In Vitro Fertilization, Artificial Insemination, and other Issues

In Vitro Fertilization Introduction

Infertility is the inability of a couple to become pregnant (regardless of cause) after 1 year of unprotected sexual intercourse -using no birth control methods.

Infertility affects about 6.1 million people in the United States, about 10% of men and women of reproductive age. New and advanced technologies to help a woman become pregnant include in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), and other similar procedures.

IVF was used successfully for the first time in the United States in 1981. More than 250,000 babies have been born since then as a result of using the in vitro fertilization technique. IVF offers infertile couples a chance to have a child who is biologically related to them.

With IVF, a method of assisted reproduction, a man's sperm and the woman's egg are combined in a laboratory dish, where fertilization occurs. The resulting embryo is then transferred to the woman's uterus (womb) to implant and develop naturally. Usually, 2-4 embryos are placed in the woman's uterus at one time. Each attempt is called a cycle.

The term test tube baby is often used to refer to children conceived with this technique. The first so-called test tube baby, Louise Brown, reached age 25 years in 2003. She was born in England.

Less than 5% of infertile couples actually use IVF. IVF is usually the treatment of choice for a woman with blocked, severely damaged, or no fallopian tubes. IVF is also used to overcome infertility caused by endometriosis or problems with the man's sperm (such as low sperm count). Couples who simply can't conceive and have tried other infertility methods that have not worked for them can also try IVF.

Factors to Consider

• Age: Women younger than 35 years who do not have problems with their partners' sperm may try IVF.
• Multiple births: Generally, in women who use IVF to establish a live birth, about 63% are single babies, 32% are twins, and 5% are triplets or more.
• Cost: One cycle of IVF costs an average of $12,400.
• Reduced surgery: If a woman has IVF, she may not have to undergo surgery on her fallopian tubes. It is estimated that the IVF technique has reduced such surgeries by half.
• Safety: Studies suggest that in vitro fertilization is safe. A recent study covered nearly 1,000 children conceived through these methods in 5 European countries and found that the children, monitored from birth to age 5 years, were as healthy as children conceived naturally. However, other studies have found a slightly increased risk of genetic disorders in children conceived through assisted reproductive technologies.

Artificial Insemination 

Artificial insemination is a technique that can help treat certain kinds of infertility in both men and women. In this procedure, sperm are inserted directly into a woman's cervix, fallopian tubes, or uterus. This makes the trip shorter for the sperm and bypasses any possible obstructions. Ideally, it makes pregnancy possible where it wasn't before. Intrauterine insemination (IUI), in which the sperm is placed in the uterus, is the most common form of artificial insemination.

Though the pregnancy rates for women undergoing artificial insemination may not be as high as they are for some more advanced techniques, this technique has a key advantage: it's a simple procedure with few side effects. For those reasons, your doctor may recommend it as an initial form of treatment for infertility.

Abortion, Early and Unwanted Pregnancy

• An abortion is a procedure to end a pregnancy. It uses medicine or surgery to remove the embryo or fetus and placenta from the uterus. The procedure is done by a licensed physician or someone acting under the supervision of a licensed physician.
•  Early and Unwanted Pregnancy

Each year in the U.S. almost one million teenagers become pregnant--at enormous costs to themselves, their children, and society. While the facts are clear, the issues of teenage pregnancy are complicated by our conflicting attitudes and behaviors. Talk of sex fills the airwaves; younger and younger girls are portrayed as sex objects; and sex is used to sell everything from clothing to news. Yet we are shocked at the rising numbers of teens who are sexually active. If we are truly concerned about the welfare of babies, children and adolescents, we must move beyond the moral panic and denial that so often distort the discussion. Designing effective solutions will require the thoughtful separation of fact, assumption and wishful thinking and an honest acknowledgment that much is still not fully understood about the causes of teenage pregnancy.

CONTRIBUTING FACTORS
1. Cause or Effect? The burdens of early childbearing on disadvantaged teens are undeniable. Trying to untangle the factors which contribute to teenage pregnancy from its effects, however, leads to a "which came first, the chicken or the egg?" dilemma. Educational failure, poverty, unemployment and low self-esteem are understood to be negative outcomes of early childbearing. These circumstances also contribute to the likelihood of teen pregnancy. For example, recent studies suggest that most adolescent mothers have already dropped out of school before they become pregnant. On the other hand, adolescents still enrolled in school when they give birth are as likely to graduate as their peers. It is not clear how well the adolescents with the most problems would have fared in the future even without early parenthood.

2. Trends in nonmarital childbearing. It may surprise some to learn that the teen birth rate was 50% higher in 1957 than it is now. Today's widespread concern over teenage pregnancy may have less to do with actual numbers and more to do with the growing percentage of teen mothers who are unmarried. Teens who have babies outside of marriage fit within a broader nationwide trend--unmarried women of all ages are having babies in increasing numbers. Births to single teens actually account for a smaller percentage of all nonmarital births than twenty years ago.

3. Economic forces. In the 1950s when men with little education could find well-paid jobs, young people married if a pregnancy occurred. The loss of those jobs makes marriage less attractive today--an effect that can be seen on teens of all races. In 1955, for example, only 6% of white teenage childbearing occurred outside of marriage; today it is 42%. Economics may also be responsible for the lower percentage of poor adolescents who terminate their pregnancies, since Medicaid policies in most states do not pay for abortions, but do pay for services related to childbirth.

4. Motivation. The Alan Guttmacher Institute states that "while sexual activity among teenagers of all income levels is now common, having a baby is not. Adolescent childbearing is heavily concentrated among poor and low-income teenagers, most of whom are unmarried." While low-income youths may not intend to have a baby, they may not be sufficiently motivated to avoid pregnancy. Without a prize beckoning from the future--a good job, financial independence and marriage--young people from low income backgrounds may have little incentive to delay childbearing.

5. Mixed Messages. The American popular culture glorifies sex and ignores responsibility. Beginning in early childhood, young people are bombarded with sexual messages. At the same time, puritanical attitudes restrict the availability of resources and frank discussions about sex. Other Western nations with similar levels of adolescent sexual activity have much lower rates of adolescent pregnancy than the U.S. In countries with straightforward attitudes about sex, teens get more consistent messages, clearer information and greater access to contraception and abortion.

6. Risk Factors. Although it is not inevitable, some life circumstances place girls at higher risk of becoming teen mothers. These include poverty, poor school performance, growing up in a single parent household, having a mother who was an adolescent mother, or having a sister who has become pregnant.

7. Sexual Abuse and Coercion. A high percentage of girls who have sex before age 15 have been victims of incest or other sexual abuse. Further, half of the fathers of babies born to women aged 15-17 are 20 years of age or older; in one fifth of the cases, they are at least six years older. In the past this behavior would have carried severe social sanctions. Today, few men are prosecuted for having sexual relations with a minor, even though it is still against the law.

 STRATEGIES FOR SUCCESS:
All teenagers need encouragement to postpone sexual involvement and information on pregnancy prevention if they become sexually active. But these components are not enough by themselves to make a significant impact on the reduction of pregnant and parenting teens. The issues of adolescent pregnancy are too complex for simple solutions. The Children's Defense Fund emphasizes that young people need both "the motivation and the capacity to avoid too-early pregnancy and parenting." Further, young people are not a homogenous group, so solutions must be sensitive to individual and group differences. The most successful programs are ongoing and comprehensive. They combine several strategies which focus on helping kids succeed. Boys and girls who do well in school, participate in nonacademic activities, and plan for their future are less likely to become pregnant or bear a child during their teenage years. A wide range of interventions aimed at youth is also insufficient, however, if we do not address the larger overriding issues of poverty, racism and media messages that contribute to the complexity of the problem.