Issue 90

The Business of Fertility, aka "Big Baby"

March 22, 2020

Hello friend! Welcome to Scrap Facts.

I'm a reporter covering health and science with insatiable curiosity. I love everything I learn, not all of which gets its own story. Each week, I'll bring you some of my favorite facts that I picked up on the job or while out living life.

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Happy Spring, friend.

Today, the days are officially longer than the nights now. Go outside if that’s possible for you. If that isn’t possible, open your window—remember that carbon dioxide buildups from constant exhalation in rooms make you sleepy and dull. Be safe and kind to others, friend, and enjoy some scrap facts from my fertility series. If you’re not already a QZ member, you can get 40% off your membership to read this guide (and so many more!) by using the code QZFLASHSALE.

An illustration of a blue egg and a pink sperm swimming toward it. Credit: Daniel Wolfe.

Limited access to information plus high-strung emotions create an irrational market.

Found while reporting: The whole gosh-darn series.

I chose to explore the science of fertility care because it’s an opposite force to those driving our globally aging population. I have never reported on a topic where I found it more difficult to get objective information, I told my colleague Jenni Avins for the newsletter Quartzy:

Jenni: What surprised you about this topic?

Foley: I’m not at a point in my life where I want to have kids, and I think what was most surprising was that purely objective, unbiased information is actually really hard to find. I just can’t imagine having to navigate this information in a heightened emotional state.

There’s RESOLVE (the National Infertility Association), the Society for Assisted Reproductive Technology, and the American Society for Reproductive Medicine, which to various degrees provide information for prospective parents. But other than those big societies, it’s either really technical stuff—like papers from embryologists—or stuff that clinics put out, but the clinics are trying to get you to come to them. FertilityIQ is good too, but, again, they’re trying to get you to buy their courses.

And because clinics are trying to sell you services, it’s like: “There are all these things you can do if you absolutely want to be a parent. But if you decide you don’t want to go further, then I guess you don’t want to be a parent.” Nobody is there to say: “It’s okay when you want to stop.”

You can read the full interview here.

The problem with a lack of clear, objective information is that it creates almost a predatory field for people who may already be vulnerable. By the time most people seek out fertility care, they desperately want a child. They will pay the thousands of dollars they can for medications, intrauterine insemination, and eventually in vitro fertilization, or IVF, as long as they can. If they can’t, they may try to borrow money from families, take out loans, or head to crowd-funding sites like GoFundMe. If they can only afford one round, they may pressure doctors to transfer multiple embryos to their uteruses—a choice that could result in multiple pregnancies, which is dangerous for both the pregnant person and their unborn children.

It’s an incredibly difficult field to navigate even when you’re not personally emotionally invested in it—my heart goes out to those who are going through it right now.

The world’s first embryologist was ignored for her work.

Found while reporting: How fertility care went from an evolutionary need to a luxury good.

There was a trio of scientists who contributed to the birth of Louise Brown, the first IVF baby, in 1978. One of scientists who developed IVF, Robert Edwards, won a Nobel Prize for his work in 2010. The second was Patrick Steptoe, who was constantly referenced in conjunction with Edwards. And the third was Jean Purdy. But she was largely forgotten in the scientific community—despite collaborators best efforts.

Sigh.

Purdy was the world’s first embryologist. She was responsible for culturing embryos to grow in the lab, until they were five days old when they are officially blastocysts—a term she also coined. She was so essential to the research that when she had to stop coming into work in order to take care of her mother, all research stopped for months. Edwards and Steptoe spoke out that she should be recognized for her contributions—and she has been, posthumously—but during her time, she was yet another victim of sexism.

Taking gender-affirming hormones does not render a transgender person sterile.

Found while reporting: Fertility care has opened more doors for trans people to have biological children.

This was my favorite story to report for this series because it is the happiest.

An image of Trystan, Biff, and one of their sons, Leo, all reading books on the couch. Courtesy of Trystan Reese.

Fertility care has opened another door for LGBTQ+ people to have kids and expand their families. Which is great! But one area that it has lagged is with regard for trans folks—particularly those who have decided to take gender-affirming hormones.

One such person is Trystan Reese, who, at 37, gave birth to a son. Trystan and his husband, Biff, already had two children through adoption. He had written off having biological kids. He was assigned female at birth, but as a young adult, he knew he was transgender. At 22, he legally changed his name and started taking testosterone—which he assumed would render him sterile. Plus, he didn’t know any trans people with kids. Kids require a certain level of love and stability, which he didn’t know was in the cards for him as a member of a marginalized community.

But then, he fell in love—first with his husband, and then with their two adopted children. “I truly wanted to create life, and to have that experience be a physical manifestation of this love that I never thought I’d find out in this world,” he told me.

Trystan was able to get great care from one a fertility clinic in Portland, Oregon that is LGBTQ+ friendly. There are many of these across the country, and even some awesome scientists researching how to make this kind of care more successful. But still, a lot of people aren’t aware that this kind of care exists, and could be for them! It’s got a long way to go, but it’s another chance for people to grow their families.

Animal of the week: Pigs

An image of a small spotted pig munching on some grass.

Like many of you, I now find myself working in close quarters with my partner constantly. This means that he has seen my daytime eating habits (read: constant snacking) and the way I prefer to keep my desk (read: unorganized to the untrained eye, but I know my system), and showering habits (read: only when I’m absolutely sure I’m done exercising for the day—why waste water? [Editor’s note: she is *never* done exercising for the day.]). The spare bedroom that we’ve converted to my office is now known as the Pig Sty. Which means that (in an extremely “I’m baby” voice) I’m Piggy.

I don’t mind because pigs are wonderful creatures. They’re are smart and playful. They’re fast. They don’t really like being muddy—they figured out that it’s an excellent way to compensate for the fact that evolution hasn’t blessed them with sweat glands. [Editor’s note: Katherine has sweat glands. They work extremely well.]

And surprisingly, their bodies—including their embryos—are surprisingly similar to our own.

Pigs have been instrumental in advancing transplant research. They’ve received genetically modified baboon hearts—and lived!—and grown working lung tissue. But they also were the animal model basis of work by Jonathan van Blerkhom. Starting in the 1970s and 80s, he used pig embryos to show that it’s possible to carry out IVF in a minimalist setting. His work is the basis of the organization The Walking Egg, a non-profit that hopes to bring IVF to developing countries for hundreds, not thousands, of dollars.

Some of the discoveries he made with them were actually an accident—he had to find a way to transfer pig embryos from one site to another, which is how he learned that a simple thermos would suffice instead of a lab-grade incubator. He also used them to figure out that a simple titration will create the specific gaseous environment that embryos need—about 90% nitrogen, 5% oxygen, and 5% carbon dioxide.

Based on research with pig embryos, van Blerkhom and his colleagues figured out how to successfully do human IVF successfully for about $200. About 200 couples in Belgium have had kids that way—it works! But it would also disrupt the status quo of expensive treatment.

One last personal request: If you are healthy, please, please stay away from others. Please forgo your group meetups for now (even runs), and only meet up with healthy loved ones who have quarantined for two weeks—assuming you have too, and you can get to them without taking public transportation. Isolation sucks, but it’s not permanent. Deaths are, though. The sooner we can take Covid-19 with the gravity it deserves, the faster we’ll get through this.

Special thanks to Ben Daniels for this issue—he’s a generous copy editor, a public health expert, and he makes sure I eat more than just trail mix and kale.

That’s all for now—stay curious, friend ❤️

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Top image by E. Y. Smith, headshot drawing by Richard Howard.