Types of Assisted Reproduction
World population has gone through remarkable changes in the last century. It has quadrupled in size —
from about 1.6 billion in 1900 to 6.5 billion today — leading many to fear the effects of overpopulation.
However, looking at world population as a whole obscures the real picture: while growth continues in the poorest countries,
the industrialized countries of Europe, North America, and elsewhere have shown much less growth. In fact, many European
countries have a negative growth rate, and actually depend on immigrants to maintain the work force.
The reason for this disparity is, of course, the many career options open to empowered and educated women.
In industrialized countries, women tend to have many fewer children — often just a single child
— and to postpone childbearing into their 30s and often into their 40s. However, this postponement means
that many, when they do decide to have a child, face difficulty in conceiving.
Assisted reproductive technology (ART) is a relatively new field of medicine in response to the tremendous demand
from women who need medical help to conceive a child. There are many such technologies. The one factor they have in
common is that they are all expensive. This is a natural industry for medical tourism. Many countries now offer not
only all the ART available in the U.S., but also a few additional techniques that are not available outside of
experimental settings in American universities.
Because of evernewer technology, this sort of medical tourism is not a oneway flow. The U.S. continues to hold a certain
cachet around the world, attracting many “reproductive tourists” from overseas, especially to the highstatus clinics of
Beverly Hills, Los Angeles, where some 2,400 doctors reap a windfall for the local tax base. For example, these women can
select sperm or eggs based on the donor’s appearance — from height, hair and eye color, right down to the shape of the mouth
and eyes, IQ,
talent for sports or music, and so on. Those who don’t want to travel to the U.S. can order sperm on the Internet. Donated,
frozen human sperm has become an American export trade product.
Women can also purchase eggs from a Mailorder Babies from Romania donor. Attractive and academically ac
The GlobalArt clinic in Bucharest, Romania, ofcomplished American college students — fers fertilized eggs, ready for
implantation. A woman especially if they are also gifted in sports, can therefore choose her baby’s features. Frozen music,
or other arts — are being offered sperm is sent to the clinic, which then fertilizes an $10,000 and more for a single extraction
egg taken from a young Romanian woman in her 20s of ovarian eggs. This is also happening, to who has the desired features.
The fertilized egg is some extent, in other countries. then sent back to the woman. Dr. Illya Barr,
a fertility By far the most common ART service specialist from Israel,
established GlobalArt in Romadesired by medical tourists is in vitro fernia because of the lax regulations there. tilization.
Cost is the primary reason:
Each attempt at IVF costs about $10,000 to $12,000 in the U.S., and it is generally not covered by health insurance.
Data from the National Center for Health Statistics shows that IVF is successful only 17 percent of the time. That means a
woman can expect an average of six cycles to conceive. The final cost can therefore easily approach $100,000. In contrast,
overseas clinics are far cheaper and usually offer further substantial discounts on multiple cycles.
Additional popular ART services include:
Transvaginal ovum retrieval
In this procedure, a small needle is inserted through the back of the vagina and guided via ultrasound into the ovarian follicles to collect the fluid that contains the egg.
Sometimes, the fertilized egg is perfectly healthy but has an abnormally thick wall and cannot implant into the uterus. This procedure is done during IVF, after the egg is fertilized but before it is inserted. It involves cutting a small opening in the outer layer surrounding the egg.
Gamete intrafallopian tubal transfer (GIFT)
In this procedure, a mixture of sperm and an egg is placed directly into a woman’s fallopian tubes.
It is a surgical procedure, following transvaginal ovum retrieval. When the egg is fertilized before the
placement, it is zygote intrafallopian tubal transfer (ZIFT).
Autologous endometrial coculture
For patients who have failed previous IVF attempts, or who have poor embryo quality, this procedure involves
placing the fertilized eggs on top of a layer of cells taken from the patient’s own uterine lining, creating
a more natural environment for embryo development.
Gestational carrier and surrogacy
This is the final option for a woman who simply cannot achieve and complete a pregnancy, but still wishes
to have a child with her DNA. There are many reasons for this: A woman may have a medical condition that does
not allow a safe pregnancy, or has no uterus, or any number of other conditions. A “surrogate” woman is found
who agrees to have the fertilized egg implanted and then carry the pregnancy to delivery, after which she hands
over the baby to the genetic mother.
In the U.S., this process is fraught with legal and ethical concerns, and therefore strongly discouraged.
Even when the most clearcut agreement is made, problems arise when the birth mother decides to keep the infant
rather than give it up. It is also, naturally, extremely expensive.
These factors combine to make such an arrangement far easier to accomplish overseas, particularly in poorer countries.
Several procedures are also possible when it is the man who is the cause of infertility:
Epididymal sperm aspiration (ESA)
and testicular sperm extraction (TESE)
These are types of surgical sperm retrieval (SSR), in which the reproductive urologist (a specialized surgeon)
sperm from testis, vas deferens, or epididymis. It is a short outpatient procedure, which often can overcome cases of
extreme male infertility. Intracytoplasmic sperm insertion (ICSI)
Also called intracytoplasmic sperm injection, it involves the injection of a single sperm into an egg, which is then
further managed as IVF. This involves an astonishingly fine needle and dexterity to accomplish the maneuver under
microscopic visualization. ICSI is a very useful technique when the sperm count is low. Even if the sperm count is zero,
ICSI can be performed with the use of ESE or TESA. Remarkably, ICSI allows the use of even malformed or immotile sperm,
since even nonfunctional sperm may still carry the genetic material.
Overseas ART clinics also offer preimplantation genetic diagnosis (PGD). This involves the use of fluorescent in situ
hybridization (FISH) or polymerase chain reaction (PCR). DNA amplification is then used to help identify genetically
abnormal embryos and improve healthy outcomes. The idea, in short, is to identify undesirable traits before implanting
the embryo. The undesired embryos are destroyed.