The Divorce of Coitus from Reproduction

Royal Library, Windsor Castle
Leonardo Da Vinci: The Fetus and the Linings of the Uterus, circa 1511–1513

During the 1960s, with the introduction of the Pill, sex became separated from its reproductive consequences. In 1977, the British scientists Robert Edwards and Patrick Steptoe successfully carried out an in vitro fertilization (IVF), the process by which an egg is fertilized outside the body—ex utero—and the embryo is transferred into a woman’s uterus several days later.

These two advances—the Pill and IVF—very quickly changed the realities of human reproduction in a way that had been difficult to imagine only a few years before. In an insightful book, The XX Factor,1 Alison Wolf describes the way some of these changes in reproductive technology, particularly the Pill, have affected the lives of many well-educated and relatively affluent women: especially those who are now able to avoid unplanned pregnancies and who have successfully pursued careers in previously male-dominated professions.

Yet if they intend to have one or more children, many women are faced with a dilemma: the years during which women can conceive and carry a pregnancy to term are limited, and they coincide with some of the most important years in their professional lives. Of course many women in this position choose natural conception through intercourse during their early professional years. But it has now become clear that the use of IVF, in a recently developed form, could ease the dilemma of many fertile women, possibly bringing about changes as momentous as those brought by the Pill.

During the last fifty years, the average age of women in Europe at first childbirth has increased from twenty-five to thirty years. According to recent data in the UK, female university graduates now have their first child at thirty-five years. As women age, two factors are of primary importance in the decline in their fertility: the ovarian factor, concerning the supply of eggs in a woman’s ovaries, and the uterine factor, concerning the part of the body where the fertilized egg is to develop.

Problems with the uterus differ widely among women, and can often be helped with hormonal support therapy in conventional gynecological practice. Problems with the ovaries, on the other hand, affect most women in much the same way as they age. Women are born with their life’s supply of eggs, and at thirty-five years old, 95 percent of these eggs are gone. At this point, the remaining eggs are aging, which can cause complications when a child is conceived. Babies born to women beyond their late thirties are five times more likely, for instance, to have Down’s syndrome. These ovarian problems have been the subject of an extraordinarily rapid and extensive worldwide research effort.

One way of circumventing these problems would be for women in their twenties to freeze their young eggs. Then, when they decide they want children later in their careers,…

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