BLOODLINES . Making Precedent . Can you judge a good parent?

You are a physician with a specialty in endocrinology. As a partner in the largest and most respected infertility clinic in your city, you love treating patients and experiencing their gratitude and joy when you successfully help them build a family.

Today, your first appointment is with a couple in their 30s who have been trying to have a child for three years. Like most of your patients, they really want a baby who is biologically related to both of them. They have undergone many rounds of treatment without success. Each time they seem close, only to have the embryos fail to implant or to miscarry in the early weeks of pregnancy. They want—and can afford—to make more attempts despite the very high likelihood of failure. You must decide whether or not to continue treating them.

Clicking on "yes" or "no" will move you to the next page. You will have a chance to reconsider your answer when you get to the end of the case and have explored some of the ramifications of your decision, but you cannot click back!


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Context

Assisted reproductive technology (ART) represents a roughly $4 billion industry, and there are about 400 infertility clinics in the United States. In vitro fertilization (IVF), the mainstay of ART, can cost between $8,000 and $14,000. Of families who choose to adopt after experiencing infertility, approximately half underwent medical treatment for an average of three years prior to adopting.

Look Deeper

Most of the approximately 30 ways to make a baby fall into the following groups: heterosexual sex; artificial insemination, where sperm is injected into a woman not during sex; GIFT (gamete intrafallopian transfer), a procedure that places unfertilized eggs and sperm into the woman's Fallopian tube; ZIFT (zygote intrafallopian transfer), a procedure in which eggs are fertilized outside a woman's body and placed in the woman's Fallopian tube; and in vitro fertilization (IVF), where an egg is fertilized in a lab and implanted in the woman's uterus. IVF is by far the most prevalent of the last three, and it is IVF that makes possible a number of embryo-creating techniques as well as donor and surrogate conception. For example: intracytoplasmic sperm injection (ICSI), a procedure that injects, with a needle, a single sperm into an egg; cloning, making a genetic replication of an organism by using its DNA and a donor's denucleated egg; and cytoplasmic transfer, putting a sperm in cytoplasm (the stuff in a cell but outside the cell's nucleus) and injecting the cytoplasm and sperm into an egg. These methods and the different combinations of sperm donors, egg donors and surrogates (both traditional, in which a surrogate is inseminated by the intended father's sperm, and gestational, in which already-created embryos are transferred into a woman's uterus to carry and deliver for someone else) yield a dizzying number of ways to create human life.





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	There are at least 30 ways to make a baby. Most of the assisted reproductive technologies (ARTs) have been developed in the last 30 years, and the latest estimates suggest that "2% of all U.S. women of reproductive age—1.2 million women—had received medical advice or treatment for infertility within the previous year and that another 13% had received [infertility] services at some point earlier in their lives."


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