What is IVF and Why it Matters in the Choices We Make Today

Our mission at Béa Fertility is to democratise access to fertility care; we believe that everyone should be able to have access to affordable, evidence-based fertility care. Very few people today have access to fertility treatment, which is confusing, given how much healthcare systems have developed since the first IVF baby was born in 1978.

Why do only 3% of people in the world have access to the fertility care that should be available to all? To answer this, we have to go back in time, looking not only at the science, but the regulation, legislation and politicisation of fertility and reproductive care.

What Happened to IVF Law?

Assisted reproduction is an ethical and moral hotbed. In merging exploratory research on stem cells and embryos (dubious or revolutionary, depending on your outlook) in the name of helping people create their dream family (a very moral endeavour), you open the door to opinion and debate.

Medically assisted reproduction sits at the intersection of religion, culture, tradition, medicine, society and legislation: people’s views of this are rather like people’s views of Brexit, Marmite, or Donald Trump: polarised.

This has created a curious legislative landscape in the world of Medically Assisted Reproduction: wild inconsistency, prohibitive policy and discriminatory laws.

The Wild West that is Assisted Reproduction Law

Austria’s assisted reproduction laws prohibit IVF except in the case of married heterosexual, cis-gendered couples using their own gametes (sperm cells). Subsequent legal challenges – still making their way through the European Court of Human Rights – may yet change these laws.

For now, Austria defends the law as protecting us from the “exploitation and humiliation of women”. A curious stance, given that the legislation was drafted and passed by an overwhelmingly male cohort.

Legislation, oversight and regulation in assisted reproduction varies by country. Many laws are by now out of date, out of touch with a world in which every family looks different, where binary gender norms and rigid relationship structures become less relevant with the passing of generations.

Heterosexuality and ‘Human Sense’

In Hungary, Medically Assisted Reproduction is permitted only for married and ‘stable’ heterosexual couples. Lesbian couples can pursue Medically Assisted Reproduction but are considered as ‘single women’ when they do so, to stay within the confines of the law

Luxembourg and Malta have no laws, instead deferring to ‘human sense’. In Cyprus, a committee was formed in 2007 to begin ‘preparation of an opinion’ (there have since been no laws, or for that matter, opinions).

In 2006, Denmark introduced a law allowing for the evaluation of ‘parental incompatibility’ when seeking IVF. In Croatia, surrogacy is prohibited. In Spain, the law does not recognise surrogacy at all.

Even in Sweden, the law states that “insemination may be carried out only if the woman is married or cohabiting. Written consent for insemination is required from the spouse or cohabitee.

In short, Medically Assisted Reproduction is one of the most highly privatised, inconsistently regulated, and wildly legislated sectors of medicine that exists today. Why? Because merging science and reproduction resonates with peoples’ moral compasses, in a big way.

A Pope, A Conjugal Act and ‘Illegitimate Children’

Creating babies in a lab is futuristic, the stuff of dreams and moral quandaries. Lawmakers, politicians, philosophers and scientists alike feel compelled to weigh in.

In 1951, Pope Pius (in an address to a college of midwives), famously said, "To reduce the cohabitation of married persons and the conjugal act to a mere organic function for the transmission of the germ of life would be to convert the domestic hearth, sanctuary of the family, into nothing more than a biological laboratory." Needless to say, some inconsistencies there in attitudes towards the purpose of marriage.

Has artificial insemination turned our homes into biological laboratories? No.

Has Pope Pius influenced the opinions of an entire generation of Catholics? Yes. And this is what is damaging.

In 1963, in the case of Gursky v. Gursky, a New York judge ruled a child born of donor insemination (consented to by the husband) to be illegitimate. A similar case a year later had the same ruling: child illegitimate (husband still liable for support).

These opinions and rulings happened not that long ago. Modern clinical techniques and attitudes were being shaped and developed in this time, and we can still see the effects of these attitudes today in the laws and regulations surrounding Medically Assisted Reproduction.

We Need More Choice – and More Power – When it Comes to Our Fertility

Lack of clarity in the law, rapid advances in research and inconsistencies in regulation, combined with the commercial drivers in the fertility sector paradoxically results in less choice.

When treatment costs £5000, suddenly only a small group of people can afford to choose it. When the law prohibits IVF for LGBTQ+ people, we take away people’s ability to choose what’s right for them. When leading religious figures and courts of law weigh in on what is right and what is wrong, it influences (read: takes away) people’s confidence to make choices that are right for them.

A lot of the laws, opinions and regulations in fertility were formed a generation ago – for some of us, that’s our parents, meaning we were raised (whether subconsciously or not) to believe certain things about fertility.

It’s why many still believe fertility to be a women’s problem. It’s why some families and some cultures do not recognise children born of IVF. It’s why we approach fertility clinics with feelings of shame. It’s why we actively avoid talking about our fertility struggles.

It’s Time to Shake Up Fertility Care

We need more choices when it comes to our fertility. We need better sex education as teens. We need to have access to fertility education as adults.

We need to be able to have our choices presented to us early on in our fertility journey, so as to make better choices for ourselves and our families later on.

The fertility sector as it is today allows those who can, to ‘have’ choices. It blocks those who cannot from ‘making’ choices. To quote Kerry Washington’s character in Little Fires Everywhere, “you didn’t make good choices, you had good choices.”

This is no longer acceptable. It’s time to crack open the fertility sector. It’s time to democratise access, add choices and empower people to make those choices. That’s what we’re on a mission to do here at Béa Fertility.