A Second Reproductive Revolution

By Jonathan Grant, Stijn Hoorens, and Aruna Sivakumar

Jonathan Grant is the president of RAND Europe. Stijn Hoorens is a RAND Europe analyst specializing in population aging and reproductive technologies. Aruna Sivakumar is a RAND Europe economic modeler.

Thirty years ago, a young British couple, frustrated with their inability to conceive, took part in an experimental medical procedure in which an egg from one of the woman’s ovaries was removed, fertilized in the lab, and the resulting embryo was implanted in her uterus. Nine months later, on July 25, 1978, the world’s first test-tube baby, Louise Jay Brown, was born.

A generation later, demand for in-vitro fertilization (IVF) is higher than ever and climbing. In the United States, the number of IVF cycles more than doubled between 1996 and 2005, and IVF has become the flagship in a fleet of treatments that offer a solution to infertility.

But if used in combination with “egg banking” — a process by which healthy female eggs are frozen for future use — the promise is even more radical: to stop the biological clock entirely. Should this happen, the result will be a second reproductive revolution equal to that sparked by the contraceptive pill in the 1960s.

Whereas the pill gave women the choice of whether to have children, the new science offers the choice of when to have them. This will transform the structure of Western society within a generation.

In the next five years, egg banking will become increasingly commercially available in the United States and Europe. The wheels are in motion. Yet uncertainties persist. The long-term health effects on children and mothers, for instance, remain a question mark. Ongoing research and careful monitoring of outcomes are essential. Regulation is also key. Without it, a profit-driven industry that caters to consumers who are making emotional purchasing decisions could run amok, with best practices giving way to unscrupulous approaches. But if the uncertainties prove surmountable, the transformation will be far-reaching, with sometimes double-edged outcomes.

Fertility treatments primarily available on a commercial basis will threaten to perpetuate an entrenched system of inequities. With older, richer parents, the children born through assisted reproductive technologies will enjoy the educational, financial, social, and political advantages that come with wealth. Although their numbers are now small, they are likely to swell within several decades. Eventually, the “IVF-lings” could emerge as a distinct political and social force — the “soccer moms” of tomorrow — with a collective voice wielding a decisive influence.

AP IMAGES/CHRIS RADBURN/PA WIRE  In-vitro fertilization pioneer Robert Edwards, Lesley Brown, her daughter Louise Brown, and Louise’s 18-month-old son Cameron mark the 30th anniversary of Louise’s birth in July 1978 as the world’s first test-tube baby.

In another sphere, an end to the biological clock promises to help halt the burgeoning pension crisis in European and Asian countries, which face aging populations and falling birth rates. By 2050, the ratio of working-age people to senior citizens in the European Union will have plummeted from today’s four to one to two to one. Pension and welfare systems are in danger of collapsing under this strain. Yet a sample of European women surveyed in 2006 indicated a desire to have at least one child more than they actually are having. Assisted reproductive technologies, as part of a mix of public policies, will contribute to reducing this “baby gap.”

By far the most transformative consequences will be societal. With age no longer a barrier to motherhood, the family as we know it will be turned on its head. Sixty-five- and 35-year-old mothers will mingle at school events. Grandchildren will routinely be older than their uncles and aunts. A 25-year-old daughter could give birth down the hall from her 55-year-old mother.

The tremendous gains for women’s liberation first achieved by the pill will be extended: Women will be freed from the demands of juggling family and career (to the detriment of career) and will attain ever-greater financial independence. The structure of the labor force and of relationships between the sexes, both inside and outside the family, will change irrevocably. As deeply embedded norms are tested, the pressure on society to adapt will be profound.