[Page 36]

Even in medical circles, fertility remains a niche market, one that is unlikely to expand beyond a small fragment of potential customers. Most of these potential customers, moreover, never avail themselves of any form of treatment: as noted earlier, only 36 percent of infertile women in the United States seek medical assistance, and only 1 percent resort to ART. [92] The others keep trying, give up, or move on to other pursuits.

Those that do enter the market, by contrast, are decidedly wealthier and better educated than average. [93] They are clearly members of a global elite, interacting in what feels very much like a luxury market: $12,400 for an average cycle of IVF, $3,500 for PGD, up to $50,000 for Ivy League eggs. The firms that serve this clientele, meanwhile, are highly concentrated and distinctly profitable. The global market for sperm is dominated by a small number of high-volume, high-profit firms. So is the market for hormones, where companies like Ares-Serono and Organon (a subsidiary of Akzo Nobel) face limited competition and almost no downward pressure on price. Egg brokers and fertility centers are newer entrants to the fertility trade, but already they seem to be evolving along a similar course, with smaller centers consolidating into networks like IntegraMed, and larger centers like Boston IVF reaping the substantial profits of scale.

The fertility industry presumably could stay this way for quite some time, settling into a small and highly lucrative corner. It could continue to serve a relatively small portion of the population, pushing along technology’s edge to refine the science of conception. It could retain a kind of Tiffany’s mentality, selling hugely valued products to couples willing to pay.

Yet experience both outside the United States and in other industries suggests that the fertility trade could also follow a very different route, one that embraces a larger market in exchange for substantially lower prices and a modicum of regulation. Consider the fact that about 75 percent of fertility’s potential customers are not yet buying the product: only 15 percent of infertile women in the United States have used fertility drugs; only 5.5 percent have employed artificial insemination, and only 1 percent have tried IVF. [94] Consider, too, that recent developments promise to extend the benefits of fertility treatment beyond the infertile population. Soon, perfectly healthy young women could regularly choose to freeze their eggs, hedging against the “risks” of a late marriage or a prolonged career. Soldiers could routinely freeze their sperm before going off to war, and homosexual couples could use assisted reproduction to conceive and bear their genetic offspring. Such applications could add millions of customers to the fertility trade—but only if prices come down and access is widened.