IVF Revolutionized Fertility. Will These New Methods Do The Same

4/25/24, 9:22 PM IVF revolutionized fertility. Will these new methods do the same?
IVF revolutionized fertility. Will

these new methods do the
same?
As more and more people postpone
parenthood, scientists are working on a
moon shot effort to slow down the aging
of the ovaries.
By Rebecca Tuhus-Dubrow, Jackie Molloy
Dec 28, 2023 12:00 PM · 13 min. read ·

View original
Two weeks before her 48th birthday, Eboni

Camille Chillis lay in a hospital bed, ready to give
birth to her first child.
As she nervously waited for the doctors to begin a

cesarean section, she put on a playlist she had
made for the occasion. It consisted of songs she
found calming and empowering, such as Diana
Ross’s “I’m Coming Out,” and “Lovely Day,” by Bill
Withers. With her phone next to her ear, she sang
along. A few nurses joined in too.
https://www.nationalgeographic.com/premium/article/advanced-methods-fertility-children 1/18
Chillis had always wanted to be a mother. In her

20s and 30s she’d expected the rom-com ending.
“I would fall in love, get married, have a baby,” the
Atlanta-based educator and entrepreneur told me.
“And it didn’t happen that way.” When the
pandemic forced her to slow down and reflect, she
committed to having a child on her own. She was
in her mid-40s. Based on her age and test results,
she was told that the odds of conceiving with her
own eggs were less than one percent, which led
her to seek an egg donor. For a year she scrolled
through profiles of egg and sperm donors,
scrutinizing their baby photos, medical history,
favorite films. After finding donors who felt like the
right fit, it was time to prepare her uterus for an
embryo transfer. She gave herself daily
progesterone injections for two weeks before the
procedure and continued the shots throughout her
first trimester.
Eboni Camille Chillis, 48, holds her newborn

daughter in the baby’s room in her Atlanta home.
When Chillis decided to have a child as a single
mother, she was faced with the reality of the
shortage of Black sperm and egg donors. She co-
wrote an article about the issue for Psychology
Today. (Her daughter’s name was withheld on
request.)
Chillis and her daughter meet friends for lunch.

Before having a baby, Chillis had a demanding
career and traveled frequently. Now her main focus
is her daughter. “I’m not chasing career, I’m not
chasing promotion. She is my job, she is my
happy, she is my end goal.”
Chillis reads to her daughter from This Is Baby. “I

don’t have anything else really to prove except
proving to my daughter that I’m going to be the
best mom and the best version of myself for her,”
Chillis says.
Last January, Chillis’s daughter was born, making

her debut as Stevie Wonder’s “Isn’t She Lovely?”
played. A nurse placed the baby on the new mom’s
chest, and her tiny mouth immediately began
searching for Chillis’s breast. When she latched,
the uncertainty of the preceding years dissolved,
and Chillis thought, We’re going to be OK.
Chillis is part of a shift that’s been under way for

decades: More and more, people are postponing
parenthood. In the United States in 1970, the
average age of a woman giving birth for the first
time was 21.4. By 2021, it was 27.3. According to
the Centers for Disease Control and Prevention
(CDC), from 1985 through 2022 the birth rate for
women ages 40 to 44 rose almost continuously,
from four to 12.5 births per thousand women. For
women over 45, the rate remained low in 2022, at
1.1 per thousand women, but represented an
increase of 12 percent from the previous year.
(CDC data do not reflect that people who give
birth have a range of gender identities.) Although
the numbers vary by country, many parts of the
world show the same trend.
To be clear, some women have always had

children later in life. In 1940 the birth rate in the
U.S. for women 40 to 44 years old, and even for
women over 45, was slightly higher than it was in
2022. But at the time, these births were typically
the mother’s third, fourth, or fifth child.
Today people are starting families later and in

some cases without partners. It’s a familiar story:
People, often with access to more reliable
contraception, prioritize education and careers—
not to mention footloose freedoms—before taking
on the all-consuming responsibilities of child-
rearing. Greater opportunities for women and
evolving gender roles have been key factors.
Meanwhile, assisted reproductive technologies
such as in vitro fertilization (IVF) have enabled
people to have children in circumstances where it
previously would have been difficult. The result
has been at least 12 million children born
worldwide through IVF and a profound
transformation of human reproduction. Now
scientists are pursuing new lines of research that
appear poised to revolutionize it even more.
(Does a woman’s fertility really plummet at age

35?)
The first baby conceived through IVF was born on

July 25, 1978, in Oldham, England. The procedure
involves fertilizing an egg with sperm in a petri
dish, creating an embryo that can be transferred
into a person’s uterus. It was initially used in
cases of blocked fallopian tubes but proved
capable of addressing other infertility issues. At
the time referred to as “test-tube babies,” children
conceived by this method inspired fascination and
alarm in the media and the public. Fears ranged
from the possibility of birth defects to religious

concerns about intervening in the reproductive
process. But it didn’t take long for the procedure
to become common and widely accepted.
Tania Dimitrova, 41, holds her daughter after

dinner with brother-in-law Boyan Kostadinov and
her sister, Galya. They live close by and provide
support to Dimitrova. A single mother by choice,
she is the chief business officer at a biotech
company. “Knowing how technology has changed
will help many women conceive later, have
careers, and choose the right partner,” she says.
A month after giving birth, Dimitrova cuddles with

her daughter, Deva, during a 2 a.m. feeding.
Dimitrova pumps breast milk as she checks emails

after putting Deva to bed in New York City.
Through her work in the medical field, she was
well informed about reproductive technology
options, which gave her confidence as she chose
to conceive via intrauterine insemination, using a
sperm donor.
In some cases, a patient’s eggs were not viable,

due to age or other factors. So the medical field
started exploring egg donation. The first
successful egg-donor birth was reported in 1984.
On February 3, a headline on the front page of the
Los Angeles Times blared: “Woman Bears Donor’s

Baby”—phrasing that suggests some confusion
about who was the mother. In March 1992, Jonie
Mosby Mitchell, a former country singer, gave birth
at 52 using an egg from a younger woman. At the
time, she was reported to be the oldest mother in
the U.S. to have a baby through IVF.
Mitchell already had four children from a previous

marriage and an adopted daughter with her new
husband, but wanted a baby with him too. When I
spoke with her recently, she remembered reading
in the newspaper about Mark Sauer, then a
physician at the University of Southern California
who was a pioneer of egg donation. She reached
out to Sauer about having a baby at her age, and
she recalled his response was, “You know, Jonie,
there’s no reason in the world you can’t have one.”
She became a patient of Sauer’s and delivered a
son, Morgan. The birth was covered widely in the
press. “Everybody was tickled,” she said.
Physician Mark Sauer stands in front of a

projection of media clips from the extensive
coverage he received in magazines and
newspapers across the country for his assisted
reproduction research and techniques that led to
people giving birth later in life, even after
menopause.
Photograph by REBECCA HALE
Bob Wilson, Barbara Strong (center), and their

daughter Cristie look through articles that covered
Cristie’s birth in 1990. With Sauer as her doctor,
Strong gave birth at 41 years old, using a donor
egg because her ovaries were damaged by
chemotherapy treatment for breast cancer. In
addition to Cristie, the couple have 10 adopted
children and one child through surrogacy.
Morgan Mitchell hugs his mother, Jonie Mosby

Mitchell, who gave birth to him at 52. “He and I
are really good friends,” says Mosby Mitchell, now
84. The former country singer was Sauer’s first
patient to give birth after 50.
Successful egg-donor pregnancies confirmed that

age was not necessarily an impediment for the
uterus, even after menopause. The challenge lay in
the ovaries, which age at a markedly accelerated
rate compared with other organs in the body.
Ovarian reserve refers to the quantity and quality
of a person’s eggs. Over time, the number of eggs
sharply decreases, and those that remain
accumulate DNA damage and chromosomal
problems, making fertilization more difficult and
miscarriage more likely.
Sauer co-authored a series of articles in high-

profile medical journals about his early IVF work,
culminating in a 1993 Lancet paper titled
“Pregnancy After Age 50.” The ensuing media

attention drew droves of new patients from around
the world. Although he faced some backlash, he
said it was gratifying to help people realize their
dreams of parenthood. He recalled friends of his
own children coming to his house and saying, “My
mom said to tell you thank you for my brother.”
(AI may be key to solving the most neglected

women's health issues.)
If it weren’t for that technology, we wouldn’t

have been parents at all
Susie Troxler
The comparatively rapid aging of the ovary has

long been a mystery. There are different theories
as to why. “People talk about how there must be
some evolutionary advantage to menopause,
perhaps,” said Rebecca Robker, a professor of
biomedicine at the University of Adelaide in
Australia who studies female reproductive biology.
“You know, like the grandmother hypothesis. Is it
beneficial for societies to have these older, wise
women assist in the families?” Another theory is
that most humans didn’t live much past 40 before
medical advances lengthened life spans. But in
that case, why do other organs remain healthy for
longer, and why does sperm production continue?
The aging of the ovary itself is distinct from the

decline in egg quantity and quality, but the two are
related, albeit in ways scientists don’t yet fully
understand. And both relate to hormone
production, which affects not just fertility but
nearly all aspects of health, from cognitive
functioning to bone density.
Egg donation as well as the increasingly popular

practice of egg freezing can enable older women
to use younger eggs, whether their own or
someone else’s. But what if scientists could figure
out a way to slow down or turn back the biological
clock, so that women could prolong their fertility
while also reducing the negative health effects
that accompany ovarian aging?
Susie Troxler and husband Tony, 63, with their

daughter, Lily, in their backyard in High Point,
North Carolina. After years of trying for a
pregnancy, the Troxlers learned Tony had fertility
issues. As Susie was in her late 40s, they
ultimately used a donor egg, and Tony had a
surgical procedure to retrieve his sperm. “You
gotta roll with the process like it is,” Susie says.
Lily Troxler’s nighttime routine consists of her dad,

Tony, reading her favorite books while her mother,
Susie, rocks her in a chair. Susie then sings her a
song, and then they pray together before Lily is put

to bed.
In recent years, a growing number of researchers

have begun to pose that question. One key
discovery was made in 2016 by Francesca Duncan,
a professor of reproductive science, and her team
at Northwestern University. They noticed that the
ovary becomes stiffer, or “fibrotic,” over time. “The
ovary’s very dynamic,” Duncan said. There’s a lot
going on, including the growth of follicles (the
structures that contain and nurture immature
eggs, or oocytes), the rupture of a follicle to
release an egg with each ovulation, and the death
and reabsorption of unreleased oocytes.
All of this activity means that tissue is constantly

getting repaired, which can lead to fibrosis—
essentially, scarring. Duncan and other scientists,
including Robker, have been investigating possible
therapies that could “soften” the ovary and extend
fertility. A 2022 paper in Science Advances, co-
authored by Robker, reported that existing
antifibrosis drugs restored ovulation in 15-month-
old mice, comparable to humans around age 50.
David Pépin, a reproductive biologist at

Massachusetts General Hospital, is investigating a
different angle. He’s studying the little-known but
important anti-Mullerian hormone (AMH),
produced by follicles in the ovaries. He believes
modulating AMH could, in effect, help switch

fertility off and on. Pépin formulated a synthetic
version of AMH that he’s tested on animals,
including mice and cats. He discovered that at
elevated levels, AMH prevents the activation of
growing follicles. When a sufficient dose of the
hormone is administered, he said, “you have very
few follicles activate, and those that do are
basically incapable of growing and maturing.” As a
result, AMH could act as a contraceptive. (He’s
developing a feline contraceptive to control feral
cat populations, but it consists of a onetime
injection, whereas the goal for humans is a daily
pill.)
Sarah McKnight, 42, is a commercial pilot and a

single mother by choice. Using IVF and donated
sperm, she had a daughter in 2019 and a son in
2021. McKnight sits with her daughter, who has a
cold, as a humidifier releases mist. (Her children’s
names were withheld on request.)
Sarah McKnight helps her daughter into her tutu

while holding her son on her lap to breastfeed
him. “I decided not to let the pandemic stop me
from having another baby,” she says. “I was home
anyway, so I figured it was a good time to try
again.”
Betsy McKnight looks after her grandchildren as

her daughter, Sarah, gets ready for work. After
Sarah’s first child was born, she moved from a
small apartment in New York City to a four-
bedroom house in New Jersey to accommodate
her growing family and her mother, who lives with
them to provide support.
Sarah pumps breast milk in the early morning. The

nature of her job as a pilot means that she is often
away for long hours. Before leaving for the day,
Sarah spends time making sure her family will
have what they need during her absence.
Betsy McKnight holds her granddaughter, who’s

upset her mom is leaving for work. Sarah spent
about $65,000 in fertility treatments, going
through several IVF attempts and embryo
transfers before carrying her first pregnancy to
term.
When treatment ceases, fertility may be restored

and possibly even enhanced. The follicles resume
growing, and because they’ve been accumulating
for the duration of treatment, more follicles than
usual grow concurrently. If someone with a dearth
of eggs were to undergo IVF at that time, the odds
of success could rise. AMH treatment could also
interrupt some of that perpetual activity in the
ovary, potentially diminishing the aging associated

with it.
Scientists agree that no single solution will

dramatically prolong fertility or ovarian health. But
if research in several relevant areas bears fruit, it
could add up to meaningful progress in the
coming years. “We’re at a point in time when
there’s a lot of eyes on this topic,” said Duncan.
For example, the Global Consortium for
Reproductive Longevity and Equality was founded
in 2019 to support research and foster a global
network of scientists and clinicians to study the
subject. The organization has distributed more
than $14 million to 48 researchers worldwide,
including Duncan. They call their efforts “a moon
shot initiative to tackle female reproductive
aging.”
(Maternal mortality is shockingly high in the U.S.—

especially if you’re Black.)
Every morning, Eboni Camille Chillis goes to the

crib, hugs her baby, and thanks her for being her
daughter. Although the path to parenthood was
different from what she’d envisioned, Chillis has
come to embrace it. “There’s a wholeness and
happiness to me that I don’t know that I’ve ever
experienced,” she said.
Other people who’ve had children through IVF

later in life are similarly enthusiastic. “It is
awesome,” said Susie Troxler, who gave birth at

age 50, using a donor egg and her husband’s
sperm after the couple tried to conceive on their
own for almost a decade. “If it weren’t for that
technology, we wouldn’t have been parents at all.”
Yet some researchers and clinicians add a note of

caution about delaying parenthood, even as their
own work has contributed to the shift. One of the
biggest risks is that the joyful endings don’t
always materialize. Sauer said that the high-profile
success stories can obscure “the reality of how
difficult it can be to achieve.” According to the
CDC’s most recent data, the percentage of live-
birth deliveries from IVF cycles by patients of all
ages was 37 percent in 2020. The rate drops
significantly for IVF patients over 40. (Using
younger donor or frozen eggs improves one’s
chances, of course, but there are still no
guarantees.) IVF is a costly procedure, often not
covered by health insurance. The successes may
give people misleading reassurance that they can
always wait.
I realized this is something I would have to do

on my own if I wanted it to happen.
Sarah McKnight
The risks of aging apply to men as well. “Men’s

sperm quality declines significantly over 40 and
continues to decline,” said Pépin. Although these
sperm may still fertilize an egg and result in a

successful pregnancy, DNA damage can result in
adverse health outcomes for a child.
There are many reasons people postpone having

children, and one of them is lack of social support.
Robker noted that with more family-friendly
government policies—affordable childcare and
paid leave—some might choose to start their
families at a younger age. “I can’t do anything
about the policies, so I’m working on how do we
help people have the best ovary health for both
their fertility and their overall health,” she said.
Beyond ovarian health, significant research is

under way on more futuristic concepts. A process
known as in vitro gametogenesis (IVG) involves
creating gametes from stem cells—for example,
deriving an egg from another kind of cell, such as
a skin cell. IVG could enable same-sex couples to
have children with genes from both parents; it
could allow more than two people to reproduce
together. There’s also the possibility of growing a
fetus outside of a uterus in a synthetic womb.
Robker expects reproduction to change

dramatically in the coming years. “People feel
very, very passionate about having biological
children,” she said. “So that is pushing the
boundaries on the development of new
technologies that can facilitate generating

embryos.”
IVG and artificial wombs are likely still years, if not

decades, away. But as these new tools evolve,
vexing medical and ethical dilemmas are bound to
follow. There are many risks, to be sure, yet there
have already been many rewards from current
reproductive technology: millions of parents who
are grateful to have children when that hadn’t
seemed possible. “She’s the light of our world,”
Troxler said of her daughter, Lily. “She’s here when
she’s supposed to be here, to do what she’s on the
planet to do.”
(7 medical breakthroughs that gave us hope in

2023.)
From her home in California, Rebecca Tuhus-

Dubrow often writes about the intersection of
society and technology. She’s the author of
Personal Stereo, a cultural history of the Walkman,
and is working on a book about nuclear energy.
Her articles have run in outlets such as Slate and
the Guardian.
Jackie Molloy, a photojournalist in New York City,
frequently focuses on the complex and evolving
nature of family. During the COVID-19 pandemic,
she documented at-home births for National
Geographic. In 2022 she was featured in the “30:
New and Emerging Photographers to Watch”

program.
This story appears in the January 2024 issue of

National Geographic magazine.

IVF Revolutionized Fertility. Will These New Methods Do The Same

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4/25/24, 9:22 PM IVF revolutionized fertility. Will these new methods do the same?

IVF revolutionized fertility. Will

By Rebecca Tuhus-Dubrow, Jackie Molloy

Dec 28, 2023 12:00 PM · 13 min. read ·

Two weeks before her 48th birthday, Eboni

As she nervously waited for the doctors to begin a

Chillis had always wanted to be a mother. In her

Eboni Camille Chillis, 48, holds her newborn

Chillis and her daughter meet friends for lunch.

Chillis reads to her daughter from This Is Baby. “I

Last January, Chillis’s daughter was born, making

Chillis is part of a shift that’s been under way for

To be clear, some women have always had

Today people are starting families later and in

(Does a woman’s fertility really plummet at age

The first baby conceived through IVF was born on

from the possibility of birth defects to religious

Tania Dimitrova, 41, holds her daughter after

A month after giving birth, Dimitrova cuddles with

Dimitrova pumps breast milk as she checks emails

In some cases, a patient’s eggs were not viable,

Los Angeles Times blared: “Woman Bears Donor’s

Mitchell already had four children from a previous

Physician Mark Sauer stands in front of a

Bob Wilson, Barbara Strong (center), and their

Morgan Mitchell hugs his mother, Jonie Mosby

Successful egg-donor pregnancies confirmed that

Sauer co-authored a series of articles in high-

“Pregnancy After Age 50.” The ensuing media

(AI may be key to solving the most neglected

If it weren’t for that technology, we wouldn’t

The comparatively rapid aging of the ovary has

The aging of the ovary itself is distinct from the

Egg donation as well as the increasingly popular

Susie Troxler and husband Tony, 63, with their

Lily Troxler’s nighttime routine consists of her dad,

song, and then they pray together before Lily is put

In recent years, a growing number of researchers

All of this activity means that tissue is constantly

David Pépin, a reproductive biologist at

modulating AMH could, in effect, help switch

Sarah McKnight, 42, is a commercial pilot and a

Sarah McKnight helps her daughter into her tutu

Betsy McKnight looks after her grandchildren as

Sarah pumps breast milk in the early morning. The

Betsy McKnight holds her granddaughter, who’s

When treatment ceases, fertility may be restored

ovary, potentially diminishing the aging associated

Scientists agree that no single solution will

(Maternal mortality is shockingly high in the U.S.—

Every morning, Eboni Camille Chillis goes to the

Other people who’ve had children through IVF

awesome,” said Susie Troxler, who gave birth at

Yet some researchers and clinicians add a note of

I realized this is something I would have to do

The risks of aging apply to men as well. “Men’s

sperm may still fertilize an egg and result in a

There are many reasons people postpone having

Beyond ovarian health, significant research is

Robker expects reproduction to change

technologies that can facilitate generating

IVG and artificial wombs are likely still years, if not

(7 medical breakthroughs that gave us hope in