The ART of Making a Baby the New-Fashioned Way

Assisted Reproductive Techniques (ART)

The science of infertility has seen an explosion of progress since Dr. Steptoe succeeded with the first "test tube" baby more than two decades ago. This milestone, called in vitro fertilization (IVF), changed everything. At the time, most people were pinning their hopes on the exotic technique of microsurgery, where (usually two) infertility surgeons looked at the entire operation through a microscope using tiny-tipped instruments so as to be as non-traumatic to the reproductive tissues as possible. The respect for the delicacy of reproductive tissues that brought about the somewhat passé advances of this GYN surgical subspecialty has in large part, because of Dr. Steptoe, been replaced by the chemical roadmaps of reproductive endocrinology that were first laid down by the secrets learned with in vitro fertilization.

No longer trying to put tubes back together with suture thinner than hair, now the levers-and-pulleys surgical skills of laparoscopy are used to practice the alchemy of reproduction. In other words, the fine technique of 10-finger dexterity to repair damaged tissue has been replaced by a medical approach of priming cycles, stimulating multiovulations, and mechanically retrieving eggs via needles or laparoscopes.

Dr. Steptoe taught us how complex the menstrual cycle is with his many failures that finally led to the success of IVF. Middle of the night hormone levels showed him circadial rhythms to portions of the cycle, and sex in a Petri dish became as much a matter of timing as it did the mixing of sperm and eggs. As the years went on (the first IVF success of Dr. Steptoe is now old enough for reproduction on her own!), other refinements were added to the chemistry and manipulations involved.

Artificial Insemination/Intrauterine Insemination (AI/IUI)

This is the technique in which concentrated sperm are delivered into the uterus for a direct deposit, so to speak, and given a head start toward the fallopian tube where fertilization happens.

In Vitro Fertilization (IVF)

"Over-ovulation" is stimulated with hormones and other agents to yield multiple eggs in one cycle. These eggs are then retrieved from the ovary through an ultrasound-guided needle through the thin wall of the back of the vagina. Eggs are then mixed with sperm in the lab -- "external (in vitro) fertilizaton."

Embryo Transfer (EF)

This is the transfer of the fertilized egg, about four days after fertilization, to the uterus (womb). It is a necessary part of IVF and ICSI (see below).

Intracytoplasmic Sperm Injection (ICSI)

When a man's sperm count is low, a single sperm can be "injected" into an egg with a small tube called a micropipette. It's still IVF, and Embryo Transfer is necessary for pregnancy in the uterus.

Gamete Intrafallopian Tube Transfer (GIFT)
In this method, eggs and sperm are placed into one or both of your tubes for a "natural fertilization," since the tube is where fertilization takes place normally. This method, therefore, avoids a lot of religious objections. GIFT requires laparoscopy.

Zygote Intrafallopian Tube Transfer (ZIFT)

In this method, there is IVF or ICSI, and then a fertilized egg or eggs are transferred to the tube(s) using a laparoscope. Any of these methods can make use of freezing extra embryos for future use, but another consideration is what happens to the fertilized eggs that don't appear to be the best candidates for implantation. For pro-life couples, this is problematic.

The specialist of the day for infertility is the reproductive endocrinologist in association with the infertility subspecialist. Me? I just want to deliver them nine months later.

The Cost of Infertility

The cost of medicine has risen proportionately similar to the rise in the cost of a good restaurant steak over the years. You're still getting the same type of steak now as you did fifteen years ago, but I can assure you you're not getting the same medicine. There are babies being born today that would have never had a chance back in the days of a five-dollar steak. Unfortunately, for the couple yet to succeed on their "investment" into assisted reproductive techniques, they're consumed by the fact that all of this does come at a cost.

Most insurance won't cover this, and it is extremely expensive, as most cutting edge medicine is. The financial awareness of infertility (the real money-pit) makes a couple realize how lucky their fertile friends are. It's also easy to see how couples suffering the bankrupting costs of infertility naturally have resentment for the pregnancies that happen in the back of cars for the cost of a drive-in movie and cheap wine. (Are there really any more drive-ins? You'd think that mosquitoes would be an effective contraceptive.)

Costs of tens of thousands, sometimes up to six figures, are not unheard of with assisted reproductive techniques. Even though it's expensive, what's a baby worth after the fact? The concept of a baby being priceless is no comfort when there is still no baby and the second mortgage runs out.

But let's look at this more closely. The cost of, say, a mid-priced car today is about 30-something thousand. This is pretty close to the average price of a successful conception via assisted reproductive techniques. Yet a few years later the car is junk. You get maybe a few thousand back on trade-in, and the cycle repeats. The average commuter gets into six figures easily during his or her car-buying career, and still future automotive obsolescence is the recurring reward.

On the other hand, a baby is...well...everything. Certainly the cost of having a baby is justified when you compare this expense to a Buick.