Assisted Reproductive Technology
Assisted reproductive technology, or ART, refers to any treatment in which both eggs and sperm are retrieved and joined to achieve conception. These procedures may involve insemination, or the surgical removal of eggs from a woman’s ovaries, joining them with sperm in a laboratory, and returning them either to the woman’s body or donating them to a recipient.
In 2013, ART was responsible for the births of 67,996 infants in the U.S., and approximately 1.5% of infants born that year were conceived via ART. Different types of ART procedures include:
While not technically encompassed by ART, artificial insemination takes place when semen (either from the father or a donor) is “washed” in a laboratory, separating sperm cells from other semen components. The sperm is then transferred into a woman’s cervix or high in the uterine cavity. The likelihood of conception through this method is about 10% per month for women who are under 35. After the age of 35, success rates of insemination (when used in conjunction with female ovulation stimulant clomiphene) decrease as follows: 9% for ages 35-37; 7% for ages 38-40; 4% for ages 41-42; and 1% for women who are over 42. Results for artificial insemination vary significantly based on age and cause(s) of infertility.
In Vitro Fertilization (IVF)
In Vitro Fertilization (IVF) is a procedure that can be used to achieve conception in the event that there is a factor (or factors) preventing the union of the sperm and the egg. IVF takes place when the sperm and egg are combined outside of the body in a laboratory. One or more eggs is extracted from the female and are then combined with the man’s sperm. Eggs that have been fertilized (or embryos), are then implanted into the woman’s uterus. From that point, they may implant in the uterine lining and begin developing. Many couples who are experiencing infertility as a result of a male factor, endometriosis, or an unidentifiable explanation choose to use IVF.
Depending on a doctor’s recommendations and the female partner’s age, the number of eggs that need to be extracted will vary. As women age, their egg quality decreases, so they may need to have more eggs extracted during IVF procedures. Women under the age of 38 have the best odds when at least 10 eggs are extracted, versus those who only have 3-6 eggs extracted. About 16% of women under the age of 35 achieve live birth after 1-2 eggs are retrieved, versus 65% of women who achieve live birth after having more than 10 eggs extracted. For women aged 35-37, those percentages are 14% and 50%, respectively.
While odds of successful conception via IVF vary from couple to couple, most have 20-35% odds of conceiving within the first cycle on average. The average fertile couple (in other words, a couple who does not require ART) has a 20% likelihood of conceiving within the first month . So, couples who are considering IVF may take comfort in knowing that this option gives them the same or enhanced odds of conceiving as average couples who do not require ART.
IVF procedures can be costly, but the amount a couple is responsible for paying will ultimately depend on whether or not their insurance provider covers the procedures. In the U.S., the average cost for an IVF procedure of one basic cycle ranges from $12,000 to $15,000.
Donor Sperm or Eggs
If a couple has determined that there may be fertility concerns with their own sperm or eggs, or if there is a specific genetic disease detected that could be passed on to a child, they may choose to complete IVF with donor sperm or eggs. Donor eggs or sperm can either be provided by a known party or by a bank, which rigidly screens donors for genetic issues, infectious diseases, and medical history.[9.ARM; see above.]
If there is a medical issue prohibiting a woman from carrying a baby, a couple may choose to consider surrogacy or gestational carrying. With surrogacy, the pregnancy is carried by the egg donor, whereas a gestational carrier has no genetic relationship to the baby and the eggs are removed from the mother, fertilized, and transferred to the carrier’s uterus.[10.ARM; see above.]
Again, if you are just beginning to think about TTC, these options are a long way off for you to consider. However, having a thorough overview of what some women may experience in their pregnancy journeys gives you well-rounded knowledge of all of the possibilities that can occur when a couple decides to bring a child into their lives. To fully cover all options for bringing a child into your life, we will also discuss adoption in the final section.