This year Louise Brown, the very first “test tube baby,” turned 35 years old. In the decades since that miraculous moment in 1978, millions of children have been brought into the world through the panopoly of ever-advancing assisted reproductive technologies (ART). This has been the cause for celebration in many households, and allowed many couples to bear their own children in spite of nature’s resistance. In the New York Times Wednesday, though, Miriam Zoll and Pamela Tsigdinos, two veterans of the ART process, pushed back against the triumphalist narrative that can dominate these discussions. Describing an ART fair, they say:

the fair’s most powerful strategy is the suggestion that all your answers can be found within the event hall — and that the power to overcome infertility can be found within yourself.

As former fertility patients who endured failed treatments, we understand how seductive that idea is.

Americans love an uphill battle. “Don’t give up the fight” is our mantra. But the refusal to accept physical limitations, when applied to infertility, can have disturbing consequences.

They acknowledge the great achievements medical science has made, and the joy that the newly-formed families must feel. But they also point out that even if we have the capacity to achieve pregnancy and deliver children artificially, over three-quarters of the attempted cycles fail, and “behind those failed cycles are millions of women and men who have engaged in a debilitating, Sisyphus-like battle with themselves and their infertility, involving daily injections, drugs, hormones, countless blood tests and other procedures.”

Reviewing a book on the industry, Cheryl Miller recounted:

For many couples, it is a costly process fraught with uncertainty and pain, often culminating in disappointment. Not that any of this dissuades fertility patients. As one doctor tells Mundy, fertility patients are more motivated than cancer patients. Indeed, sometimes the only thing scarier than the medical procedures Mundy describes is the fierce determination of the patients themselves to have a child, no matter the cost.

Zoll and Tsigdinos themselves describe how

Even among the patient-led infertility community, the prevailing belief is that those who walk away from treatments without a baby are simply not strong enough to run the gantlet of artificial conception. Those who quit are, in a word, weak.

As a result, both of us pursued increasingly invasive and often experimental interventions, many of whose long-term health risks are still largely unknown.

Now we know better. Ending our treatments was one of the bravest decisions we ever made, and we did it to preserve what little remained of our shattered selves, our strained relationships and our depleted bank accounts. No longer under the spell of the industry’s seductive powers, we study its marketing tactics with eagle eyes, and understand how, like McDonald’s, the fertility industry works to keep people coming back for more.

As for the now-$4 billion industry that is ART, “what they’re selling is packaged in hope and sold to customers who are at their wits’ end, desperate and vulnerable. Once inside the surreal world of reproductive medicine, there is no obvious off-ramp; you keep at it as long as your bank account, health insurance or sanity holds out.”

Zoll and Tsigdinos are the furthest thing from ideological opponents of in vitro fertilization or other ARTs, but they have learned from their own painful experience that the multi-billion dollar industry that has sprung up around the painfully powerful desire to bear children can blur the divide between doctors practicing medicine and industry professionals making sales. They acknowledge the successes and celebrate them, but explain that

we rarely hear from the other side, former patients who, in refusing to give up, endured addictive, debilitating and traumatizing cycles. Those contemplating treatments have a right to know about the health risks, ethical concerns, broken marriages and, for many, deep depression often associated with failed treatments.

When we have a profession like medicine that we hold to standards and values preceding and precluding pure profit-maximization, “It is time to rein in the hype and take a more realistic look at the taboos and myths surrounding infertility and science’s ability to “cure” it.”