Frontiers of Fertility

Better IVF. Cutting-edge ways to size up embryos. For couples struggling to conceive, the options are expanding—and the outlook is improving

  • Share
  • Read Later
Getty Images

A baby in utero. New techniques can improve the odds of conception.

Making babies ought to be the easiest thing you’ll ever do—indeed, it ought to be a hard thing not to do. The evolutionary game is rigged so that it’s fun, the kind of fun you want to have even when offspring aren’t on your mind. Our body cycles make parenthood a constant possibility: women are ready to conceive every month, and men are pretty much ready to go any second. And the product of all that happy activity—a chubby, cuddly, cooing baby—is something we’re hardwired to find irresistible.

But things, of course, aren’t always so simple. The human reproductive system may be a prolific thing, but it’s also a very fragile thing, and there is a lot that can go wrong with it. In the U.S. alone, more than 7 million women have received treatment for infertility, spending more than an estimated $5 billion per year. For the past 10 years, the average billed cost for a single in vitro fertilization (IVF) cycle is $12,400—something infertile couples must pony up on their own since most insurance companies don’t cover infertility treatments—and just one cycle is usually not enough. According to the U.S. Centers for Disease Control and Prevention, only 42% of assisted-reproduction cycles lead to a live birth when the woman is younger than 35. The figure drops to 22% by age 40, 12% by 42 and just 5% by 44. Outside the U.S., the odds are no better, and the number of people who need help is far greater: an estimated 48.5 million couples worldwide are unable to conceive after five years of trying, according to figures released last year by the World Health Organization.

Given the powerful, primal hold baby-making has on us, the inability to perform so straightforward a genetic job can be deeply painful. “My husband and I would look around, and everyone we knew was having kids,” says Cindy Flynn, 35, an IT worker at a Sacramento nonprofit. “We struggled so hard to get pregnant. Building a family should not be so difficult.”

For now, it still is, but the outlook is getting decidedly brighter. Scientists are steadily refining and improving assisted-reproduction techniques. They’re harvesting better eggs, using fewer drugs to do it and selecting more vigorous sperm that have a better chance of producing a baby. They’re monitoring embryos while they’re still in the lab in ways that were impossible before. Perhaps most tantalizing, they are working to engineer human stem cells so that eggs and sperm can be produced in the lab using raw cellular material taken from the parents. This would lead to a baby that was entirely, genetically theirs, the product of an ordinary union of egg and sperm—nothing short of a last-ditch miracle for people who, without this help, might have been unable to produce any healthy egg or sperm at all.

“Twenty years ago I would often tell a patient, ‘I am sorry. There is nothing we can do,’” says Dr. Craig Niederberger, head of the department of urology at the University of Illinois at Chicago College of Medicine. “Fifteen years ago I would have been saying, ‘There is something I can do, but it’s very experimental.’ Today I can often say, ‘There is at least a 2-out-of-3 chance you are going to have a baby out of this process.’ It is becoming the most exciting field, with the most gratifying outcomes you can imagine.”

Boosting the Odds
Improving the outlook for fertility patients starts with improving the art of IVF, which is not just expensive and less than reliable but a true physical grind. Women must first endure a month’s worth of hormonal dosings, including two or three shots a day in the final stretch, all of which can lead to headaches, restlessness, irritability and hot flushing. The dosing pushes the ovaries to hyperovulate, producing up to a dozen ova at once, which are retrieved via laparoscope through an incision in the pelvis. Even after all that, there’s no guarantee the eggs will be viable; many immature ones that the ovaries would never have released on their own are shoved out prematurely by the drugs.

“Every time a patient goes through conventional IVF, the number of eggs designated as waste is about 90%,” says Dr. John Zhang, founder and director of the New Hope Fertility Center in New York City.

  1. Previous
  2. 1
  3. 2
  4. 3
16 comments
IVFSpecialist
IVFSpecialist

IVF is a lifesaver for people who are unable to enjoy the bliss of having children, of course, naturally. In-Vitro Fertilization is one of the simplest but most useful advancements in technology, which has changed the lives of countless unfortunates.

socialuprank
socialuprank

“Twenty years ago I would often tell a patient, ‘I am sorry. There is nothing we can do,’” says Dr. William Hill, head of the department of No Deposit Bonus Codes at the University of William Hill Casino. William Hill No Deposit Bonus Codes

Anais
Anais

Oh my god, Dear Jeffrey and Alice, it took two people to make that many approximation and mistakes in an article?

I will adress the most ridiculous: No, eggs are not retrieve through an "incision in the pelvis". IVF is not a pleasant process but it doesn't require opening your belly: the eggs are retrieved vaginally

tktime
tktime

Another misleading statement in the article: that the Affordable Care Act increased the available tax deduction from 7.5% of pre-tax income to 10% (last page), which suggests an added benefit.  In fact, the law made things worse for infertile couples.  The new law states that you must have spent at least 10% (vs. 7.5% before) of your income in order to qualify for the tax deduction.

Fabien
Fabien

"In a perfect world, money wouldn’t stand in the way of having a child, but in a perfect world, neither would fertility problems." As a couple struggling to have children (3 years now), my wife and I wholeheartedly thank the French National Health System (the Sécurité Sociale, aka, "Sécu") and the French taxpayer for helping us to go through IUF (and soon IVF) for a ridiculously low 150 Euros bill each time (instead of the  6,000 Euros it costs). We are both foreign-born citizens with no French blood at all, and have been living in France for 8 years (my wife) and 15 years in my case. Y

We feel genuinely sorry for fellow struggling couples elsewhere, specially for those who happen to live in countries where these techniques are fairly available (good ol' USA) but cannot have access to them because, hey, you can go die for the US Army in 3rld World countries so your neighbor can still pay his gas cheap, but he will refuse to allow his  fair share of taxes to contribute to alleviate the burden of the cost of your treatment to help you become parents. Sad thing is: American lives are so cheap to be sent to death (specially the low classes) in a war, and so expensive to come by. You guys should be inspired by the French system.

RuralJuror
RuralJuror

"Starting with fewer embryos can also help mitigate the ethical issues raised when unused ones are frozen and stored in clinics, with little or no prospect of ever being implanted but little or no appetite on the part of anyone involved to destroy them."

You have used the word "implanted" in the above statement, but what you mean is "transferred".  Transfer is when the embryo is placed inside the woman. This embryo may or may not implant in the uterine wall and these embryos that do implant may or may not result in a viable pregnancy/live birth.. Furthermore, it is worth pointing out that not all embryos survive defrosting. 

kittano
kittano

There are so many inaccuracies in this article!  1. IVF eggs are not collected through an incision in the pelvis.  I know this because i just did IVF (along with many other people).  They are collected vaginally.  2. In an IVF cycle they will often collect way more than 12 eggs. 3. doctors are not 'turning away' from traditional IVF methods of mixing sperm and egg and just using ICSI.  I did not have ICSI and neither did any of the IVFers i know (who all had success).  ICSI (choosing the specific sperm) is only used if the particular couple requires it. 4. 'mini IVF' is not always clomid, sometimes it is an injectable cycle that includes the EXACT SAME drugs as IVF, just no retrieval and transfer.  I know this because i did both a clomid cycle and an IUI (mini IVF with injectables) cycle, as well as a full IVF cycle. 5. During my Clomid cycles i never used Synarel, I have never even heard of this drug. I think the author meant to say women take a 'trigger' medication such as Ovidrel shot to induce ovulation once they are ready. 6. many insurance plans cover some amount of infertility treatments. Mine did and so did those for many other couples we know.  As a journalist myself,  I find it to be quite alarming that the author of this article did not find any of this out.  So much written about infertility contains inaccuracies but i would expect more fact checking at TIME. I am not a crazy commenter - TIME copy edit staff please go ahead and check everything I said.

DrewLewis
DrewLewis

Oocytes are not "retrieved via laparoscope through an incision in the pelvis" as the author states. They are retrieved transvaginally through aspiration of the follicles with a needle guided by ultrasound.

seekay1
seekay1

tktime is correct. The article totally misinterprets this change in the law. In 2012, you could deduct the allowable medical expenses which exceeded 7.5% of your income.  In 2013, the threshold is raised to those expenses exceeding 10% of income. I used the deduction last year for my IVF expenses and will do so again this year.

JenniferBonin
JenniferBonin

@RuralJuror Granted.  But then, not all eggs naturally fertilized in the mother's body implant or survive to become a child, either.  Isn't it asking a bit much for human doctors to be better at that than God?

mellogirl5
mellogirl5

@kittano I work in the IVF space. ICSI is used far more often than conventional IVF and very often in cases in which it is not indicated. Regarding number of eggs retrieved following COS, like most 'numbers' in biology, 12 is an average and ideal number; this is not a peer-reviewed scientific paper. 

seekay1
seekay1

I created a Time.com account just to login & support what kittano has posted. I have done 5 IVF cycles myself and I noted many of the same inaccuracies when I read the article.  The description of eggs being collected by incision is so blatantly wrong that it calls in to question everything else stated in the article.  Additionally, the eggs retrieved during a traditional IVF are not "mostly immature".  My Dr. said he expects about 70% to be mature on average. There is also not a standard meaning for the term "mini IVF" -- different people use it in different ways.  Very disappointing article.

kittano
kittano

peer reviewed scientific paper or not, the article is still not meant to be blatantly inaccurate.  'up to a dozen' suggests a dozen is the maximum, which is not the case.  I'm not sure how else to understand the phrase 'up to a dozen'.  As for IVF vs ICSI, ICSI may be more frequently used than previously but the article seems to suggests it is an improved process over traditional IVF.  In fact ICSI depends as i said on the circumstances of the couple, and has its own downsides - such as a slightly higher risk of encumbent birth defects than traditional IVF technique.  Basically i'm just saying that this article is extremely poorly written in the sense of being misleading and inaccurate, I am passing no judgement either way on various IVF techniques.