Following a tragic miscarriage, Kate and Toby, characters in NBC’s hit series This is Us, are so desperate for a child that they begin IVF. Many have praised NBC for tackling this topic, however the show is too quick to ignore the risks and drawbacks of IVF, glossing over emotional decision making, serious health risks, low risk of success, great expense, and the grave ethical dilemmas involved.
Kate is already in a traumatic emotional state having lost a child. Compounding that with the emotional and physical risks of IVF with no guarantee of success seems rash. Despite this, Kate decides she’ll undergo the procedure anyway “Because I want to.” It’s as if she’s deviated from the script into a show that’s entitled “This Is I.”
Kate’s doctor initially refused to perform the procedure. The doctor was not the only person to express reservations about Kate’s choice, her mother, Rebecca also expressed concern. When Rebecca attempted to discuss her reservations about the IVF, Toby responded, “This is not about you, Rebecca! This is not about any of you! This is about me and Kate. . . .We have every expert in town telling us how dangerous this is, and we know it probably won’t work out.” Ultimately, Kate and Toby do conceive in a rather unrealistic first-cycle pregnancy, something quite rare considering Kate’s weight.
One study found that women with a healthy BMI experienced a 38% live-birth rate via IVF, while overweight women had a 35% live-birth rate, and obese women had only a 27.7% live-birth rate. Another study  found that the rates of embryo implantation, pregnancy, and live birth were inversely related to one’s BMI, dropping as BMI increased, resulting in obese women experiencing a 23% lower implantation rate, 19% lower pregnancy rate, and a 27% lower live-birth rate than women at a normal weight.
Sadly, Kate and Toby’s success with the procedure is likely to leave viewers who are considering IVF with a false hope that they too are likely to quickly achieve pregnancy. A realistic calculation, which considers all factors, delivers a very different outlook. Assuming Kate is 5’5” and 320 pounds, 38 years old, had one miscarriage, and is using her own eggs but suffering from PCOS (polycystic ovary syndrome), an online live birth success predictor shows the chances of a live birth after one IVF cycle is a measly 13%. If she went another two cycles, she will probably not end up with a baby at the end of it all.
This Is Us also fails to adequately address the economic burden of paying for IVF. On average, each cycle of IVF in the U.S. costs anywhere from $12,000-$20,000. The show fails to explain how Kate and Toby can afford IVF while living in Southern California on one primary income. Moreover, Kate and Toby do not discuss whether they will try multiple rounds of IVF if their first round is not successful, not to mention how they will pay for multiple rounds. It is unrealistic to portray IVF as a viable option to address infertility without addressing how much IVF costs and how the couple will pay for it.
In addition to the health risks, the low rate of success, and the exorbitant costs, there is also the fact that an infertile couple is choosing IVF over adoption. Randall (Kate’s adopted brother) addresses this, calling Kate out for choosing IVF over adoption, which had impacted his life so fundamentally. No one, including Randall, would deny the importance of a biological bond between parents and children. For many parents who yearn to conceive a biological child, coming to terms with the inability to do so is indescribably difficult. However, when natural procreation isn’t possible, parents can consider adoption as a method, if not the leading method, of becoming parents. Kate views adoption as only the backup plan to the backup plan.
Kate: “Of course Toby and I would consider adoption if it came to that.”
Randall: “If it came to that? Nice.”
Randall was vilified for voicing his concerns, even flying across the country to apologize.
Not surprisingly, This Is Us does not address the fact that people prioritize a desire for a biological child, yet they deny the biological case for the humanity of embryos. Kate harvested eight eggs, successfully fertilized three embryos, produced one viable embryo, and enjoyed a successful implantation. By conveniently choosing only one embryo to be viable enough to transfer, the show is able to ignore a serious ethical quandary that real IVF couples face. When multiple embryos are viable, the extras are either frozen (leading to ethical dilemmas about what happens to them down the line), or multiple embryos are transferred to the woman. This transfer is not a guarantee that those embryos will safely make it to implantation, much less to a successful live birth. It’s convenient to avoid frozen embryos, multiple transfers, unsuccessful implantation, and “selective reduction” (i.e. abortion) of multiples, all with a romanticized idea that Kate and Toby have “one shot” that in TV land, will probably work out well for them.
This is Us at least acknowledges that Kate and Toby are choosing to pay a lot of money to do IVF instead of adoption, against a doctor’s initial advice, in the face of great risks, and aware of the low chance of success. All these concerns, and many others the show ignores, are rapidly supplanted by the narrative of a beautiful shot at parenthood and a happily pregnant Kate. The show is making a clear judgement that risks don’t matter when the chance of a child, however slight, trumps all else. In a show known for its realistic family moments and accurate portrayal that decisions have consequences, it’s disappointing to see how fanciful this is.