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At its core, however, fertility is still a market where entry remains limited and size matters. Yes, there has been a scramble to enter the market, and yes, increasing numbers of physicians now offer fertility services to their eager patients. But the central players in the industry are reproductive endocrinologists, specialists who can enter the profession only after years of formal training, and the absolute number of clinics is therefore limited by their supply. Moreover, much of the fertility industry is increasingly marked by significant economies of scale, meaning that firms or clinics must serve a large number of clients simply to cover their fixed costs.

As a result, production in the fertility trade is rather concentrated, and a handful of big players—in hormones, in clinics, in sperm—accounts for a growing percentage of the total business. These are the players that generate the largest volumes, the greatest economies of scale, and the highest profits. They are also the players that have been able to keep their prices remarkably stable over time: in 1986, the price for an in vitro fertilization cycle was roughly $5,000 to $6,000 at a top-of-the-line private clinic. [4] In 2003, the average price was $12,400, or only slightly more than the inflation-adjusted price of the older $6,000 service. [5]

What makes this calculation particularly interesting is that the IVF industry expanded dramatically over this same period, growing from a tiny and experimental niche of research to an established branch of treatment. One might therefore have expected prices to decline. (Think, for example, of the early years of the computer industry, when prices fell dramatically as manufacturers rushed to supply demand.) [6] Yet instead, IVF prices nudged slightly upward, bearing evidence of both the suppliers’ power to raise prices in this market and the buyers’ willingness to pay. [7] In this regard, the fertility industry looks somewhat like a luxury trade, with a handful of powerful suppliers (think of Tiffany’s, Armani, or DeBeers) catering to a well-heeled clientele.

Yet fertility, of course, is not a luxury good. Indeed, for those who lack it, fertility is a necessity of life—a basic human right, according to many advocates. [8] And because markets are political structures—because they are conceived and shaped in a democracy by competing political demands—the fertility market also bears signs of another kind of demand: a politically expressed demand for lower prices, greater access, and expanded choice. Although this demand has been relatively quiet (infertile people are far less politically active than cancer sufferers or AIDS patients), it has still made a mark in the industry, affecting how the market develops and what suppliers can do.