Assisted Reproductive Technology

Assisted reproductive technologies (ART) are methods and procedures for encouraging fertility. In many of these treatments, both eggs and sperm are handled outside of the male and female body.

ART is employed to counteract infertility, which is often defined as the inability to reproduce after a year of intercourse without contraceptives. This problem faces about 8.5 percent of married couples between the ages of 15 and 44, affecting approximately 2.4 million married couples.

The rate of infertility has grown amongst various age groups. Increased rates of sexually transmitted diseases, growing popularity of intrauterine devices and the increase of environmental toxins have all contributed to the growth of infertility. Obesity, smoking, alcohol, recreational drugs and certain medications can also effect fertility.

Another significant factor in the rise of couples facing infertility is the age at which women choose to have children. The older age of women interested in starting families, at a time when fertility naturally declines, has generated an increased demand for fertility treatments.

ART is sometimes used by lesbian couples, gay male couples, couples in which one or both partners are transgender, women who are undergoing chemotherapy and by couples who want to screen their embryos for specific diseases or disabilities.

In vitro fertilization (IVF) and related procedures are the primary assisted reproductive technologies. During the IVF procedure, eggs are retrieved from a woman's body and are fertilized with sperm from a partner or donor in a Petri dish. Prior to egg removal, the woman generally takes ovarian stimulation drugs that encourage the production of multiple eggs. She will then undergo surgery under light anesthesia to allow the doctor to remove the eggs.

After the eggs are fertilized in the laboratory and the passage of a 48- to 72-hour period of conception, the fertilized egg (or eggs) is planted directly into the woman's uterus. IVF overcomes problems such as Fallopian tube blockages because it bypasses the Fallopian tubes, and is also used to treat infertility due to cervical mucous problems, unexplained infertility, endometriosis and a low sperm count. Most women need to undergo a number of cycles of IVF before it is successful. IVF averages a 34 percent success rate per cycle. One cycle of IVF can cost between $10,000 and $15,000 in the United States.

Variations of IVF include zygote intrafallopian transfer (ZIFT) and gamete intrafallopian tube transfer (GIFT). Like typical IVF, both procedures begin with egg retrieval. In ZIFT, after fertilization in the Petri dish, the one-cell embryo is placed directly in the woman's Fallopian tube. In GIFT, after egg retrieval, the egg and sperm are placed in the woman's Fallopian tube. With GIFT, fertilization occurs in the woman's body. GIFT and ZIFT are both more expensive than standard IVF treatments, but have a higher success rate.

Intracytoplasmic sperm injection (ICSI) is utilized in IVF when the male partner has a low sperm count, no sperm in his ejaculate, abnormally shaped sperm or poor sperm mobility. Using ICSI, sperm is injected directly into the cytoplasm of an egg, enabling it to fertilize.

In vitro fertilization allows interested parties to turn to donors for either sperm or eggs. Donor sperm or eggs are often used by people who are physically unable to produce their own gametes or by people in LGBT relationships. Donors are usually paid for their gametes.

Using cyropreservation, a process of freezing bodily materials so that they can be utilized later on, sperm, eggs and embryos have been successfully frozen. Men and women can access their sperm, eggs or embryos for later implantation and pregnancies.

Many issues and controversies have been raised over assisted reproduction technologies. Questions regarding the biological, moral and legal status of the embryos created outside of the Fallopian tube are among those difficult issues that have been discussed.

During the three days that follow the initial fertilization, the one-celled zygote divides into a number of cells. In typical IVF, the embryo will be implanted into the uterus about 48 to 72 hours after conception. During ZIFT, a one-celled zygote is transferred to the Fallopian tube. The embryo can also be cyropreserved at this stage for later use.

What is the status of the embryo at this early stage? At the extreme end, there are those who believe that even the zygote must be treated as a human being. This view entails the right of each embryo to implantation and does not allow for their disposal. In contrast, there are those who believe that the embryo has the same status as other human tissue, and there should therefore be no limits placed on actions that can be made with them.

Another important question pertains to dispositional control over the embryos. This question explores which party is legally able to decide when to create, freeze, discard, donate or implant an embryo.

Additional controversies surrounding assisted reproductive technologies relate to moral issues such as the population that is served by clinics, as there are some clinics that do not provide services to unmarried or gay or lesbian people. In addition, some claim that manipulation of the embryos to ensure a baby born without disease or disability is an outgrowth of society's devaluation of disabled people.

Assisted Reproductive Technology: Selected full-text books and articles

Endings and Beginnings: Law, Medicine, and Society in Assisted Life and Death By Larry I. Palmer Praeger, 2000
Librarian's tip: Chap. 2 "Assisted Reproduction: Do We Need Legislative Definitions of the Family?"
Genes, Parents, and Assisted Reproductive Technologies: Arts, Mistakes, Sex, Race, & Law By Bender, Leslie Columbia Journal of Gender and Law, Vol. 12, No. 1, Winter 2003
Assisted Reproductive Technologies and the Constitution By Coleman, Carl H Fordham Urban Law Journal, Vol. 30, No. 1, November 2002
God Forbid: Religion and Sex in American Public Life By Kathleen M. Sands Oxford University Press, 2000
Librarian's tip: Chap. 11 "Reproductive Technologies: Ethical and Religious Issues"
Assisted Reproduction in Jewish Law By Sinclair, Daniel B Fordham Urban Law Journal, Vol. 30, No. 1, November 2002
The Islamic Viewpoint on New Assisted Reproductive Technologies By Fadel, Hossam E Fordham Urban Law Journal, Vol. 30, No. 1, November 2002
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