In vitro fertilisation
In vitro fertilisation | |
---|---|
Specialty | Reproductive Endocrinology & Infertility |
ICD-10-PCS | 8E0ZXY1 |
In vitro fertilisation (IVF) is a process of
IVF is a type of
In July 1978, Louise Brown was the first child successfully born after her mother received IVF treatment.[1] Brown was born as a result of natural-cycle IVF, where no stimulation was made. The procedure took place at Dr Kershaw's Cottage Hospital (now Dr Kershaw's Hospice) in Royton, Oldham, England. Robert Edwards was awarded the Nobel Prize in Physiology or Medicine in 2010. The physiologist co-developed the treatment together with Patrick Steptoe and embryologist Jean Purdy but the latter two were not eligible for consideration as they had died and the Nobel Prize is not awarded posthumously.[2][3]
Assisted by egg donation and IVF, there are many women who may be past their reproductive years, have infertile partners, have idiopathic female-fertility issues, or have reached menopause, that can still become pregnant. After the IVF treatment, some couples get pregnant without any fertility treatments.[4] In 2023, it was estimated that twelve million children had been born worldwide using IVF and other assisted reproduction techniques.[5] A 2019 study that explores 10 adjuncts with IVF (screening hysteroscopy, DHEA, testosterone, GH, aspirin, heparin, antioxidants, seminal plasma and PRP) suggests that until more evidence is done to show that these adjuncts are safe and effective, they should be avoided.[6]
Terminology
The Latin term in vitro, meaning "in glass", is used because early biological experiments involving cultivation of tissues outside the living organism were carried out in glass containers, such as beakers, test tubes, or Petri dishes. Today, the scientific term "in vitro" is used to refer to any biological procedure that is performed outside the organism in which it would normally have occurred, to distinguish it from an in vivo procedure (such as in vivo fertilisation), where the tissue remains inside the living organism in which it is normally found.
A colloquial term for babies conceived as the result of IVF, "test tube babies", refers to the tube-shaped containers of glass or plastic resin, called test tubes, that are commonly used in chemistry and biology labs. However, IVF is usually performed in Petri dishes, which are both wider and shallower and often used to cultivate cultures.
IVF is a form of assisted reproductive technology.
History
The first successful birth of a child after IVF treatment,
The second successful birth of a 'test tube baby' occurred in India just 67 days after Louise Brown was born. The girl, named Durga, was conceived in vitro using a method developed independently by
Adriana Iliescu held the record as the oldest woman to give birth using IVF and a donor egg, when she gave birth in 2004 at the age of 66, a record passed in 2006. After the IVF treatment some couples are able to get pregnant without any fertility treatments.[4] In 2018 it was estimated that eight million children had been born worldwide using IVF and other assisted reproduction techniques.[10]
Medical uses
Indications
IVF may be used to overcome
According to UK's National Institute for Health and Care Excellence (NICE) guidelines, IVF treatment is appropriate in cases of unexplained infertility for people who have not conceived after 2 years of regular unprotected sexual intercourse.[11]
In people with anovulation, it may be an alternative after 7–12 attempted cycles of ovulation induction, since the latter is expensive and more easy to control.[12]
Success rates
IVF success rates are the percentage of all IVF procedures that result in favourable outcomes. Depending on the type of calculation used, this outcome may represent the number of confirmed pregnancies, called the
The success rate depends on variable factors such as age of the birthing person, cause of infertility, embryo status, reproductive history, and lifestyle factors. Younger candidates of IVF are more likely to get pregnant. People older than 41 are more likely to get pregnant with a donor egg.[14] People who have been previously pregnant are in many cases more successful with IVF treatments than those who have never been pregnant.[14]
Live birth rate
The live birth rate is the percentage of all IVF cycles that lead to a live birth. This rate does not include miscarriage or stillbirth; multiple-order births, such as twins and triplets, are counted as one pregnancy. A 2019 summary compiled by the Society for Assisted Reproductive Technology (SART) which reports the average IVF success rates in the United States per age group using non-donor eggs compiled the following data:[15]
< 35 | 35–37 | 38–40 | 41–42 | > 42 | |
---|---|---|---|---|---|
Live birth rate (%) | 55 | 41 | 26.8 | 13.4 | 4.3 |
In 2006, Canadian clinics reported a live birth rate of 27%.[16] Birth rates in younger patients were slightly higher, with a success rate of 35.3% for those 21 and younger, the youngest group evaluated. Success rates for older patients were also lower and decrease with age, with 37-year-olds at 27.4% and no live births for those older than 48, the oldest group evaluated.[17] Some clinics exceeded these rates, but it is impossible to determine if that is due to superior technique or patient selection, since it is possible to artificially increase success rates by refusing to accept the most difficult patients or by steering them into oocyte donation cycles (which are compiled separately). Further, pregnancy rates can be increased by the placement of several embryos at the risk of increasing the chance for multiples.
Because not each IVF cycle that is started will lead to oocyte retrieval or embryo transfer, reports of live birth rates need to specify the denominator, namely IVF cycles started, IVF retrievals, or embryo transfers. The SART summarised 2008–9 success rates for US clinics for fresh embryo cycles that did not involve donor eggs and gave live birth rates by the age of the prospective mother, with a peak at 41.3% per cycle started and 47.3% per embryo transfer for patients under 35 years of age.
IVF attempts in multiple cycles result in increased cumulative live birth rates. Depending on the demographic group, one study reported 45% to 53% for three attempts, and 51% to 71% to 80% for six attempts.[18]
Effective from 15 February 2021 the majority of Australian IVF clinics publish their individual success rate online via YourIVFSuccess.com.au. This site also contains a predictor tool.[19]
Pregnancy rate
Pregnancy rate may be defined in various ways. In the United States, SART and the
The 2019 summary compiled by the SART the following data for non-donor eggs (first embryo transfer) in the United States:[15]
<35 | 35-37 | 38-40 | 41–42 | >42 | |
---|---|---|---|---|---|
Positive pregnancy test rate (%) | 55.1 | 44.8 | 32.9 | 19.1 | 8.5 |
Clinical pregnancy rate (%) | 47.5 | 38.3 | 27.5 | 15.5 | 6.3 |
In 2006, Canadian clinics reported an average pregnancy rate of 35%.
Miscarriage rate
According to a study done by the Mayo Clinic, miscarriage rates for IVF are somewhere between 15 and 25% for those under the age of 35.[21] In naturally conceived pregnancies, the rate of miscarriage is between 10 and 20% for those under the age of 35.[22] Risk of miscarriage, regardless of the method of conception, does increase with age.[21]
Predictors of success
The main potential factors that influence pregnancy (and live birth) rates in IVF have been suggested to be
Biomarkers that affect the pregnancy chances of IVF include:
- Antral follicle count, with higher count giving higher success rates.[26]
- Anti-Müllerian hormone levels, with higher levels indicating higher chances of pregnancy,[26] as well as of live birth after IVF, even after adjusting for age.[27]
- Level of DNA fragmentation[28] as measured, e.g. by Comet assay, advanced maternal age and semen quality.
- People with ovary-specific FMR1 genotypes including het-norm/low have significantly decreased pregnancy chances in IVF.[29]
- induction of final maturation is associated with lower pregnancy rates in IVF cycles in women undergoing ovarian stimulation using GnRH analogues and gonadotrophins.[30] At this time, compared to a progesterone level below 0.8 ng/ml, a level between 0.8 and 1.1 ng/ml confers an odds ratio of pregnancy of approximately 0.8, and a level between 1.2 and 3.0 ng/ml confers an odds ratio of pregnancy of between 0.6 and 0.7.[30] On the other hand, progesterone elevation does not seem to confer a decreased chance of pregnancy in frozen–thawed cycles and cycles with egg donation.[30]
- Characteristics of cells from the oocyte retrieval. These cells are closely associated with the oocyte and share the same microenvironment, and the rate of expression of certain genes in such cells are associated with higher or lower pregnancy rate.[31]
- An endometrial thickness (EMT) of less than 7 mm decreases the pregnancy rate by an odds ratio of approximately 0.4 compared to an EMT of over 7 mm. However, such low thickness rarely occurs, and any routine use of this parameter is regarded as not justified.[32]
Other determinants of outcome of IVF include:
- As maternal age increases, the likelihood of conception decreases[33] and the chance of miscarriage increases.[34]
- With increasing paternal age, especially 50 years and older, the rate of blastocyst formation decreases.[35]
- Tobacco smoking reduces the chances of IVF producing a live birth by 34% and increases the risk of an IVF pregnancy miscarrying by 30%.[36]
- A
- Success with previous pregnancy and/or live birth increases chances[24]
- Low alcohol/caffeine intake increases success rate[24]
- The number of embryos transferred in the treatment cycle[38]
- Embryo quality
- Some studies also suggest that autoimmune disease may also play a role in decreasing IVF success rates by interfering with the proper implantation of the embryo after transfer.[29]
Aspirin is sometimes prescribed to people for the purpose of increasing the chances of conception by IVF, but as of 2016[update] there was no evidence to show that it is safe and effective.[39][40]
A 2013
A
Intake of
A
Method
This section needs additional citations for verification. (July 2020) |
Theoretically, IVF could be performed by collecting the contents from the fallopian tubes or uterus after natural ovulation, mixing it with sperm, and reinserting the fertilised ova into the uterus. However, without additional techniques, the chances of pregnancy would be extremely small. The additional techniques that are routinely used in IVF include ovarian hyperstimulation to generate multiple eggs, ultrasound-guided transvaginal oocyte retrieval directly from the ovaries, co-incubation of eggs and sperm, as well as culture and selection of resultant embryos before embryo transfer into a uterus.
Ovarian hyperstimulation
Ovarian hyperstimulation is the stimulation to induce development of multiple follicles of the ovaries. It should start with response prediction by e.g. age,
Ovarian hyperstimulation also includes suppression of spontaneous ovulation, for which two main methods are available: Using a (usually longer)
For the ovarian hyperstimulation in itself, injectable
When stimulating ovulation after suppressing endogenous secretion, it is necessary to supply exogenous gonadotropines. The most common one is the human menopausal gonadotropin (hMG), which is obtained by donation of menopausal women. Other pharmacological preparations are FSH+LH or coripholitropine alpha.
Natural IVF
There are several methods termed natural cycle IVF:[43]
- IVF using no drugs for ovulation suppressionmay still be used.
- IVF using ovarian hyperstimulation, including gonadotropins, but with a GnRH antagonistprotocol so that the cycle initiates from natural mechanisms.
- Frozen embryo transfer; IVF using ovarian hyperstimulation, followed by embryo cryopreservation, followed by embryo transfer in a later, natural, cycle.[44]
IVF using no drugs for ovarian hyperstimulation was the method for the conception of
Mild IVF
Final maturation induction
When the ovarian follicles have reached a certain degree of development,
Egg retrieval
The eggs are retrieved from the patient using a transvaginal technique called
Egg and sperm preparation
In the laboratory, for ICSI treatments, the identified eggs are stripped of surrounding cells (also known as
Co-incubation
The sperm and the egg are incubated together at a ratio of about 75,000:1 in a
In gamete intrafallopian transfer, eggs are removed from the woman and placed in one of the fallopian tubes, along with the man's sperm. This allows fertilisation to take place inside the woman's body. Therefore, this variation is actually an in vivo fertilisation, not in vitro.[54][55]
Embryo culture
The main durations of embryo culture are until
Embryo selection
Laboratories have developed grading methods to judge ovocyte and embryo quality. In order to optimise pregnancy rates, there is significant evidence that a morphological scoring system is the best strategy for the selection of embryos.[57] Since 2009 where the first time-lapse microscopy system for IVF was approved for clinical use, morphokinetic scoring systems has shown to improve to pregnancy rates further.[58] However, when all different types of time-lapse embryo imaging devices, with or without morphokinetic scoring systems, are compared against conventional embryo assessment for IVF, there is insufficient evidence of a difference in live-birth, pregnancy, stillbirth or miscarriage to choose between them.[59] Active efforts to develop a more accurate embryo selection analysis based on Artificial Intelligence and Deep Learning are underway. Embryo Ranking Intelligent Classification Assistant (ERICA),[60] is a clear example. This Deep Learning software substitutes manual classifications with a ranking system based on an individual embryo's predicted genetic status in a non-invasive fashion.[61] Studies on this area are still pending and current feasibility studies support its potential.[62]
Embryo transfer
The number to be transferred depends on the number available, the age of the patient and other health and diagnostic factors. In countries such as Canada, the UK, Australia and New Zealand, a maximum of two embryos are transferred except in unusual circumstances. In the UK and according to
Luteal support
Expansions
There are various expansions or additional techniques that can be applied in IVF, which are usually not necessary for the IVF procedure itself, but would be virtually impossible or technically difficult to perform without concomitantly performing methods of IVF.
Preimplantation genetic screening or diagnosis
Still, as an expansion of IVF, patients who can benefit from PGS/PGD include:
- Those who have a family history of inherited disease
- Those who want monogenic disorders with sex linkage. It can potentially be used for sex selection, wherein a fetus is aborted if having an undesired sex.
- Those who already have a child with an incurable disease and need compatible cells from a second healthy child to cure the first, resulting in a "HLA type.[68]
PGS screens for numeral chromosomal abnormalities while PGD diagnosis the specific molecular defect of the inherited disease. In both PGS and PGD, individual cells from a pre-embryo, or preferably trophectoderm cells biopsied from a blastocyst, are analysed during the IVF process. Before the transfer of a pre-embryo back to a person's uterus, one or two cells are removed from the pre-embryos (8-cell stage), or preferably from a blastocyst. These cells are then evaluated for normality. Typically within one to two days, following completion of the evaluation, only the normal pre-embryos are transferred back to the uterus. Alternatively, a blastocyst can be cryopreserved via vitrification and transferred at a later date to the uterus. In addition, PGS can significantly reduce the risk of multiple pregnancies because fewer embryos, ideally just one, are needed for implantation.
Cryopreservation
Cryopreservation can be performed as oocyte cryopreservation before fertilisation, or as embryo cryopreservation after fertilisation.
The Rand Consulting Group has estimated there to be 400,000 frozen embryos in the United States in 2006.
By 2017, many centres have adopted embryo cryopreservation as their primary IVF therapy, and perform few or no fresh embryo transfers. The two main reasons for this have been better endometrial receptivity when embryos are transferred in cycles without exposure to ovarian stimulation and also the ability to store the embryos while awaiting the results of preimplantation genetic testing.
The outcome from using cryopreserved embryos has uniformly been positive with no increase in birth defects or development abnormalities.[71]
Other expansions
- teratozoospermia, since once the egg is fertilised abnormal sperm morphology does not appear to influence blastocyst development or blastocyst morphology.[72]
- Additional methods of embryo profiling. For example, methods are emerging in making comprehensive analyses of up to entire genomes, transcriptomes, proteomes and metabolomes which may be used to score embryos by comparing the patterns with ones that have previously been found among embryos in successful versus unsuccessful pregnancies.[73]
- Assisted zona hatching (AZH) can be performed shortly before the embryo is transferred to the uterus. A small opening is made in the outer layer surrounding the egg in order to help the embryo hatch out and aid in the implantation process of the growing embryo.
- In egg donation and embryo donation, the resultant embryo after fertilisation is inserted in another person than the one providing the eggs. These are resources for those with no eggs due to surgery, chemotherapy, or genetic causes; or with poor egg quality, previously unsuccessful IVF cycles or advanced maternal age. In the egg donor process, eggs are retrieved from a donor's ovaries, fertilised in the laboratory with sperm, and the resulting healthy embryos are returned to the recipient's uterus.
- In preimplantation genetic screening.
- Embryo splitting can be used for twinning to increase the number of available embryos.[74]
- mitochondria, contained within an egg's cytoplasm.
Complications and health effects
Multiple births
The major complication of IVF is the risk of
Sex ratio distortions
Certain kinds of IVF have been shown to lead to distortions in the
Spread of infectious disease
By sperm washing, the risk that a chronic disease in the individual providing the sperm would infect the birthing parent or offspring can be brought to negligible levels.
If the sperm donor has hepatitis B, The Practice Committee of the American Society for Reproductive Medicine advises that sperm washing is not necessary in IVF to prevent transmission, unless the birthing partner has not been effectively vaccinated.[79][80] In birthing people with hepatitis B, the risk of vertical transmission during IVF is no different from the risk in spontaneous conception.[80] However, there is not enough evidence to say that ICSI procedures are safe in birthing people with hepatitis B in regard to vertical transmission to the offspring.[80]
Regarding potential spread of
In the United States, people seeking to be an embryo recipient undergo infectious disease screening required by the
Other risks to the egg provider/retriever
A risk of ovarian stimulation is the development of
During egg retrieval, there exists a small chance of bleeding, infection, and damage to surrounding structures such as bowel and bladder (transvaginal ultrasound aspiration) as well as difficulty in breathing, chest infection, allergic reactions to medication, or nerve damage (laparoscopy).
Ectopic pregnancy may also occur if a fertilised egg develops outside the uterus, usually in the fallopian tubes and requires immediate destruction of the foetus.
IVF does not seem to be associated with an elevated risk of
Regardless of pregnancy result, IVF treatment is usually stressful for patients.
Studies show that there is an increased risk of venous thrombosis or pulmonary embolism during the first trimester of IVF.[87] When looking at long-term studies comparing patients who received or did not receive IVF, there seems to be no correlation with increased risk of cardiac events. There are more ongoing studies to solidify this.[88]
Birth defects
A review in 2013 came to the result that infants resulting from IVF (with or without ICSI) have a
Condition | Relative risk |
95% confidence interval |
---|---|---|
Beckwith–Wiedemann syndrome | 3-4 | |
congenital anomalies |
1.67 | 1.33–2.09 |
ante-partum haemorrhage |
2.49 | 2.30–2.69 |
hypertensive disorders of pregnancy |
1.49 | 1.39–1.59 |
preterm rupture of membranes |
1.16 | 1.07–1.26 |
Caesarean section | 1.56 | 1.51–1.60 |
gestational diabetes | 1.48 | 1.33–1.66 |
induction of labour |
1.18 | 1.10–1.28 |
small for gestational age | 1.39 | 1.27–1.53 |
preterm birth | 1.54 | 1.47–1.62 |
low birthweight |
1.65 | 1.56–1.75 |
perinatal mortality | 1.87 | 1.48–2.37 |
Other risks to the offspring
If the underlying infertility is related to abnormalities in spermatogenesis, it is plausible, but too early to examine that male offspring are at higher risk for sperm abnormalities.[clarification needed]
IVF does not seem to confer any risks regarding cognitive development, school performance, social functioning, and behaviour.[96] Also, IVF infants are known to be as securely attached to their parents as those who were naturally conceived, and IVF adolescents are as well-adjusted as those who have been naturally conceived.[97]
Limited long-term follow-up data suggest that IVF may be associated with an increased incidence of
IVF, including
An IVF-associated incidence of
Overall, IVF does not cause an increased risk of childhood cancer.[101] Studies have shown a decrease in the risk of certain cancers and an increased risks of certain others including retinoblastoma,[102] hepatoblastoma[101] and rhabdomyosarcoma.[101]
Ethics
Mix-ups
In some cases, laboratory mix-ups (misidentified gametes, transfer of wrong embryos) have occurred, leading to legal action against the IVF provider and complex paternity suits. An example is the case of a woman in California who received the embryo of another couple and was notified of this mistake after the birth of her son.
Preimplantation genetic diagnosis or screening
Pre-implantation genetic diagnosis (PGD) is criticised for giving select demographic groups disproportionate access to a means of creating a child possessing characteristics that they consider "ideal". Many fertile couples[106][107] now demand equal access to embryonic screening so that their child can be just as healthy as one created through IVF. Mass use of PGD, especially as a means of population control or in the presence of legal measures related to population or demographic control, can lead to intentional or unintentional demographic effects such as the skewed live-birth sex ratios seen in China following implementation of its one-child policy.
While PGD was originally designed to screen for embryos carrying hereditary genetic diseases, the method has been applied to select features that are unrelated to diseases, thus raising ethical questions. Examples of such cases include the selection of embryos based on histocompatibility (HLA) for the donation of tissues to a sick family member, the diagnosis of genetic susceptibility to disease, and sex selection.[108]
These examples raise ethical issues because of the morality of eugenics. It becomes frowned upon because of the advantage of being able to eliminate unwanted traits and selecting desired traits. By using PGD, individuals are given the opportunity to create a human life unethically and rely on science and not by natural selection.[109]
For example, a deaf British couple, Tom and Paula Lichy, have petitioned to create a deaf baby using IVF.[110] Some medical ethicists have been very critical of this approach. Jacob M. Appel wrote that "intentionally culling out blind or deaf embryos might prevent considerable future suffering, while a policy that allowed deaf or blind parents to select for such traits intentionally would be far more troublesome."[111]
Industry corruption
In 2008, a California physician transferred 12 embryos to a woman who gave birth to octuplets (Suleman octuplets). This led to accusations[by whom?] that a doctor is willing to endanger the health and even life of people in order to gain money.[citation needed] Robert Winston, professor of fertility studies at Imperial College London, had called the industry "corrupt" and "greedy" stating that "one of the major problems facing us in healthcare is that IVF has become a massive commercial industry," and that "what has happened, of course, is that money is corrupting this whole technology", and accused authorities of failing to protect couples from exploitation: "The regulatory authority has done a consistently bad job. It's not prevented the exploitation of people, it's not put out very good information to couples, it's not limited the number of unscientific treatments people have access to".[112] The IVF industry has been described as a market-driven construction of health, medicine and the human body.[113]
The industry has been accused of making unscientific claims, and distorting facts relating to infertility, in particular through widely exaggerated claims about how common infertility is in society, in an attempt to get as many couples as possible and as soon as possible to try treatments (rather than trying to conceive naturally for a longer time).[citation needed] This risks removing infertility from its social context and reducing the experience to a simple biological malfunction, which not only can be treated through bio-medical procedures, but should be treated by them.[114][115]
Older patients
All pregnancies can be risky, but there are greater risk for birthing parents who are older and are over the age of 40. As people get older, they are more likely to develop conditions such as gestational diabetes and pre-eclampsia. If the birthing parent does conceive over the age of 40, their offspring may be of lower birth weight, and more likely to requires intensive care. Because of this, the increased risk is a sufficient cause for concern. The high incidence of caesarean in older patients is commonly regarded as a risk.[116]
Those conceiving at 40 have a greater risk of gestational hypertension and premature birth. The offspring is at risk when being born from older mothers, and the risks associated with being conceived through IVF.[117]
Adriana Iliescu held the record for a while as the oldest woman to give birth using IVF and a donor egg, when she gave birth in 2004 at the age of 66.[citation needed] In September 2019, a 74-year-old woman became the oldest-ever to give birth after she delivered twins at a hospital in Guntur, Andhra Pradesh.[118]
Pregnancy after menopause
Although menopause is a natural barrier to further conception, IVF has allowed people to be pregnant in their fifties and sixties. People whose uteruses have been appropriately prepared receive embryos that originated from an egg donor. Therefore, although they do not have a genetic link with the child, they have a physical link through pregnancy and childbirth. Even after menopause, the uterus is fully capable of carrying out a pregnancy.[119]
Same-sex couples, single and unmarried parents
A 2009 statement from the ASRM found no persuasive evidence that children are harmed or disadvantaged solely by being raised by single parents, unmarried parents, or homosexual parents. It did not support restricting access to assisted reproductive technologies on the basis of a prospective parent's marital status or sexual orientation.[120] A 2018 study found that children's psychological well-being did not differ when raised by either same-sex parents or heterosexual parents, even finding that psychological well-being was better amongst children raised by same-sex parents.[121]
Ethical concerns include reproductive rights, the welfare of offspring, nondiscrimination against unmarried individuals, homosexual, and professional autonomy.[120]
A controversy in California focused on the question of whether physicians opposed to same-sex relationships should be required to perform IVF for a lesbian couple. Guadalupe T. Benitez, a lesbian medical assistant from San Diego, sued doctors Christine Brody and Douglas Fenton of the North Coast Woman's Care Medical Group after Brody told her that she had "religious-based objections to treating her and homosexuals in general to help them conceive children by artificial insemination," and Fenton refused to authorise a refill of her prescription for the fertility drug Clomid on the same grounds.
Nadya Suleman came to international attention after having twelve embryos implanted, eight of which survived, resulting in eight newborns being added to her existing six-child family. The Medical Board of California sought to have fertility doctor Michael Kamrava, who treated Suleman, stripped of his licence. State officials allege that performing Suleman's procedure is evidence of unreasonable judgment, substandard care, and a lack of concern for the eight children she would conceive and the six she was already struggling to raise. On 1 June 2011 the Medical Board issued a ruling that Kamrava's medical licence be revoked effective 1 July 2011.[126][127][128]
Transgender parents
The research on transgender reproduction and family planning is limited.[129] A 2020 comparative study of children born to a transgender father and cisgender mother via donor sperm insemination in France showed no significant differences to IVF and naturally conceived children of cisgender parents.[130]
Transgender men can experience challenges in pregnancy and birthing from the cis-normative structure within the medical system,[129] as well as psychological challenges such as renewed gender dysphoria.[131] The effect of continued testosterone therapy during pregnancy and breastfeeding is undetermined.[132] Ethical concerns include reproductive rights, reproductive justice, physician autonomy, and transphobia within the health care setting.[129]
Anonymous donors
Some children conceived by IVF using anonymous donors report being troubled over not knowing about their donor parent as well any genetic relatives they may have and their family history.[133][134]
Alana Stewart, who was conceived using donor sperm, began an online forum for donor children called AnonymousUS in 2010. The forum welcomes the viewpoints of anyone involved in the IVF process.[135] Olivia Pratten, a donor-conceived Canadian, sued the province of British Columbia for access to records on her donor father's identity in 2008.[136] "I'm not a treatment, I'm a person, and those records belong to me," Pratten said.[133] In May 2012, a court ruled in Pratten's favour, agreeing that the laws at the time discriminated against donor children and making anonymous sperm and egg donation in British Columbia illegal.[136]
In the U.K., Sweden, Norway, Germany, Italy, New Zealand, and some Australian states, donors are not paid and cannot be anonymous.
In 2000, a website called Donor Sibling Registry was created to help biological children with a common donor connect with each other.[134][137]
In 2012, a documentary called Anonymous Father's Day was released that focuses on donor-conceived children.[138]
Leftover embryos or eggs, unwanted embryos
There may be leftover embryos or eggs from IVF procedures if the person for whom they were originally created has successfully carried one or more pregnancies to term, and no longer wishes to use them. With the patient's permission, these may be donated to help others conceive by means of
In
Alternatives to donating unused embryos are destroying them (or having them transferred at a time when pregnancy is very unlikely),[140] keeping them frozen indefinitely, or donating them for use in research (rendering them non-viable).[141] Individual moral views on disposing of leftover embryos may depend on personal views on the beginning of human personhood and the definition and/or value of potential future persons, and on the value that is given to fundamental research questions. Some people believe donation of leftover embryos for research is a good alternative to discarding the embryos when patients receive proper, honest and clear information about the research project, the procedures and the scientific values.[142]
During the
The ethic issues remain unresolved as no worldwide consensus exists in science, religion, and philosophy on when a human embryo should be recognised as a person. For those who believe that this is at the moment of conception, IVF becomes a moral question when multiple eggs are fertilised, begin development, and only a few are chosen for uterus transfer.[citation needed] If IVF were to involve the fertilisation of only a single egg, or at least only the number that will be transferred, then this would not be an issue. However, this has the chance of increasing costs dramatically as only a few eggs can be attempted at a time. As a result, the couple must decide what to do with these extra embryos. Depending on their view of the embryo's humanity or the chance the couple will want to try to have another child, the couple has multiple options for dealing with these extra embryos. Couples can choose to keep them frozen, donate them to other infertile couples, thaw them, or donate them to medical research.[140] Keeping them frozen costs money, donating them does not ensure they will survive, thawing them renders them immediately unviable, and medical research results in their termination. In the realm of medical research, the couple is not necessarily told what the embryos will be used for, and as a result, some can be used in stem cell research.
In February 2024, the
Religious response
The
The Catechism of the Catholic Church, in accordance with the Catholic understanding of natural law, teaches that reproduction has an "inseparable connection" to the sexual union of married couples.[146] In addition, the church opposes IVF because it might result in the disposal of embryos; in Catholicism, an embryo is viewed as an individual with a soul that must be treated as a person.[147] The Catholic Church maintains that it is not objectively evil to be infertile, and advocates adoption as an option for such couples who still wish to have children.[148]
Regarding the response to IVF by Islam, a general consensus from the contemporary Sunni scholars concludes that IVF methods are immoral and prohibited. However, Gad El-Hak Ali Gad El-Hak's ART fatwa includes that:[150]
- IVF of an egg from the wife with the sperm of her husband and the transfer of the fertilised egg back to the uterus of the wife is allowed, provided that the procedure is indicated for a medical reason and is carried out by an expert physician.
- Since marriage is a contract between the wife and husband during the span of their marriage, no third party should intrude into the marital functions of sex and procreation. This means that a third party donor is not acceptable, whether he or she is providing sperm, eggs, embryos, or a uterus. The use of a third party is tantamount to zina, or adultery.
Within the
Society and culture
Many women of sub-Saharan Africa choose to foster their children to infertile women. IVF enables these infertile women to have their own children, which imposes new ideals to a culture in which fostering children is seen as both natural and culturally important. Many infertile women are able to earn more respect in their society by taking care of the children of other mothers, and this may be lost if they choose to use IVF instead. As IVF is seen as unnatural, it may even hinder their societal position as opposed to making them equal with fertile women. It is also economically advantageous for infertile women to raise foster children as it gives these children greater ability to access resources that are important for their development and also aids the development of their society at large. If IVF becomes more popular without the birth rate decreasing, there could be more large family homes with fewer options to send their newborn children. This could result in an increase of orphaned children and/or a decrease in resources for the children of large families. This would ultimately stifle the children's and the community's growth.[152]
In the US, the pineapple has emerged as a symbol of IVF users, possibly because some people thought, without scientific evidence, that eating pineapple might slightly increase the success rate for the procedure.[153]
Emotional involvement with children
Studies have indicated that IVF mothers show greater emotional involvement with their child, and they enjoy motherhood more than mothers by natural conception. Similarly, studies have indicated that IVF fathers express more warmth and emotional involvement than fathers by adoption and natural conception and enjoy fatherhood more. Some IVF parents become overly involved with their children.[154]
Men and IVF
Research has shown that men largely view themselves as "passive contributors"[155]: 340 since they have "less physical involvement"[156] in IVF treatment. Despite this, many men feel distressed after seeing the toll of hormonal injections and ongoing physical intervention on their female partner.[155]: 344 Fertility was found to be a significant factor in a man's perception of his masculinity, driving many to keep the treatment a secret.[155]: 344 In cases where the men did share that he and his partner were undergoing IVF, they reported to have been teased, mainly by other men, although some viewed this as an affirmation of support and friendship. For others, this led to feeling socially isolated.[155]: 336 In comparison with females, males showed less deterioration in mental health in the years following a failed treatment.[157] However, many men did feel guilt, disappointment and inadequacy, stating that they were simply trying to provide an "emotional rock" for their partners.[155]: 336
Ability to withdraw consent
In certain countries, including Austria, Italy, Estonia, Hungary, Spain and Israel, the male does not have the full ability to withdraw consent to storage or use of embryos once they are fertilised. In the United States, the matter has been left to the courts on a more or less ad hoc basis. If embryos are implanted and a child is born contrary to the wishes of the male, he still has legal and financial responsibilities of a father.[158]
Availability and utilisation
The laws of many countries permit IVF for only single individuals, lesbian couples, and persons participating in surrogacy arrangements.[159]
Cost
Costs of IVF can be broken down into direct and indirect costs. Direct costs include the medical treatments themselves, including doctor consultations, medications, ultrasound scanning, laboratory tests, the actual IVF procedure, and any associated hospital charges and administrative costs. Indirect costs includes the cost of addressing any complications with treatments, compensation for the
The cost of IVF rather reflects the costliness of the underlying healthcare system than the regulatory or funding environment,[163] and ranges, on average for a standard IVF cycle and in 2006 United States dollars, between $12,500 in the United States to $4,000 in Japan.[163] In Ireland, IVF costs around €4,000, with fertility drugs, if required, costing up to €3,000.[164] The cost per live birth is highest in the United States ($41,000[163]) and United Kingdom ($40,000[163]) and lowest in Scandinavia and Japan (both around $24,500[163]).
The high cost of IVF is also a barrier to access for disabled individuals, who typically have lower incomes, face higher health care costs, and seek health care services more often than non-disabled individuals.[165]
Navigating insurance coverage for transgender expectant parents presents a unique challenge. Insurance plans are designed to cater towards a specific population, meaning that some plans can provide adequate coverage for gender-affirming care but fail to provide fertility services for transgender patients.[166] Additionally, insurance coverage is constructed around a person's legally recognised sex and not their anatomy; thus, transgender people may not get coverage for the services they need, including transgender men for fertility services.[166]
Use by LGBT individuals
Same-sex couples
In larger urban centres, studies have noted that lesbian, gay, bisexual, transgender and queer (LGBTQ+) populations are among the fastest-growing users of fertility care.
Transgender parents
Many LGBT communities centre their support around cisgender gay, lesbian and bisexual people and neglect to include proper support for transgender people.[171] The same 2020 literature review analyses the social, emotional and physical experiences of pregnant transgender men.[129] A common obstacle faced by pregnant transgender men is the possibility of gender dysphoria. Literature shows that transgender men report uncomfortable procedures and interactions during their pregnancies as well as feeling misgendered due to gendered terminology used by healthcare providers. Outside of the healthcare system, pregnant transgender men may experience gender dysphoria due to cultural assumptions that all pregnant people are cisgender women.[129] These people use three common approaches to navigating their pregnancy: passing as a cisgender woman, hiding their pregnancy, or being out and visibly pregnant as a transgender man.[129] Some transgender and gender diverse patients describe their experience in seeking gynaecological and reproductive health care as isolating and discriminatory, as the strictly binary healthcare system often leads to denial of healthcare coverage or unnecessary revelation of their transgender status to their employer.[172]
Many transgender people retain their original sex organs and choose to have children through biological reproduction. Advances in assisted reproductive technology and fertility preservation have broadened the options transgender people have to conceive a child using their own gametes or a donor's. Transgender men and women may opt for fertility preservation before any gender affirming surgery, but it is not required for future biological reproduction.[129][173] It is also recommended that fertility preservation is conducted before any hormone therapy.[170] Additionally, while fertility specialists often suggest that transgender men discontinue their testosterone hormones prior to pregnancy, research on this topic is still inconclusive.[174][129] However, a 2019 study found that transgender male patients seeking oocyte retrieval via assisted reproductive technology (including IVF) were able to undergo treatment four months after stopping testosterone treatment, on average.[175] All patients experienced menses and normal AMH, FSH and E2 levels and antral follicle counts after coming off testosterone, which allowed for successful oocyte retrieval.[175] Despite assumptions that the long-term androgen treatment negatively impacts fertility, oocyte retrieval, an integral part of the IVF process, does not appear to be affected.
Biological reproductive options available to transgender women include, but are not limited to, IVF and IUI with the trans woman's sperm and a donor or a partner's eggs and uterus. Fertility treatment options for transgender men include, but are not limited to, IUI or IVF using his own eggs with a donor's sperm and/or donor's eggs, his uterus, or a different uterus, whether that is a partner's or a surrogate's.[176]
Use by disabled individuals
People with disabilities who wish to have children are equally or more likely than the non-disabled population to experience infertility,[165] yet disabled individuals are much less likely to have access to fertility treatment such as IVF. There are many extraneous factors that hinder disabled individuals access to IVF, such as assumptions about decision-making capacity, sexual interests and abilities, heritability of a disability, and beliefs about parenting ability.[177][178] These same misconceptions about people with disabilities that once led health care providers to sterilise thousands of women with disabilities now lead them to provide or deny reproductive care on the basis of stereotypes concerning people with disabilities and their sexuality.[165]
Not only do misconceptions about disabled individuals parenting ability, sexuality, and health restrict and hinder access to fertility treatment such as IVF, structural barriers such as providers uneducated in disability healthcare and inaccessible clinics severely hinder disabled individuals access to receiving IVF.[165]
By country
Australia
In Australia, the average age of women undergoing ART treatment is 35.5 years among those using their own eggs (one in four being 40 or older) and 40.5 years among those using
Cameroon
Ernestine Gwet Bell supervised the first Cameroonian child born by IVF in 1998.[181]
Canada
In Canada, one cycle of IVF treatment can cost between $7,750 to $12,250 CAD, and medications alone can cost between $2,500 to over $7,000 CAD.[182] The funding mechanisms that influence accessibility in Canada vary by province and territory, with some provinces providing full, partial or no coverage.
New Brunswick provides partial funding through their Infertility Special Assistance Fund – a one time grant of up to $5,000. Patients may only claim up to 50% of treatment costs or $5,000 (whichever is less) occurred after April 2014. Eligible patients must be a full-time New Brunswick resident with a valid Medicare card[183] and have an official medical infertility diagnosis by a physician.[184]
In December 2015, the Ontario provincial government enacted the Ontario Fertility Program for patients with medical and non-medical infertility, regardless of sexual orientation, gender or family composition. Eligible patients for IVF treatment must be Ontario residents under the age of 43 and have a valid Ontario Health Insurance Plan card and have not already undergone any IVF cycles. Coverage is extensive, but not universal. Coverage extends to certain blood and urine tests, physician/nurse counselling and consultations, certain ultrasounds, up to two cycle monitorings, embryo thawing, freezing and culture, fertilisation and embryology services, single transfers of all embryos, and one surgical sperm retrieval using certain techniques only if necessary. Drugs and medications are not covered under this Program, along with psychologist or social worker counselling, storage and shipping of eggs, sperm or embryos, and the purchase of donor sperm or eggs.[185]
China
IVF is expensive in China and not generally accessible to unmarried women.[186] In August 2022, China's National Health Authority announced that it will take steps to make assisted reproductive technology more accessible, including by guiding local governments to include such technology in its national medical system.[186]
Croatia
No egg or sperm donations take place in Croatia, however using donated sperm or egg in ART and IUI is allowed. With donated eggs, sperm or embryo, a heterosexual couple and single women have legal access to IVF. Male or female couples do not have access to ART as a form of reproduction. The minimum age for males and females to access ART in Croatia is 18 there is no maximum age. Donor anonymity applies, but the born child can be given access to the donor's identity at a certain age[187]
India
The penetration of the IVF market in India is quite low, with only 2,800 cycles per million infertile people in the reproductive age group (20–44 years), as compared to China, which has 6,500 cycles. The key challenges are lack of awareness, affordability and accessibility.[188] Since 2018, however, India has become a destination for fertility tourism, because of lower costs than in the Western world. In December 2021, the Lok Sabha passed the Assisted Reproductive Technology (Regulation) Bill 2020, to regulate ART services including IVF centres, sperm and egg banks.[189]
Israel
Israel has the highest rate of IVF in the world, with 1,657 procedures performed per million people per year.[citation needed] Couples without children can receive funding for IVF for up to two children. The same funding is available for people without children who will raise up to two children in a single parent home. IVF is available for people aged 18 to 45.[190] The Israeli Health Ministry says it spends roughly $3450 per procedure.[citation needed]
Sweden
One, two or three IVF treatments are government subsidised for people who are younger than 40 and have no children. The rules for how many treatments are subsidised, and the upper age limit for the people, vary between different
United Kingdom
Availability of IVF in England is determined by
IVF increasingly appears on NHS treatments blacklists.[197] In August 2017 five of the 208 CCGs had stopped funding IVF completely and others were considering doing so.[198] By October 2017 only 25 CCGs were delivering the three recommended NHS IVF cycles to eligible people under 40.[199] Policies could fall foul of discrimination laws if they treat same sex couples differently from heterosexual ones.[200] In July 2019 Jackie Doyle-Price said that women were registering with surgeries further away from their own home in order to get around CCG rationing policies.[citation needed]
The Human Fertilisation and Embryology Authority said in September 2018 that parents who are limited to one cycle of IVF, or have to fund it themselves, are more likely choose to implant multiple embryos in the hope it increases the chances of pregnancy. This significantly increases the chance of multiple births and the associated poor outcomes, which would increase NHS costs. The president of the Royal College of Obstetricians and Gynaecologists said that funding 3 cycles was "the most important factor in maintaining low rates of multiple pregnancies and reduce(s) associated complications".[201]
United States
In the United States, overall availability of IVF in 2005 was 2.5 IVF physicians per 100,000 population, and utilisation was 236 IVF cycles per 100,000.[202] 126 procedures are performed per million people per year. Utilisation highly increases with availability and IVF insurance coverage, and to a significant extent also with percentage of single persons and median income.[202] In the US, an average cycle, from egg retrieval to embryo implantation, costs $12,400, and insurance companies that do cover treatment, even partially, usually cap the number of cycles they pay for.[203] As of 2015, more than 1 million babies had been born utilising IVF technologies.[34]
In the US, nineteen states have laws requiring insurance coverage for infertility treatment, and thirteen of those specifically include IVF.[204] These states that mandate IVF coverage are: Arkansas, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Hampshire, New Jersey, New York, Ohio, Rhode Island, Texas, Utah, and West Virginia.[204] These laws differ by state but many require an egg be fertilised with sperm from a spouse and that in order to be covered you must show you cannot become pregnant through penile-vaginal sex.[204] These requirements are not possible for a same-sex couple to meet. No state Medicaid program, however, covers for IVF according to a 2020 report.[162]
Many fertility clinics in the United States limit the upper age at which people are eligible for IVF to 50 or 55 years.[205] These cut-offs make it difficult for people older than fifty-five to utilise the procedure.[205]
Legal status
Government agencies in China passed bans on the use of IVF in 2003 by unmarried people or by couples with certain infectious diseases.[206]
In India, the use of IVF as a means of sex selection (preimplantation genetic diagnosis) is banned under the Pre-Conception and Pre-Natal Diagnostic Techniques Act, 1994.[207][208][209]
Sunni Muslim nations generally allow IVF between married couples when conducted with their own respective sperm and eggs, but not with donor eggs from other couples. But Iran, which is Shi'a Muslim, has a more complex scheme. Iran bans sperm donation but allows donation of both fertilised and unfertilised eggs. Fertilised eggs are donated from married couples to other married couples, while unfertilised eggs are donated in the context of mut'ah or temporary marriage to the father.[210]
By 2012 Costa Rica was the only country in the world with a complete ban on IVF technology, it having been ruled unconstitutional by the nation's Supreme Court because it "violated life."[211] Costa Rica had been the only country in the western hemisphere that forbade IVF. A law project sent reluctantly by the government of President Laura Chinchilla was rejected by parliament. President Chinchilla has not publicly stated her position on the question of IVF. However, given the massive influence of the Catholic Church in her government any change in the status quo seems very unlikely.[212][213] In spite of Costa Rican government and strong religious opposition, the IVF ban has been struck down by the Inter-American Court of Human Rights in a decision of 20 December 2012.[214] The court said that a long-standing Costa Rican guarantee of protection for every human embryo violated the reproductive freedom of infertile couples because it prohibited them from using IVF, which often involves the disposal of embryos not implanted in a woman's uterus.[215] On 10 September 2015, President Luis Guillermo Solís signed a decree legalising in-vitro fertilisation. The decree was added to the country's official gazette on 11 September. Opponents of the practice have since filed a lawsuit before the country's Constitutional Court.[216]
All major restrictions on single but infertile people using IVF were lifted in Australia in 2002 after a final appeal to the Australian High Court was rejected on procedural grounds in the Leesa Meldrum case. A
Federal regulations in the United States include screening
In 2024, the
Few American courts have addressed the issue of the "property" status of a frozen embryo. This issue might arise in the context of a divorce case, in which a court would need to determine which spouse would be able to decide the disposition of the embryos. It could also arise in the context of a dispute between a sperm donor and egg donor, even if they were unmarried. In 2015, an Illinois court held that such disputes could be decided by reference to any contract between the parents-to-be. In the absence of a contract, the court would weigh the relative interests of the parties.[230]
Alternatives
Some alternatives to IVF are:
- Artificial insemination, including intracervical insemination and intrauterine insemination of semen. It requires that a woman ovulates, but is a relatively simple procedure, and can be used in the home for self-insemination without medical practitioner assistance.[231] The beneficiaries of artificial insemination are people who desire to give birth to their own child who may be single, people who are in a lesbian relationship or females who are in a heterosexual relationship but with a male partner who is infertile or who has a physical impairment which prevents full intercourse from taking place.
- naturalor artificial insemination.
- pregnancy risksare too dangerous for the intended gestational carrier, or when a single man or a male couple wish to have a child.
- Adoption whereby a person assumes the parenting of another, usually a child, from that person's biological or legal parent or parents.
See also
- Semen cryopreservation
- Evans v United Kingdom, a key case at the European Court of Human Rights
- Sex selection
- Stem cell controversy
- Reciprocal IVF
- Test Tube Babies (film)
References
- ^ "Louise Brown: World's first IVF baby's family archive unveiled". BBC News. 24 July 2018. Retrieved 29 July 2021.
- ^ Bob Edwardsbecame the first to successfully carry out IVF by extracting an egg, impregnating it with sperm and planting the resulting embryo back into the mother
- ^ S2CID 5045457.
- ^ a b "After IVF, some couples get pregnant without help". Reuters. 3 May 2012. Retrieved 5 November 2015.
- PMID 38106562.
- PMID 31703943.
- ^ Jayaraman KS (19 October 1978). "India reveals deep-frozen test-tube baby". New Scientist. p. 159. Retrieved 4 September 2021.[permanent dead link]
- ^ "Test tube triumph & tragedy – Nobel for UK scientist stirs memory of a Bengal doctor". The Telegraph. 5 October 2010. Retrieved 22 May 2012.
- ^ Test Tube Baby. YouTube. Educational Multimedia Research Centre, Kolkata. 23 August 2013. Retrieved 4 September 2021.
- ^ European Society of Human Reproduction and Embryology (3 July 2018). "More than 8 million babies born from IVF since the world's first in 1978". ScienceDaily. Retrieved 8 December 2018.
- NICE clinical guideline. February 2013.
- ^ PMID 25164024.
- S2CID 22535393.
- ^ a b "In vitro fertilization (IVF) Results – Mayo Clinic". www.mayoclinic.org. Retrieved 5 November 2015.
- ^ a b "2019 Clinic Summary Report". Society for Assisted Reproductive Technology. Archived from the original on 4 February 2020. Retrieved 21 April 2022.
- ^ a b Branswell H (15 December 2008). "Success rate climbs for in vitro fertilisation". The Canadian Press. Archived from the original on 18 March 2009.
- ^ "2006 Assisted Reproductive Technology (ART) Report: Section 2". Centers for Disease Control and Prevention. Archived from the original on 31 March 2009. Retrieved 25 March 2009.
- ^ Neighmond P (21 January 2009). "Study: Sixth Time May Be Charm For In Vitro". Day to Day. National Public Radio.
- ^ "YourIVFSuccess". YourIVFSuccess. Retrieved 1 March 2021.
- S2CID 207633738.
- ^ a b "In vitro fertilization (IVF) – Mayo Clinic". www.mayoclinic.org. Retrieved 29 October 2022.
- ^ "Miscarriage". www.marchofdimes.org. Retrieved 18 March 2024.
- PMID 20581128.
- ^ ISBN 978-1-900364-97-3. Archived from the original(PDF) on 15 November 2010.
- PMID 23190428.
- ^ PMID 23188168.
- PMID 24532220.
- PMID 20447937.
- ^ PMID 21179569.
- ^ PMID 23827986.
- PMID 24082041.
- PMID 24664156.
- PMID 19740463.
- ^ a b Centers for Disease Control and Prevention; American Society for Reproductive Medicine; Society for Assisted Reproductive Technology (2017). 2015 Assisted Reproductive Technology National Summary Report (PDF) (Report). US Dept of Health and Human Services.
- PMID 17765235.
- ^ a b c "Regulated fertility services: a commissioning aid". Department of Health UK. 18 June 2009. Archived from the original on 3 January 2011.
- ^ PMID 30117155.
- ^ "Factors affecting IVF success". IVF-infertility.com. February 2011.
- PMID 27807847.
- PMID 21422062.
- PMID 23814102.
- ^ PMID 24077980.
- PMID 23990351.
- PMID 24916455.
- ^ "Natural cycle IVF". Human Fertilisation and Embryology Authority. Archived from the original on 12 May 2012.
- PMID 19586428.
- S2CID 25591825.
- PMID 20858698.
- ^ "IVF Treatment Step Four: Final Oocyte". Infertility.about.com. Archived from the original on 18 November 2012. Retrieved 22 May 2012.
- ^ Kovacs P (23 April 2004). "HCG Injection After Ovulation Induction With Clomiphene Citrate]". Medscape.
- PMID 21450755.
- ^ IVF Process, Methods and Solutions https://techxplore.online/ivf-process-methods-and-solutions/
- PMID 23912477.
- S2CID 25057205.
- PMID 15935840.
- ^ PMID 24480786.
- PMID 20488801.
- PMID 22975113.
- PMID 31140578.
- ^ "ERICA Embryo Ranking | Artificial Intelligence for Assisted Reproduction".
- .
- PMID 32157183.
- PMID 25473625.
- ^ "In vitro fertilization (IVF) – Mayo Clinic". www.mayoclinic.org. Retrieved 31 August 2020.
- ^ PMID 26148507.
- PMID 21733980.
- ^ PMID 21531751.
- ^ Britten N (7 May 2011). "Saviour Sibling Cures Sick Older Brother". The Daily Telegraph, Health News. Archived from the original on 10 May 2011. Retrieved 8 May 2011.
- ^ Mundy L (July–August 2006). "Souls On Ice: America's Embryo Glut and the Wasted Promise of Stem Cell Research". Motherjones.com.
- PMID 15041124.
- ^ "Genetics & IVF Institute". Givf.com. Archived from the original on 21 May 2009. Retrieved 2 November 2016.
- PMID 19200957.
- PMID 21896560.
- PMID 19217091.
- PMID 11473947.
- PMID 32827168.
- PMID 26951653.
- PMID 32669110.
- PMID 19007636.
- ^ PMID 19625309.
- ^ "Japan Bans in Vitro Fertilisation for HIV Couples". Infoniac.com. 21 July 2008.
- S2CID 10086076.
- PMID 23884897.
- ^ PMID 24676468.
- ^ PMID 19118826.
- ^ Botts S, Ryan M. Drug-Induced Diseases Section IV: Drug-Induced Psychiatric Diseases Chapter 18: Depression. pp. 1–23. Archived from the original on 23 December 2010.
- PMID 23321489.
- PMID 28859782.
- PMID 15192070.
- PMID 9935113.
- PMID 23449641.
- PMID 19010807.
- S2CID 12552533.
- PMID 16893903.
- PMID 22611174.
- ^ PMID 23449643.
- ISBN 978-0-205-77541-5– via VitalBook.
- ^ PMID 23449642.
- PMID 24947475.
- PMID 24961233.
- ^ PMID 24195549.
- PMID 19783550.
- ^ Ayers C (2004). "Mother wins $1m for IVF mix-up but may lose son". The Times.
- ^ Swedberg C (15 October 2007). "Reproductive Clinic Uses RFID to Guarantee Parental Identity". RFID Journal.
- )
- PMID 26237262.
- ^ "Fertility is an Equal-Opportunity Issue for Couples – Penn Medicine". www.pennmedicine.org. Retrieved 31 August 2020.
- PMID 25493379.
- PMID 15819997.
- ^ Lawson D (11 March 2008). "Of course a deaf couple want a deaf child". The Independent. London. Retrieved 12 November 2009.
- ^ Appel J (12 March 2009). More 'designer' options. The Winnipeg Sun (Report).
- ^ Jha A (31 May 2007). "Winston: IVF clinics corrupt and greedy". The Guardian. London.
- OCLC 782252371.
- ^ Dietrich H (May 1986). IVF: what can we do?. Liberation or Loss?. Canberra.
- PMID 11649236.
- PMID 36612987.
- PMID 21435805.
- ^ "At 74, Andhra Woman Becomes The Oldest-Ever To Give Birth". NDTV.com. 6 September 2019. Retrieved 5 November 2015.
- PMID 8612255.
- ^ PMID 19732884.
- S2CID 53028172.
- S2CID 39694945.
- ^ Dolan M (29 May 2008). "State high court may give gays another victory". Los Angeles Times.
- ^ Goldstein J (19 August 2008). "California Doctors Can't Refuse Care to Gays on Religious Grounds". Wall Street Journal.
- ^ a b Egelko B (19 August 2008). "Bob Doctors can't use bias to deny gays treatment". San Francisco Chronicle.
- ^ Mohajer ST (25 October 2010). "License hearing for Octomom doctor resumes in LA". Associated Press.
- ^ Breuer H (22 October 2010). "Octomom's Doctor Tearfully Apologizes, Admits Mistake". People. Archived from the original on 4 March 2016. Retrieved 22 May 2012.
- ^ "Michael Kamrava's medical license revoked". Los Angeles Times. 1 June 2011.
- ^ PMID 33005116.
- PMID 33211742.
- ^ Obedin-Maliver & Makadon 2016, § "Psychological considerations".
- ^ Obedin-Maliver & Makadon 2016, § "Fertility and achieving pregnancy".
- ^ a b Rafferty A (25 February 2012). "Donor-Conceived and Out of the Closet". Newsweek.
- ^ a b "'My Daddy's Name is Donor'". NPR. 16 August 2010.
- ^ Scheller CA. "The Untold Story of Donor-Conceived Children". Christianity Today. Archived from the original on 18 July 2012.
- ^ .
- ^ "Donor-conceived children use Internet to find relatives and share information". Washington Post. 26 September 2011.
- ^ McManus M (24 June 2012). "Anonymous Father's Day". Greenfield Daily Reporter. Archived from the original on 2 July 2012.
- ^ "Donor Embryo: Online Guide for Potential Donors". RESOLVE. Archived from the original on 19 February 2013. Retrieved 3 August 2013.
- ^ a b Beil L (1 September 2009). "What happens to extra embryos after IVF?". CNN.
- PMID 19337299.
- PMID 18166188.
- PMID 11656968. Archived from the originalon 8 March 2016.
- PMID 38436995.
- ^ "Pope Benedict XVI Declares Embryos Developed For In Vitro Fertilization Have Right To Life", Medical news today, archived from the original on 29 December 2008
- ^ Pope Paul VI (25 July 1968). "Humanae Vitae: Encyclical of Pope Paul VI on the Regulation of Birth, sec 12". Rome: Vatican. Retrieved 25 November 2008.
- ^ a b c Dain A (30 July 2009). "Reconciling religion and infertility". Archived from the original on 4 November 2013.
- ^ "Catechism of the Catholic Church. Section 2377". Rome: Vatican. 1993. Retrieved 25 November 2008.
- ^ "Science in hinduism-Test tube babies". 20 October 2013. Archived from the original on 8 October 2016. Retrieved 30 May 2016.
- PMID 17051430. Archived from the originalon 24 June 2009. Retrieved 3 November 2013.
- ^ Tzitz Eliezer 9 p. 247
- S2CID 144808526.
- ISSN 0362-4331. Retrieved 4 October 2019.
- PMID 25281685.
- ^ S2CID 145574208.
- S2CID 143676709.
- S2CID 22578866.
- . Retrieved 7 August 2023.
- PMID 23223400.
- ^ Keane M, Long J, O'Nolan G, Faragher L (2017). Assisted reproductive technologies: international approaches to public funding mechanisms and criteria. An evidence review (Report). Dublin: Health Research Board.
- PMID 23905708.
- ^ a b c Weigel G, Ranji U, Long M (15 September 2020). "Coverage and Use of Fertility Services in the U.S." KFF. Retrieved 30 November 2022.
- ^ PMID 19481642.
- ^ "Call for infertility care awareness". RTÉ News. 23 September 2009.
- ^ a b c d "Chapter 11: Assisted Reproductive Technologies". ncd.gov. 3 August 2015. Archived from the original on 25 November 2021. Retrieved 7 December 2021.
- ^ S2CID 205373980.
- S2CID 231990647.
- ^ "Shared motherhood: The amazing way lesbian couples are having babies". Cosmopolitan. 14 February 2018. Retrieved 21 March 2018.
- ISBN 978-3-030-35610-1, retrieved 30 November 2022
- ^ ISBN 9781351241496.
- PMID 29143629.
- S2CID 252136338.
- PMID 28486372.
- PMID 27030799.
- ^ S2CID 203983887.
- ^ ColoCRM. "Transgender Pregnancy Options for Men and Women". CCRM Fertility. Retrieved 7 December 2021.
- PMID 27099193.
- PMID 27099185.
- ^ "More IVF babies but less multiple births". The Australian. 24 September 2009. Archived from the original on 24 September 2009.
- PMID 21163475.
- ISBN 978-0-19-538207-5.
- ^ "Assisted reproductive technologies: International approaches to public funding mechanisms and criteria". Health Research Board. 2017. Retrieved 30 November 2019.
- ^ "Medicare and Drug Plans". Government of New Brunswick. 19 April 2013. Archived from the original on 5 December 2019. Retrieved 30 November 2019.
- ^ "Infertility Treatment – Special Assistance Fund". Service New Brunswick. 2018. Retrieved 30 November 2019.
- ^ "Ontario Fertility: Funding Explained". TRIO Fertility. 2016. Retrieved 30 November 2019.
- ^ a b "China to discourage abortions to boost low birth rate". Reuters. 16 August 2022. Archived from the original on 16 August 2022. Retrieved 16 August 2022.
{{cite web}}
: CS1 maint: bot: original URL status unknown (link) - PMID 32995563.
- ^ Chatterjee P. "IVF: Fertile Ground". BW Businessworld. Retrieved 8 July 2017.
- ^ "Assisted Reproductive Technology (Regulation) Bill, 2020". Retrieved 2 December 2021.
- ^ "In Vitro Fertilization". health.gov.il. Retrieved 1 August 2019.
- ^ "Three IVF attempts double chances". 14 May 2024.
- ^ "IVF, provrörsbefruktning". 1177.se (in Swedish). Retrieved 23 February 2019.
- ^ "Fertility problems: assessment and treatment". 20 February 2013.
- ^ "RIP IVF? NHS cuts to fertility treatment 'will deny thousands parenthood'". Independent. 2 November 2015. Retrieved 2 November 2015.
- ^ "IVF costs to NHS 'must be capped', says fertility expert". BBC News. 29 October 2015. Retrieved 30 October 2015.
- ^ Fertility: assessment and treatment for people with fertility problems (Report) (2016 update ed.). National Institute for Health and Clinical Excellence. February 2013. p. 7. Archived from the original on 17 February 2017. Retrieved 17 February 2017.
- ^ "NHS access to IVF being cut in England". BBC News. 7 August 2017. Retrieved 5 September 2017.
- ^ "CCGs propose range of new rationing cuts to fill deficit". Healthcare Leader. 16 August 2017. Archived from the original on 6 October 2017. Retrieved 5 October 2017.
- ^ "Number of CCGs offering recommended cycles of IVF drops 50% in 4 years". Healthcare Leader. 30 October 2017. Archived from the original on 26 December 2017. Retrieved 24 December 2017.
- ^ "CCGs warned policies could break discrimination laws". Health Service Journal. 9 November 2017. Retrieved 26 December 2017.
- ^ "Regulator says IVF cuts put mothers and babies at risk". Health Service Journal. 4 September 2018. Retrieved 8 October 2018.
- ^ PMID 18539275.
- ^ Kraft D (17 July 2011). "Where Families Are Prized, Help Is Free". The New York Times.
- ^ a b c "Discover Infertility Treatment Coverage by U.S. State". RESOLVE: The National Infertility Association. 27 August 2021. Retrieved 2 December 2021.
- ^ a b Appel JS (15 July 2009). "Motherhood: Is It Ever Too Late?". New York Times.
- ^ "China Bars In-Vitro Fertilization for Pregnancy". Redorbit.com. 12 November 2003. Archived from the original on 15 July 2011. Retrieved 22 May 2012.
- ^ Sharma NC (5 January 2018). "Health ministry receives complaints against web giants for sex determination violations". liveMint. Retrieved 9 July 2020.
- ^ "To ensure prized baby boy, Indians flock to Bangkok | India News – Times of India". The Times of India. 27 December 2010.
- ^ "Chandigarh IVF expert helps police arrest Delhi resident seeking sex selection | Chandigarh News – Times of India". The Times of India. 26 June 2016.
- ^ Inhorn MC. "Islam, IVF and Everyday Life in the Middle East" (PDF). AIME: Anthropology of the Middle East. 1 (1): 37–45. Archived from the original (PDF) on 7 July 2011.
- ^ "IVF Prohibition In Costa Rica". Ivfcostworldwide.com. Archived from the original on 3 March 2017. Retrieved 22 May 2012.
- ^ Murillo Á (12 July 2011). "La Costa Rica católica se atasca con la fertilización in vitro". El Pais.
- ^ "CIDH Extends Deadline For Approval Of Law For In-Vitro Fertilization In Costa Rica". insidecostarica.com. 24 February 2011.
- ^ Catanzaro M (28 December 2012). "Human-rights court orders world's last IVF ban to be lifted". NEWS BLOG. Nature. Retrieved 5 January 2017.
- ^ "Court strikes down Costa Rican ban on in-vitro fertilization". New York Times. Associated Press. 22 December 2012.
- ^ "Costa Rica Finally Allows In Vitro Fertilisation after 15-Year Ban | Inter Press Service". ipsnews.net. 15 September 2015.
- ^ O'Connor P (18 April 2002). "Australian court OKs fertility treatment for single people, lesbians". Associated Press.
- ^ Hoare D (15 December 2007). "Lesbian community welcomes Vic IVF changes". abc.net.au.
- US Food and Drug Administration.
- ^ "Fiscal Note, HB 2159 – SB 2136, from Tennessee General Assembly Fiscal Review Committee" (PDF). Retrieved 22 May 2012.
- ^ "SB 0078 by Stanley, Bunch. (HB 0605 by DeBerry J, Hensley.)". Wapp.capitol.tn.gov. Archived from the original on 23 August 2014. Retrieved 22 May 2012.
- ^ "Tennessee Seeking To Ban IVF For Unmarried Individuals". Eggdonor.com. 31 March 2009. Retrieved 22 May 2012.
- ^ "Legislative Update". Tnep.org. Archived from the original on 7 February 2008. Retrieved 22 May 2012.
- ISSN 0261-3077. Retrieved 22 February 2024.
- ^ "Alabama court rules frozen embryos are children, chilling IVF advocates". USA TODAY. Retrieved 22 February 2024.
- ^ "Alabama Supreme Court rules frozen embryos are 'children' under state law". NPR. 20 February 2024.
- ^ Tamsett, Isabel Rosales, Christina Maxouris, Meg Tirrell, Chris Youd, Maxime (21 February 2024). "Days after Alabama's Supreme Court ruling that frozen embryos are children, one facility pauses IVF treatment". CNN. Retrieved 22 February 2024.
{{cite web}}
: CS1 maint: multiple names: authors list (link) - ISSN 0190-8286. Retrieved 1 March 2024.
- ^ Davis, Erin (1 March 2024). "Bills to protect in vitro fertilization pass in both chambers of Alabama Legislature". WFSA. Retrieved 1 March 2024.
- ^ Knight RD (30 May 2020). "Frozen Embryos and Divorce in Illinois". rdklegal.com. Retrieved 11 June 2020.
- ^ "Demystifying IUI, ICI, IVI and IVF". Seattle Sperm Bank. 4 January 2014.
Further reading
- Henig RM (2004). Pandora's Baby: How the First Test Tube Babies Sparked the Reproductive Revolution. New York: ISBN 978-0-618-22415-9.
- Hope T, Lockwood G, Lockwood M, Bewley S, Jackson J, Craft I (June 1995). "Should older women be offered in vitro fertilisation?". BMJ. 310 (6992): 1455–1458. PMID 7613283.
- Seng SW, Yeong CT, Loh SF, Sadhana N, Loh SK (March 2005). "In-vitro fertilisation in women aged 40 years and above" (PDF). Singapore Medical Journal. 46 (3): 132–136. PMID 15735878.
External links
- "UK IVF clinics and statistics]". Human Fertilisation and Embryology Authority. Archived from the original on 7 August 2009.
- "US information, statistics, and lists on assisted reproductive technology". Centers for Disease Control and Prevention. Archived from the original on 23 March 2005.