, even if there are lots of reasons why people end up being so selfish, and even if in the end we don't want to make laws that prevent such selfishness.

It's interesting that this remains one of those statements that people just aren't allowed to say.

Another point worth discussing in light of these graphs is the difference between people's perception of health problems that one is thought to have "brought upon oneself" vs those that are thought to be "undeserved". I'm in Australia and don't really understand how the US health system works (or fails to work!), but here, I know people who would say that public funds should not be spent on costs relating to pre-term babies resulting from IVF, but who would be okay with a "normal" pre-term birth being covered. It's a similar argument to people not wanting public funds to cover smokers' lung cancer, or alcoholics' liver failure, or health costs that are seen as resulting from obesity. In the USA I imagine some insurance companies probably react similarly - unwilling to cover costs of illness that is the patient's "own fault".

Now I think that's all a load of rot: how can anyone judge who "deserves" their illness and who doesn't? Who is perfect in their behaviour anyway? And why would a few bad choices (if they WERE bad choices and WERE shown to have contributed to the medical problem) be punished with bankruptcy or death anyway?

But it's certainly a debate that's relevant to the IVF issue, anyway. (Which, for the record, I have no problem with. If we are going to start talking about biological children being a "want" not a "need" and not something that is worth that much money, then we have to do the same in cases of non-IVF childbearing, i.e. abolish maternity/paternity leave, make all parents pay for childbirth costs out of their own pocket, get rid of state-funded childcare or child education, etc.)

urbanartiste, why don't we end all surgery, medicine and vacination. We better not treat people who have repeat sinus infections because they better just die. How about kids that get appendcistus? Better let those weaklings die too. We better reintroduce small pox too so we can kill off the two thirds of our children who are just too damned weak. urbanartiste, there is a name for your position, it is eugenics.

As to the 'adopt instead' idea, adoption has ethical issues as well, but even if it did not, access to adoption in the US is pretty much limited to able-bodied upperclass married heterosexuals. As a queer, atheist, socialist, marriage opposer, with disabilities, my chances of actually being allowed to adopt ever are pretty damned low (my chances of birthing pretty low too). If I got IVF (at least two rounds) with my one medical condition, my chances of conception are now 30% over the course of my life, then, my other health condition will make me miscarry 70% of the time. If my chances of failure and miscarriage were not so high, IVF would be by far more likely to result in my being actually able to have a child. It's not that I would love an adopted child less or feel some sort of need to have a bio kid, but having a bio kid is generally easier than adopting (especially for people without fertility problems).

Hypatia: "It is completely and utterly an unessential aspect of life for the individual or couple. It’s a want, not a need."

The drive to reproduce is neither want nor need, it's biological imperative. Though nonessential to the survival of the individual organism, it is fundamental to its nature. None of us *need* even to survive, yet as life we are, so strive we to live. Civilized though we imagine ourselves to be, we are not divisible from our animal nature. There is no more pure an expression of our true nature than the incidents of birth.

Bravewolf: "I think it’s selfish to put one’s own wants and needs ahead of the future health and welfare of one’s offspring."

Should only those capable of providing optimal biological conditions across all stages of a child's lifecycle reproduce? Carriers of genetic risk factors for illness and infirmity? The subfertile? Women over 35? People of a low socioeconomic status? Alcoholics and other addicts? The uneducated? The unemployed? How much risk is a prospective parent entitled to impose upon their child from conception? Before conception? After birth? Should parents allow children to undergo potentially lifesaving, but untested medical procedures? Potentially life improving? Should parents allow children to use potentially harmful or harmless untested technology like cellular phones? Should Parent B be made to feel selfish for wanting what Parent A could not sustain, viz a biological parent-child relationship? How does the availability of adoption diminish the validity of the personal choice to biolgical parenthood? Likewise, is the choice to work in the private sector when charitable and non-profit jobs are available render one selfish?

I'm struggling struggling to see where you're coming from and what you're getting at but all I've got are questions. Let's meet at the coffee shop and have a discussion over lattes. It might get heated, but never unreasonable. We'll be respectful.

It reads to me as though you are angry, but I can't tell about what. If you would care to, perhaps you'd restate your argument with greater precision, detail and clarity.

Regulating people's reproduction is a very slippery slope. Given the health disparities in the US, black women are much more likely to have low birthweight babies or a preterm birth. Would you suggest that we consider whether it's "worth it" for a black woman to have a child? I think we could do something about the incentives for fertility clinics to have a good "success rate"--maybe some other indicators, perhaps requiring that clinics allow a certain number of single embryo transfers.

Most of the women I know that can afford to do fertility treatments or IVF are white and middle-upper class. This issue screams white privilege.

Part of the reality is women are waiting later to get pregnant and science has made it possible to get pregnant. Science may be redefining biology, but this is going to be an ongoing issue until women start having kids younger. I know many women who had their 3 or 5th kid their late forties, but the fact is many women are starting to try for their first after age 35.

As or eugenics, I don't support it, but what bothers me is the lack of explanation for what seems like a dominance of certain childhood diseases and disabilities. Can some be related to both men and women waiting until much later in life to reproduce or are they a result of scientific intervention. There are many other possibilities such as environment, chemicals, etc., but it seems everyone is marveling at medical/scientific advancement, but is anyone besides religious leaders questioning possible negative outcomes?

What makes me so angry about this is the holier-than-thou idiots who think you are just to "vain" to consider adoption. Seriously? If I could adopt a healthy baby for a low cost I would do it. But I can't handle kids who've been abused, who may be taken away and returned to their biological families, or who have severe medical issues, which pretty much sums up most of the "orphans" available for adoption. ALSO FOSTERING IS NOT ADOPTION. Of note, there are very few actual orphans in the system at all, perhaps in other countries there are, but international adoption is very expensive and there's lots of corruption. Adoption of a healthy child is MUCH more expensive than fertility treatment. MUCH MUCH MORE. We have looked into adoption. We are talking $20-30k plus and several years of waiting. Basic fertility treatment starts at $500 a month. IVF at my dr is about $8k for the first round, less if using frozen embryos. And we are 100% self pay. I hope we never have to go there and I don't know if I will take the risk of implanting two embryos. But I guess I'm a selfish bitch because I have PCOS but am not automatically willing to take on the rigors of special needs kids.

If we want less multiples being born due to fertility treatments, than insurance covering single embryo transfer IVF is the way to go. Considering just one set of preemie multiples can generate millions in medical bills, covering 8k for an IVF doesn't seem so bad. Unfortunately, my $700 a month insurance plan doesn't cover jack shit related to infertility.

But maybe we should only let people with perfect genes reproduce, right?

If a woman waits until she is over 35/40 to have children she runs a high risk of having a down-syndrome (I am well aware of the variations on disabilities) child. So is it okay to take care of a biological disabled child and not someone else's?

This is not about genetic disorders that people are unaware that they carry or chance. If the data states that many women are having to use these treatments because they put off having kids until nature says it is too late, then it can possibly be seen as selfish (if one is aware of the risks). Nature is nature and just because we can do it scientifically we need to be concience of the risks. And I am for disability rights and a big fan of the late Harriet McBryde Johnson. I also understand the issues of women and the workforce, but maybe someone should come up with a way for women to move the onset of their period to the age of 20 instead of 13 and menopause to age 70.

This is a response somewhat different from whether or not IVF is 'worth it'- but what always comes to mind for me regarding this issues is why so many couples face fertility issues, and it is relevant when considering the 'cost' of infertility.

True, many couples wait until they are older to start their families, and then due to age related issues have trouble. However, sperm counts for men are half what they were 50 years ago. Many women face issues with PCOS, and irregular periods (therefore fewer cycles of ovulation).

Why is infertility so common? Our environment is polluted with many chemicals that mimick human sex hormones and disrupt them -phalates, parbens, flame retardants, plastic compounds, and pharmaceutical hormones in our water and food. This is impacting our fertility! In Canada (where I live, and I imagine the US is similar) chemical compounds are innocent until proven guilty, meaning they can be used with few restrictions until they are proven many times over to cause harm. There is an Aboriginal community in Sarnia, Ontario where the ratio of girls to boys is highly skewed, and it's thought the numerous plastic and chemical companies nearby are to blame, yet the government has done nothing. Governments must regulate chemicals in use and consider the damaging health effects they have, and we must pressure them to do so.

Fertility issues are expensive, but without addressing the cause, the costs are only going to go up.

To read about the Sarnia community, check out http://www.independent.co.uk/environment/pollution-where-have-all-the-baby-boys-gone-472477.html

I'm not sure how much I buy the "biological urges" line. We do an awful lot of things that defy "biology".

As for not being able to cope with a disabled child being a reason pursue IVF - since when does having a biological child (via any means) guarantee a healthy child?

One thing to mention is women are given the option of abortion if blood work and amniocentisis shows results that the child will be disabled. The testing is not 100% accurate or can not tell the level of some disabilities. I think people are searching for certainty particularly due to the high rate of lawsuits in the U.S. OBGYNs carry one of the highest malpractice insurance rates.

Recently I looked into adoption in my state and it is sad to see how many disabled kids are listed. If anyone can offer explanation I would be interested to read it.