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[electronic beeping, buzzing]

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[indistinct chatter]

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[narrator] April 2016.

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Punjab, India.

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Daljinder Kaur has just given birth
to her first baby

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after 46 years of trying.

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At over 70 years of age,

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she's one of the oldest first-time mothers
in the world.

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Daljinder and her husband are delighted.

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{\an8}[in Punjabi]

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[narrator] This little miracle
was made possible

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by a medical reproductive technique

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that's changed humanity forever.

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IVF.

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In vitro fertilization.

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The "in vitro" part
is Latin for "in glass,"

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because IVF allows the fertilization
of a human egg outside the body,

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in a dish…

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making parenthood a possibility
not only for some older mothers

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but other women who otherwise
have trouble getting pregnant.

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Today, over 2%
of all babies born in the USA,

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almost 84,000 a year,

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are because of IVF.

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Denmark, where the process
is government funded,

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has the highest rate
of IVF births, around 10%.

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Since 1978,

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more than eight million babies
have been born worldwide through IVF,

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which is also big business.

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In 2021,

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the global IVF market is estimated
to be worth around 13 billion US dollars.

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But success is by no means assured.

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Even today,

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IVF attempts are on average

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only successful
just over a third of the time.

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IVF is now more popular than ever,

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but the procedures are expensive,

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and globally,
the industry is largely unregulated,

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leaving patients vulnerable
to unscrupulous providers.

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IVF has made the dream of parenthood
a reality for millions.

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But at what cost?

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[babies cry]

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Making babies.

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It's been an essential part
of humanity's survival for millennia.

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But how do these little bundles
of joy come to be?

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Time to revisit biology class.

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{\an8}Once a month, a woman's ovaries
release an egg into her fallopian tube.

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{\an8}After sex, millions of sperm
travel towards the egg.

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If one penetrates it,
then the real magic begins.

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The DNA in the sperm and egg combine,

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and the cells start dividing.

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This will become an embryo.

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It continues along the fallopian tube

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and attaches itself
to the wall of the uterus.

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The woman is now pregnant.

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But unfortunately,

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it's not always that simple.

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Some women have blocked fallopian tubes,
stopping the sperm reaching the egg.

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Some men have low sperm count,

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and egg quality declines with age,

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narrowing the window
of opportunity for conception.

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If scientists could figure out
a way to fertilize a woman's eggs

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outside the body

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and then implant the resulting embryo
into the uterus,

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it could offer a solution
for people unable to conceive naturally.

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In the 1950s,

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researchers have some success
working with small mammals.

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Then a decade later,

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{\an8}British scientist Dr. Robert Edwards
makes a key discovery.

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{\an8}Eggs take the same amount of time
to mature outside the body

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{\an8}as they do inside,

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allowing him to determine the moment
they're ready for fertilization.

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He hopes to apply his findings
to create a human embryo.

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Sounds easy, right?

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{\an8}But the problems in rabbit are simple
compared with those in the human.

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[narrator] Mmm, maybe not.

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{\an8}In 1968, he partners
with British obstetrician Patrick Steptoe,

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a pioneer of a surgical technique
called laparoscopy,

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which allows the safe retrieval
of a woman's eggs

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without a large incision.

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Along with nurse
and embryologist Jean Purdy,

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they begin attempts
at human egg fertilization

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at a hospital
in Oldham, Greater Manchester.

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After successfully retrieving eggs
using laparoscopy,

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they mix them with sperm
to create embryos.

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But none of their attempts at implantation
results in a successful pregnancy.

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{\an8}The scientists suspect
they've been waiting too long

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before implanting the embryos.

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So in 1977,

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while working with would-be parents
Lesley and John Brown,

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they implant the couple's embryo
in half the usual time.

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And… success!

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After years of infertility,

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Lesley Brown is pregnant.

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Her pregnancy becomes international news.

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In Oldham, England,
Mrs. Lesley Brown might give birth

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{\an8}to the first test-tube baby, and soon.

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{\an8}[narrator] But the pregnancy
is met with a sense of public unease.

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Will a baby born from IVF turn out,

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well, normal?

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You might have deformity.

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You've got to be careful
using the word "deformity."

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{\an8}[narrator] With all eyes on Oldham,
Lesley is placed under general anesthetic

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{\an8}for a C-section.

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{\an8}[man] You are about to see
a historic birth

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{\an8}following in vitro fertilization.

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[narrator] They film the birth
to prove the baby is Lesley's,

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and in the glare of the spotlight,

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Louise Joy Brown is born.

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-[Steptoe] It's a girl.
-[baby cries]

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[Steptoe] Good healthy cry.

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Lovely pink color.

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I am now handing the baby to Dr. Edwards,

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whose brains, skill, and perseverance
has made this birth possible.

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He's been assisted by Jean Purdy.

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[narrator] Weighing five pounds
and 12 ounces,

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Louise is a healthy, adorable baby.

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Letters flood in
to congratulate the Browns

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{\an8}and the scientists responsible
for this modern medical miracle.

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{\an8}This could be a treatment
which will give a great hope

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{\an8}to many people in the future
who can't have a baby at the present time.

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[narrator] So, how does
this "miracle" work?

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Today, doctors follow a similar formula
to those pioneers in the '70s.

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Step one, administer medicines
to suppress the natural menstrual cycle

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and stimulate the ovaries
to produce more eggs.

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Step two,

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when ready,
gently remove eggs from ovaries.

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Step three,

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select the strongest sperm.

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In a petri dish, mix with the eggs,

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and place in an incubator.

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{\an8}By morning,

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{\an8}60 to 70% should have fertilized
into embryos.

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{\an8}Step four,

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transfer one
or more embryos to the uterus,

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hoping they implant.

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Let sit for two weeks,

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then check for pregnancy.

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Following Louise's successful birth,

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IVF goes global.

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{\an8}India records the world's second IVF birth
later that year.

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And Australia welcomes
their first IVF baby in 1980.

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Three years after Louise's historic birth,

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{\an8}the USA welcomes
its first baby born from IVF,

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{\an8}Elizabeth Jordan Carr.

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America has
its first test-tube baby tonight.

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The doctors say she is perfectly normal.

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[narrator] IVF has arrived,
but it's still rare.

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By 1981,

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the number of IVF babies
born across the world is only 15.

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Just enough babies to form a soccer team,
with a few subs to spare.

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[crowd cheers]

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One possible reason uptake is slow,

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cost.

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From the get-go,

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this life-changing treatment
is restricted to those who can afford it.

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The doctors responsible
for the birth of Louise Brown open

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the world's first specialist IVF clinic,

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Bourn Hall,

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at the start of the 1980s.

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For one attempt at IVF, known as a cycle,

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patients pay around 3,000 pounds,

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about 5,400 US dollars.

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That's approximately
half the average annual income

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in the UK at the time.

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I can't resist asking you this.
Is it going to be cash on delivery?

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{\an8}[chuckles]

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{\an8}Well, we can't guarantee delivery.

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[narrator] But despite
the lack of certainty,

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patients flock to Bourn Hall,

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and more successes soon follow.

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By the mid-1980s,

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over 500 IVF babies are born there.

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But in just two years,
that number doubles to 1,000.

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But that's not the whole picture.

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Globally, only 10% of IVF attempts
are resulting in a successful birth.

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I think the chance of improving
our techniques are considerable,

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and we hope that we'll be able
to improve methods, improve results.

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[narrator] But as scientists
hone their techniques,

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more embryos are created than implanted.

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Some scientists think spare embryos
could be preserved in ice,

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but water in the embryo cells,
when frozen, can form harmful crystals.

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Until scientists discover,

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by dropping the temperature gradually
down to minus 196 degrees Celsius

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and then storing the embryo
in liquid nitrogen,

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they can suspend it in time for weeks,

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years, maybe even indefinitely.

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[man] She's just like any other baby
except she's a miracle of modern science.

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The world's first frozen-embryo baby.

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{\an8}[narrator] In 1984,

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{\an8}Baby Zoe is born in Australia

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from an embryo frozen
two months prior to implantation.

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Now, spare embryos can be saved
for future pregnancies

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or donated to women
whose own eggs aren't viable,

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opening up the potential for women
to have babies later in life.

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But despite these so-called miracles,

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not everyone thinks it's okay
to give nature a helping hand.

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{\an8}In 1987,

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{\an8}the Catholic Church issues
its most important statement

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on reproduction in over 20 years.

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{\an8}The procreation of a new person

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{\an8}is not to be separated
from that act of intercourse

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{\an8}in which two people
express their love for each other.

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[narrator] The Catholic Church's
condemnation of IVF is a devastating blow

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for many
of its more than 800 million followers.

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{\an8}There are a large number of my patients

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{\an8}who are going to be shattered
by this news,

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{\an8}who are going to feel,
if they decide to disobey the church,

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{\an8}they will feel desperately guilty.

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[narrator] Despite some opposition,
for many wannabe parents,

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IVF has created a new hope,

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and not just for heterosexual couples.

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At the start of the 1980s,

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the Sperm Bank of California

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becomes the first fertility clinic
in the US

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open to lesbian couples
wanting to start a family.

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But a 1988 study finds that,
among all hopeful mothers in America,

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lesbian couples are the most likely
to be refused IVF services.

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And in some European countries,

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same-sex couples are banned entirely
from accessing treatment.

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[crowd chanting indistinctly]

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IVF is not yet
an equal opportunity for all.

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[toddler giggles]

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Despite the lack of access for some,
IVF is on the rise.

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Globally,

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the total number of IVF babies
born by 1990 is 95,000.

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That's more babies
than there are spectators

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at a Major League Soccer game.

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[crowd cheers]

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But this growing industry
remains largely unregulated by lawmakers,

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which means there's not much they can do
if practitioners step out of line.

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{\an8}A problem that becomes clear in 1992,

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{\an8}in the case of US IVF doctor
Cecil Jacobson.

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Please, ma'am.

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[narrator] Jacobson allegedly used
hormone treatments to mislead some women

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into believing they were pregnant

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when their implantation
had actually failed.

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But when those patients
visited other doctors,

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they discovered the devastating truth.

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{\an8}I thought he meant
that we'd lost the baby,

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{\an8}but he said, "No."
He said, "There… There just is no baby."

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[narrator] But that isn't all.

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During the investigation,

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it emerges that Jacobson
also secretly used his own semen

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to inseminate many
of his other IVF patients.

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00:14:01,040 --> 00:14:04,680
DNA tests reveal
the doctor is the biological father

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00:14:04,760 --> 00:14:07,800
of at least 15 children
born to his patients.

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Dr. Jacobson told the court
he'd only been trying to help his victims,

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00:14:12,480 --> 00:14:15,560
but Judge James Cacheris
said he'd never before heard a case

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which involved such a degree
of psychological trauma.

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[narrator] But it turns out
that some of what Jacobson did

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isn't technically against any law.

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He can only be found guilty
of secondary charges,

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including mail fraud and perjury.

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His punishment?

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A five-year prison sentence

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00:14:34,600 --> 00:14:38,080
and fines of just over $100,000.

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And the Jacobson case
is not an isolated one.

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Similar cases have been reported
in Canada, the Netherlands, and the UK,

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among others.

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By the end of the 1990s,

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critics are speaking out about the lack
of laws governing the IVF industry,

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including reports of clinics
manipulating data to mislead patients

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and using
increasingly aggressive sales techniques.

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{\an8}They're more likely to, for example,
quote national success rates

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00:15:09,440 --> 00:15:12,400
{\an8}rather than clinic-specific success rates.

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{\an8}They're more likely to talk about
pregnancies but not miscarriages.

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[narrator] But patients aren't put off.

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By the year 2000,

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the number of IVF babies born
hits one million.

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That's enough babies to fill
Europe's biggest soccer stadium,

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Camp Nou in Barcelona, ten times.

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[crowd cheers]

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As IVF continues to rise in popularity…

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♪ Money… ♪

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…so does the price tag.

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At the turn of the new millennium,

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it cost almost $10,000
per treatment in the USA.

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But just over a fifth of cycles
results in a successful outcome.

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To maximize their chances,
patients are happy to, shall we say,

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put all their eggs in one basket
and implant multiple embryos at a time.

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[woman] I had suggested,
like, three or four embryos,

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just because of the cost

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00:16:11,200 --> 00:16:14,680
{\an8}and the psychological trauma
you go through.

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{\an8}To just have one implanted
is, um… it almost doesn't seem worth it.

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[narrator] With patients
feeling the strain of rising costs,

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by the early 2000s,

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over 50% of babies
born through IVF are twins, triplets,

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or other multiples.

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00:16:32,320 --> 00:16:35,760
But carrying more than one baby at a time
comes with drawbacks.

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More than half
of all twins are born prematurely,

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and moms are at higher risk
of pregnancy complications,

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including preeclampsia
and gestational diabetes.

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In the USA, regulators recommend that
with healthy patients under 35 years old,

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no more than two embryos
should be transferred at one time.

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But with no official restriction,

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doctors are left
to use their own discretion.

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00:17:07,280 --> 00:17:12,160
{\an8}In one of the most extreme examples
of a physician ignoring this guideline,

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{\an8}a patient of California doctor
Michael Kamrava

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finds herself pregnant with eight babies.

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The press nickname her…

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00:17:21,400 --> 00:17:24,960
[reporter] "Octomom" Nadya Suleman
with her own media circus.

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[man] Hey!

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00:17:25,960 --> 00:17:30,000
[reporter] It's now turned her
into a lightning rod for public sentiment.

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[narrator] Although premature,
all of Suleman's babies are born healthy.

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Her doctor admits exercising poor judgment

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but argues Suleman
had consented to treatment.

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00:17:42,440 --> 00:17:45,080
But the California Medical Board
would later discover

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00:17:45,160 --> 00:17:48,840
Dr. Kamrava implanted
12 embryos into Suleman.

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They revoke the doctor's license.

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But many IVF providers

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remain open to transferring
more than the recommended number

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at the request of patients
pressured by rising costs.

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{\an8}In the US, by 2015,

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it's estimated patients need to spend
$12,000 for each cycle of IVF treatment.

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00:18:14,200 --> 00:18:16,000
To up those profits further,

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some clinics push expensive extras.

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A 2016 study found

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that of the 27 add-on treatments
available in the UK,

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00:18:27,960 --> 00:18:31,960
26 of them were not supported
by approved scientific evidence.

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Like… assisted hatching,

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00:18:35,640 --> 00:18:38,360
where doctors thin
or pierce the egg's outer layer

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to help the embryo emerge.

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00:18:43,400 --> 00:18:45,960
{\an8}And an endometrial receptivity array,

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00:18:46,040 --> 00:18:49,640
which supposedly tests to find
the optimal time for embryo transfer.

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00:18:51,080 --> 00:18:55,080
Of the more than 480 fertility clinics
across America,

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most have very little regulation,

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and globally,

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almost half of all IVF countries
operate with either voluntary guidelines

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or none at all.

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00:19:10,280 --> 00:19:13,360
But the miracle of IVF
will not be held back,

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00:19:13,440 --> 00:19:16,840
as babies around the world
continue to break records.

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{\an8}November 2017,

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{\an8}in Tennessee.

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00:19:21,920 --> 00:19:26,680
{\an8}Newborn baby Emma is believed
to be the oldest frozen embryo ever

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00:19:26,760 --> 00:19:28,400
{\an8}to result in a successful birth.

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00:19:29,240 --> 00:19:33,000
{\an8}The embryo was donated
and frozen 24 years earlier

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00:19:33,080 --> 00:19:34,800
{\an8}in 1992,

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00:19:34,880 --> 00:19:38,520
{\an8}when her future birth mother
was just a baby herself.

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{\an8}[woman] I was like, "Wow."

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00:19:40,480 --> 00:19:43,400
{\an8}If this embryo had been born
when it was supposed to have been,

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00:19:43,480 --> 00:19:46,720
{\an8}we could've been best friends.
I was like, "I'm only 25!"

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00:19:48,280 --> 00:19:50,920
[narrator] As IVF becomes
more commonplace,

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{\an8}an increasing number of public figures

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00:19:52,800 --> 00:19:55,640
{\an8}start speaking
about their own fertility struggles,

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00:19:55,720 --> 00:19:59,440
including Michelle Obama in her 2018 book

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00:19:59,520 --> 00:20:01,400
and singer Natalie Imbruglia.

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00:20:01,960 --> 00:20:04,040
{\an8}I think there's a lot to be gained

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00:20:04,880 --> 00:20:07,120
{\an8}from this conversation being out there,

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00:20:07,200 --> 00:20:10,520
{\an8}and I don't think women
should feel they can't talk about it

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00:20:10,600 --> 00:20:12,000
{\an8}or they're alone in it.

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00:20:13,760 --> 00:20:15,960
[narrator] And IVF numbers
continue climbing.

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00:20:17,040 --> 00:20:18,440
By 2018,

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00:20:18,520 --> 00:20:22,560
the total number
of babies born globally thanks to IVF

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00:20:22,640 --> 00:20:24,200
hits eight million.

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00:20:25,480 --> 00:20:29,680
That's more than double the number
of babies born in America every year.

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00:20:33,000 --> 00:20:34,360
But in 2020,

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00:20:34,440 --> 00:20:38,520
a global pandemic
brings IVF growth to an abrupt stop.

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00:20:39,720 --> 00:20:43,120
During lockdown,
IVF treatment is considered nonessential

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00:20:43,200 --> 00:20:44,560
in many countries,

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00:20:44,640 --> 00:20:46,560
and clinics are forced to close.

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00:20:48,640 --> 00:20:49,600
In the US,

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00:20:49,680 --> 00:20:53,360
an estimated 30,000 cycles
are disrupted or canceled

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00:20:53,440 --> 00:20:55,520
in the first month of the pandemic.

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00:20:56,440 --> 00:20:57,760
Across the world,

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00:20:57,840 --> 00:21:00,800
potential parents experience
the same heartache.

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00:21:01,600 --> 00:21:06,040
{\an8}Biggest fear is that we don't get
to experience what a pregnancy feels like.

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00:21:06,120 --> 00:21:09,880
That may not happen
as a result of these delays.

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00:21:09,960 --> 00:21:13,680
I just can't comprehend
the level of grief that that would be.

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00:21:16,680 --> 00:21:20,480
[narrator] But even a global pandemic
won't slow the rate of IVF for long.

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00:21:21,920 --> 00:21:23,600
By the end of this century,

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00:21:23,680 --> 00:21:28,600
it's estimated 400 million babies
will have been born thanks to IVF.

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00:21:31,480 --> 00:21:34,440
With IVF now commonplace
in many countries,

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00:21:34,520 --> 00:21:36,800
there's growing pressure
on lawmakers to regulate

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00:21:36,880 --> 00:21:38,920
this multi-billion dollar industry

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00:21:39,000 --> 00:21:41,040
and better protect its patients.

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00:21:45,400 --> 00:21:46,880
In 2019,

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00:21:46,960 --> 00:21:50,320
Indiana becomes the first US state
to outlaw doctors

378
00:21:50,400 --> 00:21:53,560
from using their own sperm
without a patient's knowledge.

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00:21:55,880 --> 00:21:57,600
In 2021,

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00:21:57,680 --> 00:22:00,280
UK regulators request tougher penalties

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00:22:00,360 --> 00:22:03,360
for selling
ineffective IVF add-on treatments.

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00:22:05,320 --> 00:22:10,120
India passes a bill to ensure the safe
and ethical practice of IVF services.

383
00:22:12,840 --> 00:22:16,960
And a change to French law
grants single women and lesbian couples

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00:22:17,040 --> 00:22:20,240
equal access to fertility treatment
for the first time.

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00:22:24,760 --> 00:22:25,680
Ideally,

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00:22:25,760 --> 00:22:30,320
the IVF industry will become fairer
and, with better science, more effective.

387
00:22:31,640 --> 00:22:34,040
In the years following
Louise Brown's birth,

388
00:22:34,120 --> 00:22:36,400
success rates were in single digits.

389
00:22:37,440 --> 00:22:39,760
Now, over 40 years later,

390
00:22:39,840 --> 00:22:43,560
nearly half of IVF cycles
in American women under 35

391
00:22:43,640 --> 00:22:44,840
are successful.

392
00:22:46,600 --> 00:22:50,240
IVF has literally changed
the society in which we live,

393
00:22:50,320 --> 00:22:53,240
creating hope for many
whose dreams of parenthood

394
00:22:53,320 --> 00:22:54,880
might now become a reality.

395
00:22:55,760 --> 00:22:58,720
But only if they're prepared
to pay the price,

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00:22:58,800 --> 00:23:01,280
both financially and emotionally.

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00:23:02,400 --> 00:23:04,640
[downtempo electronic music plays]