At least one in eight women of reproductive age has sought help for infertility. Despite this prevalence, it’s a lonely road. A sense of failure, shame, and envy seeps into the lives of hopeful parents who want — but somehow can’t attain — something that seems so biologically effortless for so many.
Meanwhile, the cost of in-vitro fertilization is prohibitively expensive, and socioeconomic disparities in health care access persist. According to RESOLVE: The National Infertility Association, the average cost of an IVF cycle in the United States is $23,000.
The pandemic further complicated matters, as many fertility centers were termed inessential services at COVID’s outset, forcing patients to put their plans on hold. And as celebrities such as Chrissy Teigen normalize the grieving process of miscarriage and pregnancy loss, infertility remains taboo.
Filmmaker Larkin McPhee aims to change that with her new PBS NOVA documentary “Fighting for Fertility,” airing on GBH throughout the month. The film spotlights hopeful parents who share their quests to get pregnant while confronting specific barriers confronted by historically underserved communities. It also touches on the many paths to parenthood, from IVF to surrogacy to adoption.
I spoke with her about the film and the future of reproductive technology.
Q. This is an interesting time to release a documentary about fertility, since birth rates are dropping in the United States, declining by 4 percent in 2020. Why do you think that is?
A. My own gut sense of this is economic insecurity and uncertainty with the pandemic. I feel like people don’t really want to build families if they don’t have a sense that they’re going to be able to afford a family. The pandemic, I think, just threw everybody for a loop, and it was very difficult.
But I will make one comment about a couple in the film. We filmed them just as the pandemic was hitting, and what I can tell you is, that they carried on. There was some delay with the pandemic, but they were so determined. They were so committed, nothing was going to stop them. I think that people who are already down that path may have stuck to it.
Q. What motivated you?
A. There’s this huge need out there for more education around this topic, and it appears to be getting harder. One in eight couples suffers from infertility, but one of our experts says she believes it’s much higher than that. We include a world-class epidemiologist in the film, Dr. Shanna Swan, who talks about how boys, today, have half the sperm that their grandfathers had. That’s an arresting fact. Sperm has, in fact, dropped by 50 percent in the last 40 years, and this epidemiologist reports that they see no bottom. It’s just going down.
Q. Why has sperm declined so much?
A. Lifestyle factors: binge smoking, drinking, obesity. These are all things that contribute to the lower sperm count. But also — this is really interesting — endocrine-disrupting hormones, which are ubiquitous in our society. We use them in cosmetics, in some of the tools we use to cook with, and the plastic that we microwave with, particularly soft plastics like those crushable water bottles. We show this in the film. The idea is that, if a mother is pregnant and she’s in that window of sensitivity with the developing fetus, and particularly a male fetus, if those hormones are circulating in her body, they are disrupted. There’s less testosterone. The male becomes less male. The sperm itself is affected.
The good news about these endocrine-disrupting hormones is that they’re short-lived. They’re not the forever chemicals that we hear about. You can literally reduce your exposure to them in your kitchen or bathroom.
Q. Is fertility also declining because women are waiting longer to get pregnant? Anecdotally, when I was having kids, that seemed to be the reason friends mentioned for having trouble getting pregnant: They were just older.
A. Your point’s really well-taken about the aging egg. That is the [number one] reason that people struggle to get pregnant. Women delay childbirth. The population of women who are having the most babies right now are the older women, right? That’s the number-one reason why we’re seeing people struggling with fertility, as well as male factors, which have to do with sperm counts, shape of sperm, and so forth. That’s not a well-told story, either. I think this is one of the important messages in the film. We actually begin with a story about a man who has no sperm because we really want to hit home that it’s not just a woman’s problem. Traditionally, women go to the OB-GYN. A guy doesn’t go to the doctor. But, actually, it’s probably cheaper and more efficient to also start look at the male at the same time.
Q. Your documentary also focuses on fertility barriers faced by the LGBTQ and Black communities, for instance. What are those barriers, and what do you hope to spotlight that has perhaps gone unaddressed?
A. Absolutely. Just to begin with, African American rates of infertility are twice as high, and it’s really a constellation of factors. We’re familiar with the history of reproductive coercion and how there’s a mistrust in the African American community — a reverend in this film talks about just feeling dismissed in a doctor’s office. And maybe the most profound thing that we report on in this film is the phenomenon of weathering, which is the premature aging of the body in African Americans because of generational oppression and racism. And so, rather than just having an episodic event of stress, it is an ongoing constant, and I think this played out with COVID.
And then access is a huge issue — geographic access and socioeconomic cost. IVF is very expensive. We have an expert from Stanford who says we don’t have any real health care in our country that supports reproductive medicine; it’s usually not covered by private insurance or the state federal program, Medicaid. Here’s a quote from him: “We’re one of the few rich countries that doesn’t think of it as part of health care coverage.” I think that that’s a big barrier for lots of people, not just African Americans.
Q. What about LGBTQ access to fertility treatment?
A. What I have consistently heard is stigma, stigma, stigma. A lot of doctors don’t even want to treat transgender people. They’ve made it very difficult, hindered access, and then it’s unaffordable. Traditionally, I don’t think they’ve been counseled. I think a lot of doctors’ offices are really now trying to do that and understand about fertility preservation. They’re trying to tell these young people, ‘Do you want to consider preserving your eggs or your sperm?’
Q. What do you think is on the horizon for fertility treatments?
A. There’s a surgical procedure called microTESE, which is a micro-testicular sperm extraction. For a man who has no sperm, you can use this technology to extract sperm from his testicle. If there was no sperm in his semen, he would’ve been deemed sterile in a prior lifetime. Here, he has a chance.
We had a fascinating conversation with our ethicist, Hank Greeley at Stanford, who talked about skin cells and how there are already experiments out there with mouth cells where they’ve turned cells from a mouth into an egg or a sperm, and then put them together and created a baby.
Greeley says in the future he could see us just plucking a little sample of our skin, making them potent cells, and turning them into an egg or a sperm and creating children. He said, ‘With IVF, you have so many eggs that you can extract. With skin cells, how many do you want?’ It’s almost this endless supply. It raises so many ethical questions. Do we grab some celebrity’s skin cells off the red carpet and try to make a baby? It’s just a wild world to imagine.
Q. What do you hope that people learn from watching this?
A. My hope is that there are several takeaways. One is, yes, it’s a heartbreaking topic. I have worked on a film about depression for PBS, and that’s very painful topic and hard, but I would say this topic is equally painful and devastating for people. They feel broken. Another message is just that there’s so many ways to build a family, and it’s really thanks to the advances in technology and IVF itself to have a partially genetic child or a fully genetic child of their own.
I think we’re trying to dispel myths. Men play a role, that the aging egg does matter, and we’re not going to be able to turn the clock back on that, at least not for now.
Another really critical message is that people embark on this journey, and they have their expectations of what they want, but the path is likely to change. They may draw red lines in the sand. I have observed many women crossing those red lines and yet ending up in a place they never imagined themselves to be, but they’re over the moon happy because somehow, some way, they found their baby.
Reverend Stacey Edwards-Dunn [founder of Fertility for Colored Girls] says it best at the very end: ‘Your path is not deficient. It’s just different. There is a way to your miracle baby.’
Interview has been edited and condensed.