Memoir on Fertility Raises Questions About Industry, Reproductive Science

Just as the birth control pill gave women the freedom not to have children too soon, reproductive medicine has allowed many to have babies after they thought it was too late. But a new memoir has raised questions about whether the fertility industry can deliver what it promises. 

When Miriam Zoll was in the prime of her reproductive years, she wasn’t sure she wanted to be a mother. Her career was in full swing. The love of her life had married someone else.  Her own childhood had been stressful and unhappy. And anyway — there was no rush to decide.

“I had certainly heard about the biological clock,” says Zoll. “That conversation fell off the table in the late 90s and early 2000, and was replaced with,  ‘You don’t have to worry about your biological clock. If you have trouble getting pregnant, just go to a fertility clinic and they’ll get you pregnant.”

Plus, as a women’s health advocate who co-founded the Ms.Foundation’s Take Your Daughter to Work Day, she didn’t want to be defined by her biology.

“But when I decided I wanted to become a mom, everything began to focus on my hormones,” she says. “It was like all those years I didn’t focus on it, Mother Nature was now giving me payback.”

That payback began at 40, after Zoll had reunited with and married her first love. They moved from New York City to a quiet farmhouse in Western Massachusetts and tried for two years to get pregnant naturally. When that didn’t work, they didn’t panic. They went to a fertility clinic.

Miriam Zoll is author of ‘Cracked Open: Liberty, Fertility and the Pursuit of High Tech Babies.'

“Most people in our social circle were endorsing the treatments.  Everybody was saying the treatments work,” says Zoll. “And when our first cycle failed, we were dumbstruck.”

As she chronicles in her memoir, ‘Cracked Open: Liberty, Fertility and the Pursuit of High Tech Babies,’ Zoll and her husband spent a heartbreaking decade — and tens of thousands of dollars — going through six failed cycles of In-Vitro Fertilization. In IVF, an egg and sperm are combined in the lab and implanted in the woman’s uterus.  Zoll had one miscarriage and tried twice to use donor eggs that turned out not to be viable.

“It was then I began to really question what we were doing and why we were doing it. And it was also when I realized there were no consumer protections in place.”

Zoll argues that fertility clinics take advantage of the desperation of many older, infertile couples — by encouraging costly, physically demanding treatments they know have a small chance of working. The Society for Assisted Reproductive Technogies (SART) reports that about 40 percent of standard IVF treatments for women under 35 lead to babies. By the age of 42, that number goes down to 4 percent.

Zoll doesn’t doubt many fertility doctors have good intentions, but, she says, “I also think, because they are simultaneously wearing their doctor hats and their business hats, that when for example our doctor told me that my chances of having a baby through IVF were very low, he also told us that – ‘you never knew, it only took one good egg, and why not try.’

It’s that enticement, Zoll says — along with news of older celebrity pregnancies and miracle births — that lead women like her to become what she calls “fertility junkies”.

“Couples become so obsessed, and their faith in the science to overcome a medical condition is so strong, that they believe it will work the next time,” Zoll says.  “And it’s a psychological mechanism that I believe the industry understands. It’s why the websites are full of beautiful babies in pink and blue blankets. It’s why you don’t see pictures of couples crying into each other’s arms. It’s why you don’t see pictures of women injecting syringes into their bellies.”

[Sound of door opening.]

“So this is our reproductive biology IVF unit,” says Doctor Cynthia Sites, who’s offering a tour of Baystate Reproductive Medicine in Springfield, which performs about 500 IVF cycles a year — as well as less invasive treatments.  Test tubes and long needles populate the lab, where biologist Lisa Ashcraft analyzes sperm under a microscope — and counts the healthy swimmers.

Although Miriam Zoll was not a patient here, Sites has sat with many a tearful couple whose treatment failed. She says Baystate is always transparent about the chances of a live birth.

“These are the types of statistics that we have down here, and we also have them in our office to show patients,” says Sites, picking up several laminated pages from a hospital bedside table. “And as you can see, as patients get older, it’s anywhere from four or five percent to 30 percent.”

Despite’s Zoll’s critique of industry profits, Sites says Baystate’s doctors are salaried and have no incentive to encourage couples to keep at it indefinitely. After three or four failed cycles, Sites may suggest they take a break from treatments or get a second opinion.

“We don’t want to waste their time. We don’t want to waste our time,” says Sites. “It’s fruitless… It’s nearly fruitless. As I said, I never say never, but the chances are diminishing. They may not hear it; they may not want to hear it.”

“I think our OB was very frank with us and very honest with us,” says Erin Chrusciel, who’s been going through treatments for a decade, including hormonal injections, intra-uterine insemination, several failed IVF cycles and 3 miscarriages.

Like Zoll, Chrusciel delayed motherhood in part for her career, and assumed she’d be among the women who get pregnant easily when they’re older. When she learned her ovaries would not perform on command, “it was devastating,” she says.  “It literally felt like someone punched me in the gut and remember not being able to stand.  And I think as we got into fertility treatments, it’s a horrendous experience. It’s invasive. It feels demeaning. But I don’t blame the industry on that. I think it’s just the nature of the beast.” 

Erin Chrusciel and her daughter. 

One key difference between Chrusciel’s experience and Zoll’s…. is the outcome. Chrusciel  gave birth to a daughter three years ago — using an egg donated by a distant relative.  At 42, Chrusciel is now pregnant with her second child through egg donation and IVF.

“It’s kind of crazy to think someone would be doing this for ten years, and it IS crazy,” says Chrusciel. “It took a piece of me away. It’s nothing I would wish on anyone. But you know, (my daughter) is more than I could ever imagine, and I spent a lot of time imagining.”

Miriam Zoll and her husband eventually adopted a baby boy — whom they adore. So it’s hard for Zoll, now 50, to wish things had gone differently. But she does urge other women to try for children earlier than she did, which she says would be easier if employers offered better family leave policies and workplace flexibility.

“We have a right to be mothers and a right to work,” says Zoll. “We should not feel that our economic and professonal status is dependent on whether we agree to subject our bodies to fertility treatments because we’re delaying motherhood.”

Zoll has recently joined the board of “Our Bodies, Ourselves,” the women’s health collective based in Boston. Her goal is to make sure women have the facts they need to be informed reproductive health consumers.