Don't change us, change the world

YESTERDAY THE annual meeting of the European Society of Human Reproduction heard from Italian researchers that women over 40 might now have the same chance of having a baby through IVF as women in their twenties. The breakthrough was conveyed to us through excited newspaper headlines, and indeed it conjures up all sorts of dreams.

Although the gradual decrease in fertility leading to the menopause would once have come as a blessed release to women tired out from bearing children throughout their youth, these days the biological clock seems to work against us. More women than ever before now hit their thirties and forties having deliberately delayed having children - usually because they've been looking for a good partner or working too hard - and the numbers who then start trying to conceive when their ovaries are winding down is constantly increasing.

The press reaction to this advance in reproductive technology was optimistic, and you can see why. There's a dream scenario ahead - that one day women might feel as secure as men in putting off having children. This would mean an end to those novels and television series, from Bridget Jones's Diary to Sex in the City that are based around the premise that the world is full of thirtysomething women who are desperate to get married before it's too late. But will this breakthrough really smash the biological clock?

If so, we will all be cheering. It would be glorious if women could choose to have children at any point over three or more decades of reproductive life. But we should hold off the cheers for quite a while. Medical breakthroughs tend to be presented to us through rosy-tinted spectacles. Fertility advances, in particular, are often presented as miracles, as though all uncertainty and suffering over reproduction will now be swept away. Yet the reality never lives up to the hype.

For generations the idea that science should be able to banish the messiness of natural reproduction has been held up as one of the highest goals of medicine. But despite the best efforts of thousands of committed doctors and drug companies and compliant women, reproduction remains a pretty hit-and-miss affair. One study of rates of IVF success published in The Lancet in 1996 showed that even women of 25 to 30 stood only a 16 per cent chance of becoming pregnant from each treatment.

Many miserable women go through four or five complicated and invasive treatments and yet never achieve their longed-for child. In addition, the effects of the fertility drugs and the implantation procedure, both on the child and the mother, are still open to question. Two prominent British women who died recently of cancer - Liz Tilberis, editor of Harper's Bazaar, and the journalist Ruth Picardie - understandably believed that the fertility treatments they had endured had encouraged the growth of their ovarian and breast cancers.

Where the treatments involve procedures such as introducing otherwise unviable sperm directly into the egg, or using frozen embryos, the doctors who carry out the procedures will frankly tell you that they do not know what the long-term effects will be on the resultant children.

These concerns do not mean that women shouldn't go for these treatments if they think the longed-for benefits will outweigh the risks. But we should never put our faith in the doctors to iron out all the glitches of the natural world. And maybe, rather than looking to medical science for easy answers, we also should look at why women are turning away from having babies when it is physically easier for them to do so, in their twenties.

Fertility specialists often refer to their older clients as "career women". Career women still operate in a man's world, one in which the masculine model of workers without domestic responsibilities disadvantages those who have them. Somehow, we have internalised the idea that this is as it should be, that women in their teens and twenties who have babies are unambitious and irresponsible.

But maybe it's the world around them which is unambitious and irresponsible. Why should we assume that it is better for women to fit into the traditional career model for as long as they possibly can, rather than trying to build a world that might suit them better, a world in which employers accept that workers have domestic responsibilities? Affordable childcare, longer parental leave and better opportunities for returning workers might allow more women to have children before their ovaries give up.

The quick fixes of medical science are all very well, but they are no substitute for a world in which women have real control of their bodies and their lives.

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