[electronic beeping, buzzing]
[indistinct chatter]
[narrator] April 2016.
Punjab, India.
Daljinder Kaur has just given birth to her first baby
after 46 years of trying.
At over 70 years of age,
she's one of the oldest first-time mothers in the world.
Daljinder and her husband are delighted.
[in Punjabi]
[narrator] This little miracle was made possible
by a medical reproductive technique
that's changed humanity forever.
IVF.
In vitro fertilization.
The "in vitro" part is Latin for "in glass,"
because IVF allows the fertilization of a human egg outside the body,
in a dish…
making parenthood a possibility not only for some older mothers
but other women who otherwise have trouble getting pregnant.
Today, over 2% of all babies born in the USA,
almost 84,000 a year,
are because of IVF.
Denmark, where the process is government funded,
has the highest rate of IVF births, around 10%.
Since 1978,
more than eight million babies have been born worldwide through IVF,
which is also big business.
In 2021,
the global IVF market is estimated to be worth around 13 billion US dollars.
But success is by no means assured.
Even today,
IVF attempts are on average
only successful just over a third of the time.
IVF is now more popular than ever,
but the procedures are expensive,
and globally, the industry is largely unregulated,
leaving patients vulnerable to unscrupulous providers.
IVF has made the dream of parenthood a reality for millions.
But at what cost?
[babies cry]
Making babies.
It's been an essential part of humanity's survival for millennia.
But how do these little bundles of joy come to be?
Time to revisit biology class.
Once a month, a woman's ovaries release an egg into her fallopian tube.
After sex, millions of sperm travel towards the egg.
If one penetrates it, then the real magic begins.
The DNA in the sperm and egg combine,
and the cells start dividing.
This will become an embryo.
It continues along the fallopian tube
and attaches itself to the wall of the uterus.
The woman is now pregnant.
But unfortunately,
it's not always that simple.
Some women have blocked fallopian tubes, stopping the sperm reaching the egg.
Some men have low sperm count,
and egg quality declines with age,
narrowing the window of opportunity for conception.
If scientists could figure out a way to fertilize a woman's eggs
outside the body
and then implant the resulting embryo into the uterus,
it could offer a solution for people unable to conceive naturally.
In the 1950s,
researchers have some success working with small mammals.
Then a decade later,
British scientist Dr. Robert Edwards makes a key discovery.
Eggs take the same amount of time to mature outside the body
as they do inside,
allowing him to determine the moment they're ready for fertilization.
He hopes to apply his findings to create a human embryo.
Sounds easy, right?
But the problems in rabbit are simple compared with those in the human.
[narrator] Mmm, maybe not.
In 1968, he partners with British obstetrician Patrick Steptoe,
a pioneer of a surgical technique called laparoscopy,
which allows the safe retrieval of a woman's eggs
without a large incision.
Along with nurse and embryologist Jean Purdy,
they begin attempts at human egg fertilization
at a hospital in Oldham, Greater Manchester.
After successfully retrieving eggs using laparoscopy,
they mix them with sperm to create embryos.
But none of their attempts at implantation results in a successful pregnancy.
The scientists suspect they've been waiting too long
before implanting the embryos.
So in 1977,
while working with would-be parents Lesley and John Brown,
they implant the couple's embryo in half the usual time.
And… success!
After years of infertility,
Lesley Brown is pregnant.
Her pregnancy becomes international news.
In Oldham, England, Mrs. Lesley Brown might give birth
to the first test-tube baby, and soon.
[narrator] But the pregnancy is met with a sense of public unease.
Will a baby born from IVF turn out,
well, normal?
You might have deformity.
You've got to be careful using the word "deformity."
[narrator] With all eyes on Oldham, Lesley is placed under general anesthetic
for a C-section.
[man] You are about to see a historic birth
following in vitro fertilization.
[narrator] They film the birth to prove the baby is Lesley's,
and in the glare of the spotlight,
Louise Joy Brown is born.
-[Steptoe] It's a girl. -[baby cries]
[Steptoe] Good healthy cry.
Lovely pink color.
I am now handing the baby to Dr. Edwards,
whose brains, skill, and perseverance has made this birth possible.
He's been assisted by Jean Purdy.
[narrator] Weighing five pounds and 12 ounces,
Louise is a healthy, adorable baby.
Letters flood in to congratulate the Browns
and the scientists responsible for this modern medical miracle.
This could be a treatment which will give a great hope
to many people in the future who can't have a baby at the present time.
[narrator] So, how does this "miracle" work?
Today, doctors follow a similar formula to those pioneers in the '70s.
Step one, administer medicines to suppress the natural menstrual cycle
and stimulate the ovaries to produce more eggs.
Step two,
when ready, gently remove eggs from ovaries.
Step three,
select the strongest sperm.
In a petri dish, mix with the eggs,
and place in an incubator.
By morning,
60 to 70% should have fertilized into embryos.
Step four,
transfer one or more embryos to the uterus,
hoping they implant.
Let sit for two weeks,
then check for pregnancy.
Following Louise's successful birth,
IVF goes global.
India records the world's second IVF birth later that year.
And Australia welcomes their first IVF baby in 1980.
Three years after Louise's historic birth,
the USA welcomes its first baby born from IVF,
Elizabeth Jordan Carr.
America has its first test-tube baby tonight.
The doctors say she is perfectly normal.
[narrator] IVF has arrived, but it's still rare.
By 1981,
the number of IVF babies born across the world is only 15.
Just enough babies to form a soccer team, with a few subs to spare.
[crowd cheers]
One possible reason uptake is slow,
cost.
From the get-go,
this life-changing treatment is restricted to those who can afford it.
The doctors responsible for the birth of Louise Brown open
the world's first specialist IVF clinic,
Bourn Hall,
at the start of the 1980s.
For one attempt at IVF, known as a cycle,
patients pay around 3,000 pounds,
about 5,400 US dollars.
That's approximately half the average annual income
in the UK at the time.
I can't resist asking you this. Is it going to be cash on delivery?
[chuckles]
Well, we can't guarantee delivery.
[narrator] But despite the lack of certainty,
patients flock to Bourn Hall,
and more successes soon follow.
By the mid-1980s,
over 500 IVF babies are born there.
But in just two years, that number doubles to 1,000.
But that's not the whole picture.
Globally, only 10% of IVF attempts are resulting in a successful birth.
I think the chance of improving our techniques are considerable,
and we hope that we'll be able to improve methods, improve results.
[narrator] But as scientists hone their techniques,
more embryos are created than implanted.
Some scientists think spare embryos could be preserved in ice,
but water in the embryo cells, when frozen, can form harmful crystals.
Until scientists discover,
by dropping the temperature gradually down to minus 196 degrees Celsius
and then storing the embryo in liquid nitrogen,
they can suspend it in time for weeks,
years, maybe even indefinitely.
[man] She's just like any other baby except she's a miracle of modern science.
The world's first frozen-embryo baby.
[narrator] In 1984,
Baby Zoe is born in Australia
from an embryo frozen two months prior to implantation.
Now, spare embryos can be saved for future pregnancies
or donated to women whose own eggs aren't viable,
opening up the potential for women to have babies later in life.
But despite these so-called miracles,
not everyone thinks it's okay to give nature a helping hand.
In 1987,
the Catholic Church issues its most important statement
on reproduction in over 20 years.
The procreation of a new person
is not to be separated from that act of intercourse
in which two people express their love for each other.
[narrator] The Catholic Church's condemnation of IVF is a devastating blow
for many of its more than 800 million followers.
There are a large number of my patients
who are going to be shattered by this news,
who are going to feel, if they decide to disobey the church,
they will feel desperately guilty.
[narrator] Despite some opposition, for many wannabe parents,
IVF has created a new hope,
and not just for heterosexual couples.
At the start of the 1980s,
the Sperm Bank of California
becomes the first fertility clinic in the US
open to lesbian couples wanting to start a family.
But a 1988 study finds that, among all hopeful mothers in America,
lesbian couples are the most likely to be refused IVF services.
And in some European countries,
same-sex couples are banned entirely from accessing treatment.
[crowd chanting indistinctly]
IVF is not yet an equal opportunity for all.
[toddler giggles]
Despite the lack of access for some, IVF is on the rise.
Globally,
the total number of IVF babies born by 1990 is 95,000.
That's more babies than there are spectators
at a Major League Soccer game.
[crowd cheers]
But this growing industry remains largely unregulated by lawmakers,
which means there's not much they can do if practitioners step out of line.
A problem that becomes clear in 1992,
in the case of US IVF doctor Cecil Jacobson.
Please, ma'am.
[narrator] Jacobson allegedly used hormone treatments to mislead some women
into believing they were pregnant
when their implantation had actually failed.
But when those patients visited other doctors,
they discovered the devastating truth.
I thought he meant that we'd lost the baby,
but he said, "No." He said, "There… There just is no baby."
[narrator] But that isn't all.
During the investigation,
it emerges that Jacobson also secretly used his own semen
to inseminate many of his other IVF patients.
DNA tests reveal the doctor is the biological father
of at least 15 children born to his patients.
Dr. Jacobson told the court he'd only been trying to help his victims,
but Judge James Cacheris said he'd never before heard a case
which involved such a degree of psychological trauma.
[narrator] But it turns out that some of what Jacobson did
isn't technically against any law.
He can only be found guilty of secondary charges,
including mail fraud and perjury.
His punishment?
A five-year prison sentence
and fines of just over $100,000.
And the Jacobson case is not an isolated one.
Similar cases have been reported in Canada, the Netherlands, and the UK,
among others.
By the end of the 1990s,
critics are speaking out about the lack of laws governing the IVF industry,
including reports of clinics manipulating data to mislead patients
and using increasingly aggressive sales techniques.
They're more likely to, for example, quote national success rates
rather than clinic-specific success rates.
They're more likely to talk about pregnancies but not miscarriages.
[narrator] But patients aren't put off.
By the year 2000,
the number of IVF babies born hits one million.
That's enough babies to fill Europe's biggest soccer stadium,
Camp Nou in Barcelona, ten times.
[crowd cheers]
As IVF continues to rise in popularity…
♪ Money… ♪
…so does the price tag.
At the turn of the new millennium,
it cost almost $10,000 per treatment in the USA.
But just over a fifth of cycles results in a successful outcome.
To maximize their chances, patients are happy to, shall we say,
put all their eggs in one basket and implant multiple embryos at a time.
[woman] I had suggested, like, three or four embryos,
just because of the cost
and the psychological trauma you go through.
To just have one implanted is, um… it almost doesn't seem worth it.
[narrator] With patients feeling the strain of rising costs,
by the early 2000s,
over 50% of babies born through IVF are twins, triplets,
or other multiples.
But carrying more than one baby at a time comes with drawbacks.
More than half of all twins are born prematurely,
and moms are at higher risk of pregnancy complications,
including preeclampsia and gestational diabetes.
In the USA, regulators recommend that with healthy patients under 35 years old,
no more than two embryos should be transferred at one time.
But with no official restriction,
doctors are left to use their own discretion.
In one of the most extreme examples of a physician ignoring this guideline,
a patient of California doctor Michael Kamrava
finds herself pregnant with eight babies.
The press nickname her…
[reporter] "Octomom" Nadya Suleman with her own media circus.
[man] Hey!
[reporter] It's now turned her into a lightning rod for public sentiment.
[narrator] Although premature, all of Suleman's babies are born healthy.
Her doctor admits exercising poor judgment
but argues Suleman had consented to treatment.
But the California Medical Board would later discover
Dr. Kamrava implanted 12 embryos into Suleman.
They revoke the doctor's license.
But many IVF providers
remain open to transferring more than the recommended number
at the request of patients pressured by rising costs.
In the US, by 2015,
it's estimated patients need to spend $12,000 for each cycle of IVF treatment.
To up those profits further,
some clinics push expensive extras.
A 2016 study found
that of the 27 add-on treatments available in the UK,
26 of them were not supported by approved scientific evidence.
Like… assisted hatching,
where doctors thin or pierce the egg's outer layer
to help the embryo emerge.
And an endometrial receptivity array,
which supposedly tests to find the optimal time for embryo transfer.
Of the more than 480 fertility clinics across America,
most have very little regulation,
and globally,
almost half of all IVF countries operate with either voluntary guidelines
or none at all.
But the miracle of IVF will not be held back,
as babies around the world continue to break records.
November 2017,
in Tennessee.
Newborn baby Emma is believed to be the oldest frozen embryo ever
to result in a successful birth.
The embryo was donated and frozen 24 years earlier
in 1992,
when her future birth mother was just a baby herself.
[woman] I was like, "Wow."
If this embryo had been born when it was supposed to have been,
we could've been best friends. I was like, "I'm only 25!"
[narrator] As IVF becomes more commonplace,
an increasing number of public figures
start speaking about their own fertility struggles,
including Michelle Obama in her 2018 book
and singer Natalie Imbruglia.
I think there's a lot to be gained
from this conversation being out there,
and I don't think women should feel they can't talk about it
or they're alone in it.
[narrator] And IVF numbers continue climbing.
By 2018,
the total number of babies born globally thanks to IVF
hits eight million.
That's more than double the number of babies born in America every year.
But in 2020,
a global pandemic brings IVF growth to an abrupt stop.
During lockdown, IVF treatment is considered nonessential
in many countries,
and clinics are forced to close.
In the US,
an estimated 30,000 cycles are disrupted or canceled
in the first month of the pandemic.
Across the world,
potential parents experience the same heartache.
Biggest fear is that we don't get to experience what a pregnancy feels like.
That may not happen as a result of these delays.
I just can't comprehend the level of grief that that would be.
[narrator] But even a global pandemic won't slow the rate of IVF for long.
By the end of this century,
it's estimated 400 million babies will have been born thanks to IVF.
With IVF now commonplace in many countries,
there's growing pressure on lawmakers to regulate
this multi-billion dollar industry
and better protect its patients.
In 2019,
Indiana becomes the first US state to outlaw doctors
from using their own sperm without a patient's knowledge.
In 2021,
UK regulators request tougher penalties
for selling ineffective IVF add-on treatments.
India passes a bill to ensure the safe and ethical practice of IVF services.
And a change to French law grants single women and lesbian couples
equal access to fertility treatment for the first time.
Ideally,
the IVF industry will become fairer and, with better science, more effective.
In the years following Louise Brown's birth,
success rates were in single digits.
Now, over 40 years later,
nearly half of IVF cycles in American women under 35
are successful.
IVF has literally changed the society in which we live,
creating hope for many whose dreams of parenthood
might now become a reality.
But only if they're prepared to pay the price,
both financially and emotionally.
[downtempo electronic music plays]