Reel Science: The Lottery

From Margaret Atwood’s novel The Handmaid’s Tale to Timothy J. Sexton’s screenplay for Children of Men, infertility epidemics have proven fertile ground for science fiction storytellers. The latest dystopian vision of a world without babies comes via Lifetime Television’s new series The Lottery, on which Sexton serving as writer and executive producer. Set in the year 2025, when no new children have been born for five years, the pilot episode focuses on a scientist, Alison Lenon (Marley Shelton), who has managed to fertilize 100 eggs. The government then concocts a plan to hold a lottery, giving 100 women the chance to be not only surrogate mothers, but also saviors of the human race.

Such apocalyptic scenarios may be enduring, but scientific research presents a much less frightening outlook. A report issued last year by the National Center of Health Statistics, which covered data from 1982-2010, suggests infertility rates have actually decreased among U.S. women of childbearing age. At this rate, over-population appears to be a far more real concern than declining birth rates.

Sloan Science and Film spoke with one of the report’s co-authors, Dr. Anjani Chandra, a demographer and health scientist at the Center for Disease Control’s National Center for Health Statistics. A member of the National Survey of Family Growth Team, Dr. Chandra conducts research on the fertility and reproductive health of women, and spoke to SSF about infertility data, the latest work in infertility treatments and CDC action plans.

Sloan Science and Film: So do we have any reason to fear an outbreak of infertility?

Anjani Chandra: No. The answer is simply: no. There has not been any real shift in the prevalence of infertility. In fact, some might argue that there has been a small decline if you use the traditional 12-month measure. It’s obviously an appealing thing to worry about, but there is no evidence of any systematic increase in age-specific infertility. The reason I say age-specific is because everyone knows the biological ability to have a child gets less with age. But if you look at age-specific infertility rates and ask: Is a 25-29-year-old any more likely to be infertile now than she would have been in 1982, or 1900, for that matter? The answer is: no. If we see any blips in the patterns over time, it’s related to other factors that relate to people trying to get pregnant. There’s certainly been delayed marriage; so if people are getting married later then that shifts the timing of when they’re trying to have their first child. But other than that, no. Even people’s concerns with environmental estrogens, or impacts on sperm count are not significant. Maybe there’s been some adverse impact on sperm count and sperm functioning, but even there, it’s not anything of the magnitude that would lead to catastrophe.

SSF: Are there any geographic areas where infertility rates have been more impacted than others?

AJ: You will see patterns related to demographic characteristics, related to income or race. But even there, you’re measuring not infertility itself but the timing of first births or the first attempt at child bearing. So you might see women of higher education who are more likely to delay marriage and child-bearing, which might have more trouble, but it doesn’t mean age-specific rates of infertility are any higher. It’s just that subgroups are trying at older ages. Almost everything you see in the patterns is linked more plausibly to these biological infertility probabilities. If you’re older when you try, that’s it. In this new show, to what are they attributing the lack of children being born?

SSF: There’s no explanation, at least not yet.

AJ: Well, barring any kind of cataclysmic or environmental exposure—the atomic bomb or something—it’s just not likely going to cause this.

SSF: Are there any anomalies in the data where things have gone up or down over the years?

AJ: Actually, what we’re seeing with married women, especially, over the time period we’ve been surveying is that infertility has reduced, not increased, which more has to do with medical treatments for infertility. People will seek out medication attention.

SSF: That leads me to a question about fertility treatments. Has that swayed the data?

AJ: No, fertility treatments have plateaued, even after the uptick in the use of medical services for infertility in the early 90s. And this is an artifact of the huge generations of baby boomers who are now aging. The youngest baby boomers are probably fifty, so they’re past their reproductive years. You might hear in the news about an increase use of IVF and other reproduction assisted technologies, but a very small portion of the population uses them.

SSF: In the show, one of the imagined consequences of the crisis is the rise of a black market in infertility drugs. From what you’re saying, it doesn’t sound like this would be actually lucrative or viable.

AJ: Just generally, even with what’s happening in infertility treatments, they have been tweaking the technique of ART [assisted reproductive technology], but they aren’t inventing new ways to do it. There are donor eggs and donor sperm, and there are different places you can implant, and they’re improving their success rates. But there’s only so much creativity you need: Biology is still biology.

SF: Are you aware of anything going on at the CDC that plans for what to do in a crisis scenario?

AJ: It’s not exactly for a crisis, but last week the CDC put out a national action plan for the diagnosis, prevention and management of infertility. It’s a public health approach, and what future directions of research and public health practice should be in the area of infertility. There’s no real crisis foreseen, so this national action plan doesn’t speak about what to do in the case of bio-terrorism, but the everyday challenges for people who may face infertility and what diagnostic and treatment options there might be.

SSF: So what do you think these fears of infertility are about in these stories since it doesn’t seem to be based even remotely in any kind of reality?

AJ: My own personal opinion is that it obviously taps into some kind of primal fear we have about the survival of the species. That’s one of the reasons I’ve always liked to read The Handmaid’s Tale, and other stories where it comes back to the fact that humans need reproduction to continue the species. If you lose that, no matter how much technology and power you have, you go extinct.