In vitro fertilization (IVF) is a method of infertility treatment in which an egg and sperm are joined in a laboratory container ("in vitro" means "in glass"). This is in contrast to normal "in vivo" conception, in which fertilization occurs in the fallopian tube of a woman's reproductive tract. Scientist S. L. Schenk began animal IVF research in 1880, but it was not until 1959 that the first animal IVF was clearly documented by another scientist, Michael Chang. In 1978 Patrick Steptoe and Robert Edwards in England produced the first human IVF baby, Louise Brown, who became known as the world's first test-tube baby. The first IVF baby in the United States was born in 1981, largely due to the research work of Howard and Georgeanna Jones. The Joneses varied their technique from that of Steptoe and Edwards, and these newer techniques grew into contemporary IVF. In the United States alone, over thirty-five thousand babies were born through assisted reproductive technologies (ART) techniques in 1999. ART use has increased 54 percent between 1996 and 2000, the only years for which data is available. It is unclear if increase in use is due to actual increases in infertility over this time period, increases in knowledge and availability of services, or due to the aging of the large baby-boom cohort, many of whom delayed childbearing and reached their later and less fertile reproductive years during this time. Even so, ART is used by only 1 percent of all reproductive aged women, and by only 7 percent of all women who seek services for infertility.
Typically a woman's ovary produces one egg per month. Physicians who specialize in IVF use FERTILITY DRUGS to stimulate a woman's ovaries to produce multiple eggs. Eggs are then retrieved during an office procedure in which a needle is inserted into the ovary through the vagina. The eggs are then mixed with sperm in order to allow fertilization. After a period of growth and observation in the laboratory, a number of fertilized eggs, now known as embryos, are returned to the uterus of the woman who will carry the pregnancy. The embryo transfer is another brief office procedure in which embryos are deposited into a woman's uterus through a small plastic tube that is inserted in the cervix.
IVF was originally developed to treat infertility due to blocked or absent fallopian tubes in women under thirty-five years of age. The use of IVF has expanded considerably over the years, and it is now considered to be a treatment for ovulation dysfunction in women, male infertility, and infertility of unknown etiology. Some IVF facilities offer egg donation programs so women without ovaries or women whose advanced age or menopausal status makes successful conception impossible can achieve pregnancy. Embryos can be frozen and stored indefinitely for later use, for donation to other couples, or for transfer to the uterus of a surrogate mother. Embryos can also be screened for genetic disorders prior to transferring them to a woman's uterus.
The American Society for Reproductive Medicine publishes an annual report detailing success rates for IVF clinics in the United States. Success rates vary depending upon patient age, fresh or frozen embryo use and a variety of other factors. Data from 2002 shows that on average for every egg retrieval procedure a woman undergoes she has a 29.1 percent chance of delivering a live infant. There is currently no evidence of increased rates of birth defects in IVF babies, although recently, investigators have raised the possibility that placenta formation in these pregnancies is abnormal, which can lead to fetal growth problems.
IVF raises a host of medical, ethical, legal, sociological and religious questions and controversies. Medically, the techniques pose some risks to women. Fertility drugs can produce ovarian hyperstimulation syndrome (OHSS), which in rare instances can be life threatening. In addition, most IVF practitioners transfer several embryos into a woman's uterus in order to maximize the chance of successful pregnancy. This in turn carries a risk of twin (approximately 25 percent), triplet, and higher order pregnancies (approximately 5 percent). Multiple pregnancies carry increased risks to pregnant women compared to singleton pregnancies, and carry increased risk of premature delivery and associated newborn problems like cerebral palsy, blindness, and death. All of these consequences of IVF place enormous stress on families and on health care systems.
IVF is sociologically interesting because an IVF baby can have up to five "parents"–a genetic mother, a genetic father, a gestating mother, a rearing mother, and a rearing father. The separation of genetic, gestational, and rearing contributions to childhood raises questions about the meaning of parenthood and the family. Legal battles have arisen over "custody" of frozen embryos and of children born to surrogate mothers. Some religious groups prohibit IVF on the grounds that it separates sex and procreation. The issue of what to do with "leftover" embryos is also a source of intense controversy. When embryos are discarded or used for research purposes, as in the case of stem cell research, IVF becomes entangled in the intractable abortion debate in the United States.
IVF also raises questions related to issues of gender, race, and class. While some feminist scholars argue that IVF provides women with additional choices in life because it permits biological motherhood in otherwise impossible circumstances; others argue that it enforces women's conventional roles as reproducers and creates traffic in women's bodies. Some feminist critics argue that the medicalized discourse of "disease" that surrounds infertility prevents clear perception of the ways in which infertility is a socially constructed diagnosis. The racial dimensions of IVF are not well understood, and may relate, among other things, to the stereotype that excess fertility, not infertility, is the most salient black reproductive issue. Although black women in the United States have infertility rates one and one-half times higher than white women, white women use ART techniques at rates twice as high as those of blacks. IVF is inextricably linked to class, as the costs of IVF are exceedingly high–typically $10,000 per month–and not always covered by insurance, and even more rarely covered by public medical insurance.
Brinsden, Peter, ed. 1999. A Textbook of In Vitro Fertilization and Assisted Reproduction, 2nd ed. New York: Parthenon Publishing.
Chandra, Anjani, and Elizabeth Stephen. 1998. "Impaired Fecundity in the United States: 1982–1995." Family Planning Perspectives 30, no. 1: 34–42.
Jones, Howard. 1991. "In the Beginning There Was Bob." Human Reproduction 6: 5–7.
Raymond, Janice. 1994. Women as Wombs–Reproductive Technologies and the Battle Over Women's Freedom. New York: Harper Collins.
Roberts, Dorothy. 1997. Killing the Black Body–Race, Reproduction, and the Meaning of Liberty. New York: Vintage Press.
Seoud, M., and H. Jones. 1992. "Indications for In Vitro Fertilization: Changing Trends: The Norfolk Experience." Annals of the Academy of Medicine 21: 459–70.
Society for Assisted Reproductive Technology and the American Society for Reproductive Medicine. 2002. "Assisted Reproductive Technology in the United States: 1998 Results Generated from the American Society for Reproductive Medicine/Society for Assisted Reproductive Technology Registry." Fertility and Sterility 77: 18–31.
Speroff, Leon, Robert Glass, and Nathan Kase, eds. 1999. Clinical Gynecologic Endocrinology and Infertility, 6th ed. Baltimore: Lippincott Williams and Wilkins.
American Society for Reproductive Medicine. Available from www.asrm.org.
CDC Reproductive Health. 2002. "2000 Assisted Reproductive Technology Success Rates–National Summary and Fertility Clinic Reports." Available from www.cdc.gov.
National Center for Health Statistics. "National Survey of Family Growth." Available from www.cdc.gov/nchs/nsfg.htm.
LISA H. HARRIS