IVF has become more common but still carries both controversy and risk.

The birth of a test tube baby used to be a newsworthy event; now, some 25 years after America’s first, it is rarely ever mentioned in the press. With hundreds of thousands of test tube babies living in the world, in vitro fertilization (IVF) has become much more common. Yet the process is never routine, nor is a successful pregnancy guaranteed.

Who Gets IVF
According to the Centers for Disease Control (CDC), in 2002 about 2% (1.2 million) of the 62 million American women of reproductive age had made a doctor’s appointment related to infertility within the past year, and an additional 10% (roughly 6 million) had received some sort of infertility treatment at some point in their lives. But IVFand related measures account for fewer than 5% of all infertility treatments, and typically doctors first try other methods, such as fertility drugs, surgery, or artificial insemination. IVF is usually reserved for instances in which a woman suffers from blocked or damaged fallopian tubes or a man has low sperm count.

The Process of IVF
The typical IVF cycle begins with drug treatment designed to control ovulation. One common method is to take five days of nasally administered gonadotropin-releasing hormone analogue (GnRH) to shut down the ovaries, followed by ten days of injections of follicle-stimulating hormone (FSH) designed to spur the production of multiple eggs. Blood tests and ultrasound exams help determine the best time to remove the eggs from follicles in the ovaries, which is done surgically about 36 hours after an injection of human chorionic gonadotropin (hCG). The eggs are then mixed with sperm from the patient’s partner that has been donated that same day, and the mixture is incubated in a glass dish for 2-5 days as the fertilized eggs develop (despite the popular terminology, this is not done in a test tube). Then selected eggs are placed in the patient’s uterus by means of a catheter inserted through the vagina and cervix, and the patient remains in bed for the next several hours. Most of the time multiple eggs are implanted to improve the chance of pregnancy, although this also increases the odds of multiple births. Any remaining embryos are typically frozen for future attempts.

The Cost of IVF
IVF is an expensive procedure, with the American Society of Reproductive Medicine reporting an average cost of $12,400 per cycle and many couples having to go through more than one cycle. Insurance of IVF remains a major issue: in 2006 the following states were the only ones to mandate IVF coverage, and some of these placed significant restrictions on its scope: Arkansas, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Montana, New Jersey, Ohio, Rhode Island, and West Virginia.

The Business of IVF
Not surprisingly, considering the number of infertile couples hoping to become parents, IVF is a multi-million dollar business, with more than 400 clinics operating in the U.S. alone; a state-by-state listing is available from the CDC. Since the process of IVF lasts a number of weeks, statistics are typically given in terms of cycles of treatments. In 2003, American clinics reported 122,872 Assisted Reproductive Technology (ART) cycles, with IVF representing more than 99% of all ARTs.

The Chances of Success
A 1992 law requires all American clinics to provide annual data on their ART success rate, which is then published by the CDC. In 2003, the 122,872 cycles resulted in 35,785 live births (defined as deliveries of one or more live babies); because of multiple births, the total number of live infants born in 2003 through ART was 48,756. The “success rate” for IVF in 2003 was therefore just under 30%. But success varies widely with a woman’s age. In 2003, while about 37% of the cycles begun to women under 35 resulted in live births, only 11% of the cycles involving women age 41 or 42 did. The bottom line is that some 25 years after the first American test tube baby, Elizabeth Carr, was born, IVF treatment is no guarantee of success. Recent data also suggests that IVF babies are significantly more likely than naturally conceived infants to have low birth weights and major birth defects, although the overall chances of such defects are still low. Despite these risks, the popularity of IVF continues to grow, and there is no denying the happiness that the procedure has brought to hundreds of thousands of people who would never have had children without it.


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