Infertility has been diagnosed in at least 1 of 6 couples in developed countries and in the United States, and almost 17% of women ages 25-44 years received some sort of medical fertility treatment or testing (Stanford 449). These numbers seem small in comparison with other diseases or medical diagnosis, yet they play a large role in the lives of families. In-vitro fertilization is a treatment that many couple choose to use for a fertility treatment. With an average cost of $12,000 to $15,000 per cycle or try, American women are spending more on this treatment compared to anyone in the world. (Anderson) Many people argue that in-vitro fertilization is inhumane, causes overpopulation and genetic disorders, and is harmful to the mother. Religion and However, IVF is a way for couples to conceive a child even if they are infertile. Fertility treatments, specifically IVF, should not be so costly and should treated as any other medical procedure.
In-vitro fertilization has been around for less than fifty years. The idea and trials of in-vitro fertilization date back to 1976, when Patrick Steptoe and Robert Edwards successfully implanted a fertilized embryo into Lesley Brown, who was infertile with her husband, John. Two-years later, Louise Brown was born and became known as the first “test-tube” baby (Zhu). According to Mayo Clinic, in-vitro fertilization is a manual process of collecting mature eggs from the ovaries and fertilizing them with sperm. It is a long, invasive, multi step procedure to overcome some causes of infertility. In women over the age of 40, IVF is usually the first treatment doctor go to. Younger couples with fertility problems are usually told to try a less invasive procedure like fertility drugs (Mayo Clinic). In most cases, however, IVF seems to be the only option. Reasons like fallopian tube damage, endometriosis, impaired sperm production, or a fear of passing down a genetic disorder are common reasons to receive IVF treatment (Mayo Clinic). For many women, multiple tries or cycles are needed to be done in order to succeed and give birth to a child (Mayo Clinic).
There are many steps involved in in-vitro fertilization. According to Rochester Medical Center, the first step in IVF is Controlled Ovarian Hyperstimulation (COH). Women’s eggs develop in sac-like structures called follicles. During regular menstruation, many follicles enlarge to produce eggs, yet only one or two eggs reaches maturity. In IVF, the goal is to obtain as many mature eggs as possible, so a drug called FSH, or follicle stimulating hormone is administered to complete that task. It allows more than one follicle to produce a mature egg, making it easier to collect multiple eggs for IVF. The next step in IVF includes retrieving the eggs. In a surgical procedure, a needle is guided through the uterus using ultrasounds. Once collected, the eggs are put into a dish and incubated until insemination (Rochester Medical Center).
The last, most complex step in IVF is the fertilization and transfer of the embryo. According to Rochester Medical Center, “If sperm parameters are normal, approximately 50,000 to 100,000 motile sperm are transferred to the dish containing the eggs” (Rochester Medical Center). This is the insemination process. If the sperm are abnormal, meaning there is either a low number of sperm or they have low mobility, additional assistance is needed where a single sperm is picked up by a fine glass microneedle and inserted into the eggs cytoplasm. This technique is called ICSI and increases the fertilization rate. After about twenty hours, the fertilization is assessed and cultured to support the zygote growth (Rochester Medical Center). Many things like size, appearance, and number affect the embryo quality, which decides when it will be implanted into the womb. Depending on what the embryologist says, the transfer will either be on day 3 or day 5 of insemination. Day three embryos are at the cleavage stage and have around four to five symmetrical cells. Day five embryos are called blasteocells and are more developed and larger in size. The actual transfer or implantation procedure is noninvasive and requires no anesthesia. The embryos are put into a catheter and placed in the uterine wall through the cervix (Rochester Medical Center). Finally, a positive pregnancy test shows completion and success of IVF.
The greatest controversy over in-vitro fertilization is focused around religion. According to Gareth Jones, a religion professor, The Roman Catholic response to clinically produced babies is that “Researchers are, it asserted, usurping the place of God, since they are choosing which embryos will be allowed to live and which will be ‘sent to death’; ‘defenseless human beings’ are being ‘killed’” (Jones 149). They also argue that the process of freezing embryos “exposes them to grave risks of death or harm and also deprives them of maternal shelter and gestation” (Jones 149). Roman Catholics believe that technology should have no place in contraception because it leads to “the domination of technology over the origin and destiny of the human person” (Jones 149). Protestant believers also have their own contradictions on fertility treatments and IVF. Their main concern is the idea of IVF being unethical. According to Jones, Paul Ramsey was a Princeton theologian who sparked these responses after the first “test tube baby.” He was concerned about the experiments that were brought upon young embryos because there was no way of foretelling the accidents and harm they would undergo, especially to the first few trial embryos (Jones). Ramsey also rebutted that the child or embryo gave no consent, which in turn was “treating an adult’s desires” (qtd in Jones 152). Protestants, specifically Ramsey, also reject IVF because of its ability to overcome genetic diseases or disabilities. They believe that we as humans should care for everyone, and that this “genetic advance may destroy our concern that genetically defective lives are to be cared for” (Jones 153). Jones mentions Donald MacKay, neuroscientist and Christian thinker who viewed in-vitro fertilization differently than most. MacKay focused his critique on the bible. He came to the conclusion that “Nowhere in the Bible is technological achievement disapproved, except where is expressed human pride and vainglory” (qtd in Jones 154). MacKay talked about how God put technology into our lives to improve stations of out life, like family and work. He challenges original controversy by providing us with the idea that we as humans are procreators and our job on earth is to bring children into existence either natural or artificial means.
Along with the religious controversy, several health risks may occur after using in-vitro fertilization. Premature and early delivery is the most common along with miscarriages. Mayo Clinic states, “The rate of miscarriage for women who conceive using IVF with fresh embryos is similar to that of women who conceive naturally — about 15 to 25 percent — but the rate increases with maternal age. Use of frozen embryos during IVF, however, may slightly increase the risk of miscarriage” (Mayo Clinic). Ovarian Hyperstimulation Syndrome is a risk for mothers who use fertility enhancing drugs, such as FSH, which causes painful and swollen ovaries. Another risk occurs in the egg-retrieval process. Since needles are being used to eject the egg, a possible of bleeding, infection, or damage to the surrounding organs has a high chance of occurring (Mayo Clinic).
Another risk involving IVF is the possibility of multiple births. According to Kulkarni, “[IVF] is associated with an increased risk of multiple births due to transfer of multiple embryos during IVF or inability to control the number of fertilized eggs” (Kulkarni et al.). When the embryos are being chosen and implanted, usually more than one is implanted in the uterus. With higher possibility of success, there also lies the possibility of all the embryos to succeed and produce more than one offspring. This also causes a higher risk of low birth weight and early labor compared to a single fetus pregnancy (Mayo Clinic).
Even though the list of risks seems long and unnerving, in-vitro fertilization has many benefits. The main benefit is that IVF a superior way to treat infertility. Patients using IVF also have the ability to choose their embryos. Many times, couples are afraid of passing down a genetic disorder or chromosomal abnormalities and have the option of using screening techniques like preimplantation genetic screening, or PGS, to choose the healthiest embryo (Mayo Clinic). IVF can also serve as a fertility preservation for diseases such as cancer. Women have the option of either harvesting the embryos in an unfertilized state and freezing them, or inseminating the extracted embryos and freezing them for future use. (Mayo Clinic) Although it is not 100% successful, in-vitro fertilization has the highest success rate compared to other methods of infertility treatment (Anderson).
Fertility treatments have an outrageous cost compared to other medical treatments. In-vitro fertilization is a number of different procedures each with their own price. Just one cycle of treatment is very expensive for many families in the United States, adding up to about $12,000 to $15,000 (Anderson). Paul Magarelli, a doctor of medicine in obstetrics and gynecology and a reproductive endocrinologist, says, "When someone asks 'How do I have a baby?' the answer shouldn't be 'How much are you willing to pay?'" (qtd in Anderson). In-vitro fertilization has a basic outline beginning with stimulating a woman's ovaries, harvesting the eggs, fertilizing them with sperm, and then implanting them back in the woman's uterus. Yet, extra testings and procedures can be done to increase the success rate (Anderson). Couples get to answer questions such as how many embryos to implant, whether to use fresh or frozen eggs, whether to use a needle to put the sperm in the egg, or whether to have assistance in hatching the eggs, but each having additional cost. Margarelli says, “This is a predicament unique to fertility. In no other medical situation would you ask someone to choose a less effective option just to save money. Have you ever heard of a surgeon charging extra to remove the whole appendix and not just the infected part?” (qtd in Anderson). Fertility is a medical procedure that should be treated the same as any other.
Another large part involved in the cost of in-vitro fertilization is the medication administered throughout. FSH and Gonadotropins, another set of hormones used as the foundation of infertility treatments, are very expensive drugs. (Anderson) Patricia Katz, who has PhD in fertility states that, “Median per-person costs ranged from $1,182 for medications only.” (Katz et al.). With the cost of medications and treatments, IVF is very expensive. Mayo Clinic highlight that most people end up receiving this treatment up to four time until it is successful (Mayo Clinic). This would explain why “Although approximately 12% of American women will receive infertility services during their lifetime, only 1–2% will undergo treatment with assisted reproductive technologies (ART), primarily in vitro fertilization (IVF),” according to Katz (Katz et al.).
In-vitro fertilization should be cheaper because it would lower multiple birth rates and keep American citizens safe. Since the first successful treatment of Louise Brown, over 8 million babies have been born world-wide from in-vitro fertilization (Science Daily). According to Kulkarni, “Fertility treatments are costly, particularly IVF, and this may motivate patients and providers to increase the chance of success by transferring more embryos during a cycle” (Kulkarni et al.). The problem with this is that in some cases, implanting more embryos poses a higher risk for multiple births. If the cost was cheaper, the multiple birth rate would decrease. Another reason why IVF should be cheaper is that women are using a method called “baby tourism,” whereby they travel outside of the United States for a cheaper IVF treatment (Anderson). This poses great risk for disease and contamination of the embryos. It also is dangerous for the mother if she experiences a medical emergency outside of the United States. According to Anderson, only 15 states require insurances to cover infertility treatments. This is a very low number in contrast to the 6.1 million woman in the United States who have difficulty getting pregnant or staying pregnant (Warner).
Throughout the forty-eight years that in-vitro fertilization has been around, it has been more developed and studied. The success rate has greatly increased with the help of technology and development (Coughlan et al.). Even with the religious and ethical controversy in today's society, IVF remains the most successful infertility treatment available. Helping couples conceive is its main goal, but it is blocked by the overwhelming cost of the treatment. Couples and families in the United States face paying outrageous amount of money toward in-vitro fertilization out of pocket. Many insurance companies exclude IVF as an infertility treatment, leaving couples with limited options. In-vitro fertilization should have reduced costs because it will lower the number of clinically created multiple births. It will also give families another option rather than leave the United States, risking harm to themselves or the embryos. The negative stigma around in-vitro fertilization and other infertility treatments is causing many people and insurances to brush aside the idea of government help and pay for IVF. In-vitro fertilization is usually a couple’s last resort and should be more readily available and cheaper to get.