Over 1.2 million women in the U.S. seek treatment each year for infertility, according to the Centers for Disease Control and Prevention. Some conceptions require only fertility-enhancing medications or artificial insemination. Other babies start life in a test tube, conceived through invitro-fertilization. Older couples and those with reduced egg or sperm production add the services of egg or sperm donors, and sometimes even surrogates are required to make a child's life possible.
When to Seek Help
Many people who seek infertility treatment know they will need help to conceive, including gay and lesbian couples and single people as well as women who have been rendered sterile after surgery, chemotherapy or radiation treatment.
For other couples the American College of Obstetricians and Gynecologists recommends first preparing the body for a healthy pregnancy and taking 0.4 mg of folic acid for at least three months to prevent open neural tube defects like spina bifida. Then a couple should try to conceive for 12 months or for six months if the woman is over 35, before beginning a fertility evaluation. Women over 40 have a greatly diminished chance of conception and are advised to seek a fertility assessment immediately upon deciding they may want to become pregnant.
Ovarian Stimulation
The simplest procedure in assisted reproduction technology is ovarian stimulation with medication. The drug used most often to increase ovarian production is Clomid. If this is not effective, injectable gonadotropin medications can be used but these carry a higher risk of hyperstimulating the ovaries, resulting in multiple pregnancies. Because of the dangers of prematurity associated with having more than one baby at a time, the ovaries of a woman taking gonadotropins are monitored by ultrasound. If many ovum are maturing, the physician will advise the couple to refrain from trying to conceive that month. Ovarian stimulation used alone contributed to 4.6 percent of all U.S. births in 2005, according to research published in the October 2009 issue of the "American Journal of Epidemiology."
Artificial Insemination
To impregnate a woman, a man's semen must contain greater than 20 million sperm per ml. The sperm must be fairly speedy about swimming towards a waiting egg and have a forward moving sense of direction. In addition, at least 50 percent of them must be normal in shape, according to the World Health Organization standard.
When the sperm is not optimal, as well as when a sperm donor is used or a man has banked his sperm to protect them for future use, a sample of semen is placed, by syringe, into the woman's uterus. This is done at the time of ovulation as determined by a sudden rise in her level of luteinizing hormone in her urine.
IVF and PGD
Invitro-fertilization, or IVF, involves collecting ovum and sperm and fertilizing them outside the body. After incubating for five days, one or two embryos are implanted in the mother's uterus and the rest are either discarded, donated to other infertile couples or preserved for future implantation.
IVF can be combined with preimplantation genetic diagnosis, or PGD, for older women concerned about genetic abnormalities and for couples with a genetic disorder they do not want to pass on to their children. It can also be used for couples who have had repetitive miscarriages. PGD involves collecting one cell from each of several growing embryos on the third day after IVF conception for genetic testing. On day five, one or two embryos that are genetically healthy are implanted in the intended mother's uterus. IVF with PGD allows these couples the chance to become pregnant without having to face an abortion decision after a second trimester amniocentesis.
Donors and Gestational Surrogates
When a woman is past her early 40s, the chance of conceiving using her own eggs approaches zero. For these women, the use of an egg donor is an option. The live birth rate for a 44-year-old woman using IVF with donor eggs approaches 60 percent, according to the 2007 Assisted Reproductive Survey, in contrast to her 1.9 percent chance of having a baby with IVF using her own eggs.
If carrying a pregnancy to term is not safe or possible, a gestational surrogacy may be considered. Sometimes surrogacy is accomplished using only artificial insemination, but if the couple wants to use their own egg and sperm, IVF is performed. Then the surrogate is referred to as a gestational carrier.
A woman's body and her emotions are engaged in the process of pregnancy and birth and the process of surrogacy presents many ethical and legal dilemmas. State laws differ in terms of awarding custody to a surrogate who seeks to retain the right to parent the child she has carried, but all protect the right of a woman to obtain a legal abortion, to have or to refuse testing and to make medical decisions for herself and for her unborn child at least until the baby is delivered, according to a review by ethicist Grayce P. Storey, published by the Yale-New Haven Teachers Institute.
An Alternative to the Alternatives
For some people who want to have a child, raising a human being and providing nurturance, support, guidance and love throughout their lifetime is the real objective, and the opportunity to reproduce genetically, experience pregnancy or even start out with a baby is less important. For those people, the option of adopting a child is a viable way to create a family.
There were 123,000 American children whose parental rights had been terminated and who were waiting for adoption on the last day of the 2008 federal calendar, according to the U.S. Department of Health and Human Services, and UNICEF sets the number of orphans around the world at close to 150 million. The adoption process takes time and requires much more screening than parenting by birth but is not always expensive, and fees for adopting through a state agency may even be subsidized.
References
- Centers for Disease Control and Prevention: Assisted Reproductive Technology: 2007
- American Congress of Obstetricians and Gynecologists: Evaluating Infertility
- "American Journal of Epidemiology": Estimation of the Contribution of Non--Assisted Reproductive Technology Ovulation Stimulation Fertility Treatments
- "Human Reproduction": WHO Standards for Human Semen Characteristics
- Yale-New Haven Teachers Institute: Ethical Problems Surrounding Surrogate Motherhood
