Unseen victims of the corona panic: IVF babies and their parents

Did you know that Australia has over 13,000 IVF babies born per year, the UK over 20,000, the West as a whole (Europe+US+offshoots) over 200,000 and the world as a whole 500,000? And did you know that due to the corona panic these services have been halted pretty much everywhere, meaning those children don’t get born and the parents will be childless, which causes tremendous pain and grief?

Here I want to calculate just how many lost babies and childless families are being created by the panic and every subsequent month of lock downs. The bottom line is that in Australia, there is an equivalent loss of life years to about 26,000 corona-related deaths per month due to the halt in IVF services. For every person who has died with corona in Australia so far, more than 2,000 years of life of IVF babies has been sacrificed, and a similar number of years of thwarted parenthood have been inflicted. For the West as a whole, the bottom line is that within 6 months of lock downs, more life will have been prevented and blighted via the halt in IVF services than is likely to have been lost if there would have been no panic and no particular prevention policies at all. These are enormous and unconscionable losses.

To know the total loss of halting IVF treatments we need to get an idea as to how easy it is to “start up again” once the process has been disrupted, and whether it is likely or not that delayed treatment will turn into no babies.

One key thing to know about fertility treatments is that women need over a month preparation before they can have the treatment, quite apart from the consultations and paperwork. They need to be on hormone treatments to get their eggs to ovulate, which can then be harvested, and they need to be on a stable hormone level before any fertilised eggs can be placed back. Disruptions to the process mean one needs to start again.

This means that even a single week of corona virus lock downs means more than one month’s worth of preparation is down the drain as all bets are off with the planned IVF treatments. So the first month of corona related lock downs will roughly cost two months worth of IVF treatments, though after the initial month, one loses only one month of treatment for every subsequent month of lock downs.

Many of the women going through fertility treatments are so close to infertility that postponement will mean they will never get another child. Also, of course, the clinics were rather busy before the lock downs and can only handle so many cases. Given how the hospitals have large gluts of untreated patients they will need to “go through” when the lock downs are lifted, it should thus be doubted that there will be much catch up of any missed fertility treatments. Probably the opposite: IVF treatments wont have priority so further delays are more likely than catch-up. Tellingly, the industry reaction to the lock downs reportedly was that “it hopes most women will be able to resume treatment within a few months“.

So we have to be honest and drily note that the first month of lockdowns meant at least 2,100 IVF babies will not be born in Australia, 3,500 not born in the UK and 35,000 not born in the West as whole. These babies would have expected 80 years of life, meaning that 3 million years of life have been destroyed in the first month of lock downs alone, together with over 2 million years of life of women and men who now wont have another child. That latter number uses the rough rule of thumb that half the IVF babies would have been to a single mother and half to a “regular” couple, and that these patients were about 40 years of age on average. For the West as a whole, each subsequent month means a loss of another 1.3 million years of life due to babies not being born, and 1 million years of unhappier lives of their carers.

How does this compare to the benefits of the lock downs, ie the prevented deaths? In a previous post, I calculated the likely benefit of preventing any corona deaths versus a “do nothing” approach to be 45 million years of life for the world as a whole, which was based on a death rate of 0.2% and the rule of thumb that the average person dying with corona would otherwise have had 3 more high-quality years. If you look at the low numbers of deaths even in places where they do nothing special (like Sweden), those assumptions are now looking very generous towards the potential benefits of lock downs. However, those numbers held for the world as a whole. For the West, which is less than a sixth of the world population, we should hence count about 7 million years of life potentially saved by lock downs.

So within about 5 to 6 months, the potential benefits of the lock downs, if we are being generous to the lock downs, already cause an equivalent loss in terms of IVF babies not being born. That goes on top of all the other losses due to the lock downs, via loneliness, unemployment, disruption of health services, etc.

For Australia, which basically has very few corona deaths, before or after the lock downs, the picture looks far more dramatic still. There have only been 71 recorded deaths with corona so far. Yet, there will be 2,100 babies not born due to the lock downs, meaning that per corona death, 30 babies will not get born. Its a causal and ongoing loss.

Another way to put this is that per month of lock down, Australia is preventing the birth of over 1,000 babies who would have expected 80 years of a happy life. If we cared equally about a year of life saved from corona and a year of life actively prevented by the lock downs, then this means we are looking at the equivalent loss of life of 26,000 corona deaths per month, more if we also count the suffering of their potential mothers and fathers.

We really do have to open our eyes to these enormous losses in life and wellbeing due to the lock downs and the whole panic around them. These are not reasonable tradeoffs to make: there is a strong moral imperative in lifting the lock downs immediately and putting the onus of proof in terms of continued lock downs on those who want to continue inflicting these pains on others. Indeed, every person who agrees with the statement that “the measures taken to date have come at a cost to economic activity and jobs, but believe these are far outweighed by the lives saved and the avoided economic damage” is now personally co-responsible for all the surplus misery caused by extended lock downs.

Please tell me in the comments below of other groups of somewhat unseen victims of the corona panic and the lock downs. With links to evidence please!

 

 

 

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36 Responses to Unseen victims of the corona panic: IVF babies and their parents

  1. Dahl says:

    What’s your counterfactual?

    Ceteris paribus?

    • the counter factual is that these clinics are operational because people can go to work and can get these treatments.

      Treating the corona virus as just another contagious disease that goes around in the world, which we of course fight but not close our economies and health systems for, would do that trick.

      So the government needs to lift the lock downs immediately, and alongside that do all in its power to let normal life resume, ie take away the fear (as per my previous post). Every month that it delays has the costs detailed above (even if it takes a while to convince people to resume normal life: the sooner one starts the convincing the better).

  2. Dahl says:

    Except where it’s allowed to run freely, the health systems have failed. Staff have had to be redirected from less acute areas of the system etc etc.

    One likely area for staff to be redirected is fertility.

    I think you’d need to see the actual choices in hospitals in northern Italy, or NYC, when overrun to make judgements on counterfactuals.

    • paul frijters says:

      I look forward to seeing your numbers Dahl (if that is your real name). As I linked to in a previous post, many hospitals are actually rather empty apart from their IC unit…..indeed in Australia where the number of patients is extremely low (before and after the lock downs), the hospitals are underutilised….

      • Dahl says:

        Sure. In Australia where elective surgeries have been cancelled and corona virus cases have been reduced through social distancing measures, the hospitals aren’t very busy. Point taken.

        But in areas where corona virus ran freely for a time, NYC and Northern Italy for example, I don’t think the same holds.

        Hence, I wonder how the counterfactual you’ve gone with would compare to an area that had let the virus take its natural course, free of intervention.

        I’d be surprised if there’s anywhere in the world that has gone with those settings though, so it’s unlikely there would be a precise analogue.

    • Dahl on a adjusted basis Sweden is doing OK , actually better than the UK and France. If Sweden come out of this about the same or even a bit better than other comparable EU nations that have done the full shut down , but with an economy that is less damaged than those other comparable nations, then ‘it’s all over red rover’ for your position.

      And because of very high rates of in hospital infections and transmissions, the last place anybody with the virus ( unless very ill) should have gone is, a hospital.

      • Dahl says:

        Sweden has done a great deal of social distancing etc. they’re not a case of bau. This is lost in much of the discussion.

        Shades of grey everywhere.

        While not as firm a set of restrictions as aus, no gatherings of over 50. Loads of social distancing. Limit for tact with the vulnerable.

        Below provides some, but not comprehensive info on Sweden’s case.

        https://voxeu.org/article/underpinnings-sweden-s-permissive-covid-regime

        • Thanks I do realise that the Swedes have done a lot , for example patronage of buses etc in Stockholm is down around 50% ,however the Swedes really have stuck to a approach to the matter that is fairly close to the approach the UK ,initially started on ,before they ‘lost their nerve ‘

          • Dahl says:

            In fairness, my position is you can’t rely on the numbers where the analysis uses business as usual as a counter factual.

            Even Sweden hasn’t done what the counterfactual is here.

            And I think you’d need to look at cultural differences between Sweden and other countries to judge whether what they’re doing could be implemented in other countries.

            The UK I don’t think lost their nerve. I think they saw lots of death that their systems couldn’t cope with and, faced with the realpolitik, acted.

            • paul frijters says:

              “you can’t rely on the numbers where the analysis uses business as usual as a counter factual”

              There are two problems with this:
              1. The questions on “what do you think would otherwise have happened” never end. Whatever one answers, there is always another question “but what about”. So its a delay and deflect tactic whereby one implicitly favours the status quo.
              2. The status quo should be no intervention. We are living a massively invasive experiment with huge costs. It should not be up to those who want those costs to stop to prove their case, but up to those who want to continue the mass imprisonment and flattening of all our lives to prove their case.

              So whilst I am actually quite careful in the post to calculate both the cost of the entirety of the changes, I also calculate the marginal effects of extended lock downs (and extended fear: if its the fear that would close the clinics, the sooner one tackles the fear, the better, see the previous post).

              This is also why critique is cheap. Coming up with alternative numbers forces one to think what the more likely outcomes are. Give me your numbers….

              btw, I do agree Sweden is not a pure case of “do little” though within the West their reaction is closest to what I have in mind and I do think other countries would have been better off doing as they have done. Their neighbours are starting to agree….

              • Dahl says:

                I think the ways to come up with the numbers would be through observation (ie NYC or Northern Italy and extend the trend before lockdowns), or some expert heuristics based on hospital preparedness games, or more likely a combination of those.

                I’m afraid my family would not like me doing (badly) either of those things for a discussion on the internet.

            • Dahl
              Your squirming re ‘cultural differences ‘ is just squirming. The Swedes have followed a very different path , if they come out of it much the same or even better the conclusion is ‘you are wrong’.

  3. Conrad says:

    Philosophically, if I’m right in interpreting Derek Parfit’s work on the non-identity problem, I don’t think you can consider something that is never born as something that would have been born (or at least consider it negatively — so it isn’t an unseen victim). In this case, no harm is done to anyone (see intuition (1) in the document and the discussion), presumably excluding the desires of the parents which are trivial compared to existence.

    • paul frijters says:

      well, that is a political and moral choice. I think our unborn children are rather important, and many expenses in our societies show how much we prepare and value them. That’s partially why we have marriages and help with pregnancies.

  4. Aaron says:

    I wonder what happens if the virus runs through the population and health care systems are too overwhelmed to allow IVF treatment. Could this end up being an argument in favor of the shutdown?

    I wonder if there’d be some way to model out the impact of an overwhelmed health care system. One proxy I’ve seen is to bump up the mortality rate. So if a virus has a normal mortality rate of 0.2%, bump it up to 0.4% or 0.6% or whatever to account for the overwhelmed system. The challenge there is it’s not taking into account the age of the affected, so it might not be the best calculation. I’m unsure how to perform a better calculation. Any ideas?

  5. Christopher Hood says:

    I doubt that IVF has no ready ability to increase capacity and deal with an overhang from lockdown. You say it has so little capacity to deal with an overhang that all deferred treatment is forgone forever; only on that basis are the postponed births lost.
    The history of increasing IVF capacity, controlled only by medical specialisation keeping up its fees, seems plainly inconsistent with the notion that deferred treatment is lost forever.
    You say that IVF will be behind other elective medical procedures, and for that reason too will never deal with an overhang of deferred treatment. This I also doubt. Plainly IVF facilities are specialised and do not simply substitute into other elective procedures generally. Plainly IVF specialists – medical and technical and supportive – do not simply substitute into other elective procedures either.
    I expect that IVF will deal pretty quickly with an overhang of deferred treatment. I expect that if distancing and isolation relax on epidemiological grounds that overhang won’t be terribly large and won’t be terribly long.
    Most who would have succeeded will go on to do so.
    How many will lose their chance? How much of a chance will the losers have had? For this we would need to consult IVF specialists – but just on public information the losers will be few of those deferred, and the losers will not have had a high chance, certainly not a probability, of a birth had they not been deferred.
    Counting all forgone births as not at all deferred, but as entirely lost, seems to need facts that are entirely absent from your estimate.

    • paul frijters says:

      oh really? The IVF clinics were close to capacity before and of course many women really close to infertility and delay means they miss their chance.
      It actually takes months for these systems to ramp up again as operations have to be scheduled and then other treatment planned around that. The “+1 month” argument in the post was actually a quite conservative estimate.

      However, as you say, this is indeed an area IVF specialists should be more vocal on. There will be those who know a lot more than me about what numbers are reasonable. Where are their calculations? Why are they not speaking out on behalf of the women and men using their services?

      I think its scandalous the IVF specialists are missing in action over this in the public debate, leaving it to economists like me to do my best to make the case for these women, men, and the unborn babies.

      • Christopher Hood says:

        IVF has been among the first areas of elective medicine to be reopened. You speculated that it would be behind other areas: you had no basis for saying so: and you have proved to be plainly wrong.
        The obvious reason the IVF specialists aren’t making your case is not that they are ‘scandalous’ and ‘missing in action’. It’s that your case is baseless.

        • oh really? When I posted it I made the effort of going to individual websites of many of the IVF clinics in Australia. Consultations yes, but otherwise disrupted treatment. You say they are open for business. I would be very happy if that were true, but I’d like to see evidence of that happening. The hospitals remain rather empty as I understand it.
          Also, of course, the post talks about the UK and the West in general. If Australia opens up first, that would be great, but Australia is not the whole of the West.

  6. Anthony says:

    The issue is there has been a PPE shortage. See here for link. At one point I saw a university department donating gloves to hospitals.

    Now that supply chains are hopefully responding to the shortage, perhaps there is enough to allow less critical procedures to occur.

    In the ‘let it Rip’ scenario previously advocated here and elsewhere, PPE shortages will be more acute. Especially given Australia has been unprepared for a pandemic.

    Lastly, what is the demand for being pregnant during a pandemic? Pregnant women are immune compromised. Viruses like Zika causes birth deformities, and there is no good information on birth defects caused by Covid 19.

  7. Murph
    Report in the spectator:
    “As of Saturday, Sweden had suffered 150 deaths from Covid-19 per million population. That is significantly more than its locked-down Nordic neighbours – Denmark was on 60, Norway on 30 and Finland on 17 – but a long way short of other European countries which have been in lockdown for weeks. Britain has suffered 228 deaths per million, France 296, Italy 384 and Spain 441. The worst country, incidentally, is none of these – it is Belgium, with 490 deaths per million. “

    The null hypothesis looks plausible.

    • Christopher Hood says:

      For ‘plausible’ read ‘not absolutely impossible’. There you are: proof-read.

    • Dahl says:

      What does inwards tourism and business migration look like in winter in those countries?

      • Dahl
        Probably much the same as it is in Scotland and northern Britain.

        Would guess that cross country skiing would have some appeal. And the absolutely internationally famous top table restaurants in Stockholm and Sweden, would apeall regardless of the temperature outside .

        • PS
          Scandinavians have been traveling, into Europe and beyond and back ,in significant numbers for a very long time. The Byzantine emperors Varangian Guard were originally made up of “Rus” I.e. a mixed lot of Scandinavians and others from around the Baltic. These days as well as the famous “bridge “ there are car ferries carrying swedes in crossing the baltic all the time.

  8. Conrad says:

    I’ll just use a different column here given the unreadability of the threads, but I think part of the problem with comparing countries on simple quantitative numbers like is being done here is that it is very difficult to interpret. This is because cases grow following a power law, and that means that any minor amount of variability can be multiplied to look terrible. It is probably more meaningful to look at strategies and trajectories.

    A good example of this is Korea where you had a super-spreader or two and they ended up causing thousands of cases. In most places, they wouldn’t know if there were such spreaders. If these two people hadn’t existed, they probably would have had vastly smaller amounts, so the number of cases they had doesn’t really tell you whether they had good policies or not. It just tells you they had bad luck compared to, say, Australia. Another example is New York compared to other big cities in the US. Do they have massively more numbers of cases because of anything inherently different in policy? I don’t think so. They just had bad luck.

    • Dahl says:

      I wonder whether the Swedes noted the heightened corona virus risk and deferred non critical travel.

      And it does appear that Sweden has quite a small inbound market, particularly so in mid winter.

    • Dahl says:

      Wrong thread. Sorry.

      But I reckon inbound travellers to NYC might give you a faster growing base than most other parts of the US.

      • Dahl says:

        The movement of people is the primary vector.

      • Dahl
        Just outside the entrance to the Venice arsenal their is a naval museum, the top floor is devoted to the long ongoing relationship of Swedish ship building with the shipbuilding of Italy.
        And in general Lombardy is a major manufacturing and design hub plenty of essential reasons for Swedes to have gone there in December and January, prior to WHO belatedly sounding the alarm at the end of January.

    • Yes the various national Health outcomes have a lot more to do with good or bad luck, than with policy.
      However the same can’t really be said for the economic damage.

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