Plain English with Derek Thompson Episode: Fertility Needs a Scientific Revolution Release Date: July 16, 2025

In this compelling episode of Plain English with Derek Thompson, host Derek Thompson engages in an enlightening conversation with Roxandra Tesla, a scientist and writer, to dissect the intricate challenges surrounding modern fertility. The discussion delves deep into the socio-economic, biological, and technological facets influencing fertility trends today, and explores the potential scientific breakthroughs that could revolutionize fertility treatments.

1. The Fertility Dilemma

Derek Thompson opens the conversation by highlighting the growing trend of delayed parenthood:

[01:38] Derek Thompson: "The reasons tend to be complex and easily simplified. Yes, it's about labor economics... housing economics... gender relations... and biology."

Roxandra Tesla expands on this, explaining how various factors contribute to the postponement of having children:

[01:52] Roxandra Tesla: "Young people are more likely to go to college and use their 20-something years to become established in their careers before settling down and having kids."

The interplay between career establishment, rising housing costs, shifting gender relations, and biological constraints creates a "dilemma" where societal advancements clash with natural reproductive timelines.

2. Current Fertility Technologies: IVF

The conversation transitions to In Vitro Fertilization (IVF), the primary solution available for addressing fertility issues:

[02:11] Derek Thompson: "IVF is a decades-long practice which is based on science. And so you might think that the procedure is highly predictable, something close to an act of precision engineering. But it's not."

Tesla breaks down the IVF process, emphasizing its unpredictability:

[03:25] Roxandra Tesla: "One might like to think that they have a clear sense of how many eggs they'll retrieve, but here again, the doctors are often just as surprised as the patient by what they collect."

Despite being a scientific procedure, IVF involves significant uncertainties at each step, from hormone dosage to embryo viability, resulting in success rates below 50% per cycle:

[04:12] Derek Thompson: "With an overall success rate well below 50% per round, some couples have to go through the process several times a year for several years..."

3. Limitations and Challenges of IVF

Tesla elaborates on the emotional and financial burdens IVF imposes on couples:

[27:08] Roxandra Tesla: "I will say... IVF is kind of terrible for a lot of couples who go through it. It's expensive... stressful, it's painful... often results in no embryos, in no viable embryos."

The episode highlights IVF’s current state as a process of trial and error rather than a refined, precision medicine approach, underscoring the need for advancements in fertility science.

4. Historical Context: The Baby Boom

Roxandra Tesla draws parallels between the first baby boom and potential future trends:

[06:13] Roxandra Tesla: "The baby boom actually started in the 1930s... electric appliances like refrigerators and heating machines proliferated... advances in antibiotics dramatically reduced maternal mortality."

She posits that technological and medical advancements were crucial in sparking the initial baby boom, suggesting that similar innovations could address today’s fertility challenges.

5. Underfunding of Fertility Research

A significant portion of the discussion focuses on the lack of investment in fertility and maternal health:

[29:31] Derek Thompson: "Advancing quite slowly. IVF is the best we've got in many cases... Why do you think fertility and maternal health are underfunded fields?"

Tesla explains the cultural and institutional inertia that prioritizes funding for lethal diseases over quality-of-life issues like fertility:

[30:11] Roxandra Tesla: "We tend to treat and we tend to fund things that are like, lethal... much less... don't see things that affect life quality as important."

She advocates for increased funding and support for fertility research, emphasizing its fundamental role in human life and societal sustainability.

6. Future of Fertility Technology: Induced Pluripotent Stem Cells

The conversation shifts to groundbreaking scientific advancements that could transform fertility treatments. Tesla introduces induced pluripotent stem cells (iPSCs) and their potential applications:

[34:48] Roxandra Tesla: "Induced pluripotent stem cells... you can turn back the clock and make them back into something that is more like a stem cell."

Derek Thompson and Tesla explore the futuristic concept of creating eggs from ordinary cells:

[36:03] Roxandra Tesla: "Where older women could essentially develop youthful, healthy eggs from their own ordinary epidermal cells."

While acknowledging the current scientific limitations, Tesla remains optimistic about the possibilities:

[37:49] Roxandra Tesla: "I think we will get there. I think the question is like, how will we test it? How will we make sure it's safe?"

7. Recommendations and Conclusions

Roxandra Tesla outlines a strategic roadmap for addressing the fertility crisis through scientific innovation:

[42:24] Roxandra Tesla: "Making it easier for researchers to get eggs... funding fertility research... philanthropic money could have a really big impact."

She emphasizes the necessity of sustained investment and institutional support to foster breakthroughs that could lead to higher success rates in IVF and beyond.

Derek Thompson and Tesla conclude by reflecting on the importance of integrating technological advancements with policy measures to potentially ignite a new baby boom:

[45:52] Roxandra Tesla: "Science and technology might have been critical to the first baby boom, and they might be critical for another baby boom."

Key Takeaways

• Complex Interplay: Fertility delays result from a combination of economic pressures, societal shifts, and biological constraints.
• IVF Limitations: Current IVF practices are fraught with uncertainties, emotional strain, and high costs, highlighting the need for improved technologies.
• Historical Insights: The first baby boom was significantly influenced by technological and medical advancements, suggesting a path forward for today’s fertility challenges.
• Funding Gaps: There is a critical underfunding in fertility and maternal health research, partly due to cultural priorities that favor funding lethal diseases over quality-of-life issues.
• Scientific Frontiers: Advances in induced pluripotent stem cells and other reproductive technologies hold promise for revolutionizing fertility treatments and addressing the biological limitations of delayed parenthood.
• Strategic Investment: Increased funding, both governmental and philanthropic, is essential to support the scientific breakthroughs needed to enhance fertility technologies.

This episode serves as a clarion call for a scientific revolution in fertility, urging stakeholders to prioritize research and innovation to support the reproductive choices of modern couples.

Notable Quotes:

• Derek Thompson [01:38]: "The reasons tend to be complex and easily simplified..."
• Roxandra Tesla [03:25]: "One might like to think that they have a clear sense of how many eggs they'll retrieve..."
• Roxandra Tesla [27:08]: "IVF is kind of terrible for a lot of couples who go through it..."
• Roxandra Tesla [34:48]: "Induced pluripotent stem cells... you can turn back the clock and make them back into something that is more like a stem cell."
• Roxandra Tesla [42:24]: "Making it easier for researchers to get eggs... funding fertility research..."
• Roxandra Tesla [45:52]: "Science and technology might have been critical to the first baby boom, and they might be critical for another baby boom."

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