The world of artificial pregnancies is ever-changing, as methods get fine-tuned and researchers discover new wonders of the human reproductive system to use in our favor. For infertile couples, fertility aids, including in-vitro fertilization (IVF) and other artificial pregnancies, can offer hope, but also a great deal of stress. There are different levels of artificial pregnancies, as well as different kinds of IVF and choosing the right method for your situation can be a difficult decision.
The details of these processes can be hard for those who aren't in medicine to interpret, and there can be hidden emotional and physical stresses that a couple needs to know about before they embark on this long and expensive process. We'll go over the in and outs of IVF and other fertility treatments, including details like how a doctor selects the "best" embryo, or whether IVF is more likely to result in birth defects for your baby, and what kind of genetic screening is available.
We'll also mention how to choose an ideal fertility program for you and where you can look for any clinic's success rates . There's also new hope to be had in the world of artificial pregnancies. There's a new method on the horizon that could be potentially helpful for older women in particular! It is called "Augmented IVF" and it resulted in it's first adorable little baby in 2015. We'll explain how the lucky parents got their little boy, along with the other details on artificial pregnancies that you need to know, below.
15 Artificial Insemination
When you think of 'artificial pregnancy' your mind might automatically jump to the well known procedure called in-vitro fertilization. However, there is a simpler technique that a fertility doctor is likely to recommend to you first, called artificial insemination. If a couple's fertility problems are the result of endometriosis, "unreceptive cervical mucous", or only moderate sperm in-viability, this procedure could be an option. During this technique physicians select sperm that appear to be viable and then inject that sperm directly into the woman's uterus, or sometimes her cervix or Fallopian tubes.
The woman will have to have her egg production stimulated before hand, to ensure that an egg is waiting for the sperm. Thus doctors ensure that a higher percentage of viable sperm arrive near the egg. However, the egg stimulation is much less rigorous than the egg stimulation during IVF, as doctors only want one or two eggs to be produced. They don't go through an egg selection process, so producing multiples will just make for a higher risk pregnancy.
14 How Effective is Artificial Insemination?
Many couples find themselves drawn to this technique because it is more cost-effective than IVF. It also does not involve the time-consuming retrieval of eggs, unlike IVF. However, artificial insemination is not very effective, only fourteen per cent of those who under go the procedure will conceive a child. Unfortunately, there are usually a variety of factors that combine to make conception difficult for a couple and this procedure only reduces two of those factors.
The injection process allows weak sperm to skip over the process of swimming through the cervix, which may be difficult due to a woman's mucous being the wrong PH or the wrong thickness, or because her endometriosis has changed the shape of her womb. So really, this procedure only involves minor selection for viable sperm and only allows them to skip over the process of finding the egg. From there, the egg may still not result in a viable pregnancy.
13 In-Vitro Fertilization
Those who are unfamiliar with IVF may be surprised to learn exactly how much preparation, time, and money are involved in the procedure. In the United States, IVF treatment will cost any couple at least twelve thousand dollars. You need to make some investments for initial testing before you can ever be approved for the full procedure. Once the ball is rolling, private insurances vary wildly on what they'll cover, so it may be important for you to look into which medications you have coverage for before the process begins.
Sometimes doctors can choose certain hormone treatments over others if your insurance only covers select options, depending on your medical circumstances of course. You may need to be injecting yourself daily with hormones for weeks, culminating in a small surgical procedure where the eggs are collected. Your partner has to provide a fresh sample of sperm on-site (in a private room of course), and the two ingredients have to be mixed and watched to see if they develop.
12 The Six Day Wait
After your eggs are secured and mixed with your partner's sperm, doctors will watch the fertilized egg's development for as many as seven days. They'll choose the best embryos to implant into your womb, but how exactly do they make that choice? Ultimately doctors are looking for a successful egg, so they consider those which have grown the most outside of the womb to be better candidates for implantation. The above egg is three days old and is at the eight-cell stage or the "cleavage" stage. You can only see six of the cells from this angle, because the other two are tucked into the back.
This kind of even growth is another factor doctors examine when selecting the best eggs. You may think that the longer a doctor waits to make their decision the better quality embryo you'll receive. However, there is some recent research that suggests waiting until the next cell stage, the blastocycst (comprised of a dozen or more cells that are five days from conception) may increase the risk of pre-term birth for the embryos. It's uncertain whether the advantages of watching an egg's development for longer outweighs this risk.
11 The Emotional Challenges
While couples have already undergone some emotional stress on their fertility journey, many underestimate the new emotional and physical challenges that await them if they attempt an artificial pregnancy. While everyone who has a successful pregnancy after IVF would certainly say these challenges are worth the end result, it is important to be prepared for the experience. Daily needles are one area many women may get frustrated with. Ever tried giving yourself a needle? It's actually very challenging and you may need your partner to do it for you. Of course, you may have side-effects from these hormones too, include hot flashes, mood swings, pain and headaches.
There's also a huge panel of tests couples have to undergo before any IVF can begin, which can be physically demanding and uncomfortable. Then, for the female partner, there's daily blood tests for at least a week before the actual procedure, so doctors can carefully monitor your hormone levels and ensure that you will have eggs for them to harvest. Next, after all of that money, time, and energy, the wait to hear a doctor confirm you're pregnant is agonizing. Make sure you have a good support network for you and your partner before you start with IVF.
10 How Effective is IVF?
The answer to this varies depending on the couple's age and the reason for the infertility, if it is known. Generally, the older the woman specifically is the lower the odds of IVF success. Around 29 per cent of all attempts at IVF result in a pregnancy, and 75 per cent of those result in live births. By age, 40 per cent of mothers under 35 will have successful IVF, while only 11 per cent of those over 40 will. A couple can try IVF again if the first attempt was unsuccessful, and the costs may be reduced if the doctors were able to gather enough viable embryos for a second attempt, although many doctors prefer to gather new eggs, to get the best possible quality of growth.
9 Doesn't IVF Cause Birth Defects?
You may have heard about a few studies that demonstrated that IVF and other artificial pregnancy techniques could cause higher than normal rates of birth defects. However, many of these studies were not able to take into account all of the factors surrounding birth defects and thus their findings are far from conclusive. For example, some conditions that a mother may have, like poly-cystic ovarian syndrome, increase her children's rates of birth defects while they reduce her fertility. Therefore, the higher rate of birth defects may be caused by the condition that a couple has, not the technology they use to conceive their child. There's even better news from the CDC, who did a study of more than four million children conceived with the use of varied fertility aids.
This study did not find any increase in genetic birth defects, but they did find greater likelihood of non-genetic defects. These are issues like cleft lips and heart defects that are caused when a baby's lip, heart, or other affected area develop into the wrong shape. Luckily, these are usually minor or cosmetic problems. On the other hand, this CDC study couldn't eliminate the same factor that plagues the other smaller studies. Conditions that make couples infertile may also increase their likelihood of producing a child with genetic defects. More studies, especially studies that can eliminate this variable, need to be performed.
8 Multiple Pregnancies
Artificial pregnancies come with the risk of multiples. For example, during IVF doctors usually want to implant at least two viable eggs in a woman, in case one fails to take. This makes sense, because once a couple has put so much energy and money into the process it would be a real shame for everyone involved if they ended up without a pregnancy. However, multiple pregnancies carry some risks, including preterm birth and low-birth weight.
The famous Kate Gosselin gave birth to six babies after having IVF treatment where seven eggs were implanted. Each of the six babies who implanted successfully needed a doctor and three nurses dedicated to them during their birth. Each was born ten weeks early, ranging in weight from two to three pounds, and had to be immediately placed on a ventilator. While all of these babies survived their birth, not all multiples will be so lucky. Generally, because of these risks triplets or more place on a mother, and the pregnancy as a whole, a physician will want to prevent these multiple pregnancies.
7 Pregnancy Reductions
In countries where implanting more than two fetuses during IVF is routine (including here in the United States) some women opt to reduce their pregnancies to twins if three or more of their eggs are successful. The American Congress of Obstetricians and Gynecologists has the autonomy of their patients as their guiding principle in terms of this issue. A woman considering reducing her pregnancy should be made aware of the pros and cons surrounding this decision and allowed to freely choose which option will work best for her and her family.
On the other hand, a physician does not have to perform a pregnancy reduction if her patient requests it. So, if you feel this procedure is right for you, you may have to find a physician who offers it. Similarly, the ACOG advises that while a patient should not be prevented from knowing the sex of her fetuses during a selective pregnancy reduction, the ACOG does not believe procedures that identify the sex of the fetuses should be performed solely to make a sex-selective pregnancy reduction.
6 Genetic Screening : Eggs
In terms of artificial pregnancies, there are two forms of genetic screening that can be done. The first is where a genetic test is done on the eggs before their combination with the sperm. This method was invented in the 1990s, and banned or limited in several countries at that time, but not the United States. If a woman has a risk of passing on a heritable genetic disorder, (particularly one that would cause the fetus to spontaneously abort should it inherit it) genetically screening eggs and choosing only those who do not carry the disorder could be useful to her and her offspring. Some diseases, like sickle-cell anemia, hemophilia, and forms of muscular dystrophy, are linked to the woman's X chromosome and therefore the chances for these diseases may be reduced or eliminated using this screening method.
5 Genetic Screening: Embryos
The second form of genetic screening can be done after an egg and sperm have combined into an embryo. This genetic screening might be more useful to you and your spouse if you both carry a risk factor for a genetic disorder, particularly if you both carry a risk for the same disorder. Genetic screening of embryos gives a more complete picture of the potential child's genetic makeup and has thus been used for some controversial practices, including sex selection, selecting a child who will be able to donate to their sick sibling, selecting a child who is deaf or a sufferer of dwarfism like their parents, and selecting a child who does not share their mother's early-onset Alzheimer's disease. Of course, this genetic screening is not wholly accurate and any of these selections might not result in the desired embryo. Regardless of how you feel about these various ethical decisions surrounding genetic screening it is important to realize that such procedures are available, to those who can afford it.
4 A New Kind of Conception
There's a new fertility procedure that has had its first success recently, with the birth of Canadian baby Zain Rajan in 2015. It turns out that the lining of a woman's ovaries contains specialized stem cells that are capable of producing new eggs. While doctors have yet to discover how to encourage these stem cells to become eggs, they are still using the mitochondria of these stem cells to rejuvenate a woman's existing cells. All human cells have mitochondria, they're like the power plant of the cell.
The mitochondria of a woman's eggs are called upon for a special job though, as they have to allow the egg to multiply several times before it implants into the mother's uterus. Essentially, this means the mitochondria won't get a re-supply of nutrients for five days and some are too old or otherwise ill-equipped to "power" the egg for this long. However, the mitochondria in these stem cells are young and fresh, and more likely to be able to support an egg. So, doctors took out the mitochondria from Zain's mom's stem cells and implanted it into her eggs. The result is that adorable little guy.
3 The Remaining Embryos
After a successful implantation there may be remaining embryos, which the couple can choose to keep frozen and viable for use in the future. If the doctors did not use all of a woman's collected eggs during the insemination process, she may also choose to preserve those eggs for future use. Luckily, the process of freezing eggs (Cryopreservation) does not increase the odds for birth defects or other negative outcomes, although, not all of the embryos will survive being frozen. However, those embryos that do survive are just as safe and effective for a couple to use as "fresh" embryo. On the other hand, there is a cost to this storage as the embryos must be kept at negative 320 degrees Fahrenheit using liquid nitrogen. If the couple decides that they will not be using the eggs they may request the storage facility dispose of them, donate them to a couple, or donate them to researchers.
2 The Research Question
Like with stem cells, controversy surrounds the decision to donate embryos for scientific research. While many religious and other organizations have moral qualms with using embryos for research, 41 per cent of couples who have stored embryos say that they have seriously considered donating them to research. This is much more than the 16 per cent who say they've considered donating their embryos to a prospective mother or couple and its more than the 12 per cent who say they prefer their embryos simply be discarded. While many couples are willing to donate their embryos, there are not always scientists with funding in need of embryos, and so it may not be an option for you and your partner even if that would be your preferred use for your remaining embryos.
1 Selecting A Fertility Clinic and Program
If you've made the decision to choose a fertility clinic and/or program you may be overwhelmed with the number of choices available in your area. Different programs have different costs, facilities, and rates of success, so you'll want to research your options before you sign up with any. The Centers for Disease Control keep a record of each American program's success rate for you to look through. Visiting the clinic with questions in mind is another good way to narrow down your options. In particular, make sure to ask what kind of accreditation the facilities and the staff have.
Another major area of questioning is what kind of support is available to you. Is there counselling, a twenty-four hour help line if something has gone wrong, embryo donations, and on-site lodging? The staff should also be willing to go over every aspect of IVF in detail with you, and let you know where they stand on the major decisions like how many eggs can be implanted, what kind of genetic testing is available, and what your financial obligations are-- especially if you don't end up actually getting viable embryos implanted.