What does it take to make a family when natural conception is difficult or even impossible? The PBS documentary 'Fighting for Fertility' explores this through the eyes of different people that are affected by infertility. For many years I worked in a clinical environment, developed, and performed various preimplantation genetic tests (PGT) to assist people requiring fertility treatment via IVF, to become parents. Working in the laboratory we would frequently come across samples from patients who would have treatment after treatment, without having much luck in getting to that embryo who would become their child. 'Fighting for Fertility' is all about these people, who refused to give up their dream of making a family, despite facing different types of infertility challenges.
The hour-long documentary was written and directed by Larkin McPhee and was produced by Janey Klebe. It aired in the USA in May 2021, but I was able to watch it on YouTube while it was available. Having worked in the USA for a couple of years myself, I thought that this documentary accurately describes the situation with IVF and associated treatments in the USA now, something which was very brave to do. Issues related to the emotional and financial burden associated with IVF treatments are addressed with raw honesty.
I found the selection of people who were followed during their fertility journeys bold. The creators included an African American woman, and a transgender man in addition to two white heterosexual couples to depict the current state of fertility treatment in the USA. The documentary focuses on various issues related to fertility treatments ranging from costs, to discrimination due to race and sexual preferences. On the subject of IVF-related costs, it is brought to the viewers' attention that most American fertility clinics are located in affluent areas. Does this mean, however, that fertility treatments are only for the financially well-off? Are infertile couples from lower socio-economic backgrounds being indirectly discriminated against, by potentially having to travel long distances and spend a significant amount of money in order to make a family?
In addition to the people who are being followed through their fertility treatment, the documentary includes experts, both medical doctors and scientists, as well as cartoon representations to explain genetic tests like PGT and biological concepts such as meiotic chromosome division, embryo mosaicism, and . As would be expected, the language being used frequently included complex medical terms, but the use of cartoon representations, as well as the interchange between medical experts and the people who were having the fertility treatment made the documentary easy to watch and understand for both scientist and non-scientist viewers.
Embryo mosaicism, the presence of two genetically distinct cell lines in the same embryo arising from chromosome division errors taking place after fertilisation, has been an area I am particularly interested in and have worked on in the past. I therefore watched the documentary part related to mosaicism with great interest. In that part, Erin, one of the documentary's participants very vividly describes infertility as a 'a special little corner of hell that goes on and on' and the baby girl that was the outcome of her final IVF attempt as 'the spoils' of war. Both statements clearly depict the frame of mind that she and her partner, Gary, had when they were going through IVF. Erin and Gary had to use a surrogate, and their baby was the result of an embryo that, after PGT for aneuploidy, was identified to carry a mosaic chromosome abnormality. The documentary had a medical doctor, Dr James Grifo, and a scientist, Dr Shawn Chavez discuss about mosaic embryos, talk about high- and low-level mosaicism, and embryo self-correction during early development. Embryo mosaicism and its impact on viability is a controversial subject. The debate on the clinical management of mosaic embryos is still ongoing. The documentary rightly decided to address this subject, but perhaps should have dedicated a bit longer on explaining the biology behind the events of mosaic chromosome abnormalities to make them better understood to the viewers.
In a world where IVF treatment is still considered a taboo subject by many, 'Fighting for Fertility' is an honest, raw, and gripping documentary to watch. We have all been caught up in the COVID-19 pandemic for the past two years, but, as pointed out by Drs Aimee Eyvazzadeh and Shanna Swan in the documentary, infertility is also a pandemic that is increasingly becoming worse, with the average man today, for example, having half the number of sperm compared to his grandfather. Yet nobody's openly talking about this infertility pandemic and its causes, which as the documentary suggests could be a combination of genetic and environmental factors. We therefore need more documentaries like 'Fighting for Fertility' as well as other campaigns to educate the public on reproductive challenges and remove the stigma associated with fertility treatments once and for all.