NOVA Online | 18 Ways to Make a Baby | The 18 Ways (And Then Some)

"Eighteen ways to make me? I'm speechless."

The 18 Ways (And Then Some)
by Sarah Holt

When I first heard there were 18 ways to make a baby, I was flabbergasted. Dr. Jamie Grifo, a specialist in reproductive endocrinology at New York University Medical Center, casually mentioned the fact in an interview that I taped with him for this NOVA program.

Imagine my amazement when I learned that there were actually many more than 18.

Before producing the film, I probably would have been surprised to hear there were more than three or four. Like most people, I was familiar with artificial insemination and in vitro fertilization and frozen embryos, but not much more. While working on the program, I had come to have a layperson's understanding of some of the latest techniques, which have futuristic names like Intra-Cytoplasmic Sperm Injection and Preimplantation Genetic Diagnosis. Nevertheless, I was initially hard-pressed to come up with 18 ways.

Eventually I did, and I ran the list past Dr. Grifo to ensure it was accurate. It was, and here it is.
Note: Click on highlighted terms for a definition.

Natural sex
Artificial insemination—of mother with father's sperm
Artificial insemination—of mother with donor sperm
Artificial insemination—with egg and sperm donors, using surrogate mother
In vitro fertilization (IVF)—using egg and sperm of parents
IVF—with Intra-Cytoplasmic Sperm Injection (ICSI)
IVF—with frozen embryos
IVF—with Preimplantation Genetic Diagnosis (PGD)
IVF—with egg donor
IVF—with sperm donor
IVF—with egg and sperm donor
IVF—with surrogate using parents' egg and sperm
IVF—with surrogate and egg donor
IVF—with surrogate and sperm donor
IVF—with surrogate using her egg, sperm from baby's father
IVF—with surrogate using egg and sperm donors*
Cytoplasmic transfer**
Nuclear transfer and cloning

*In this case, the newborn essentially has five parents: the birth parents who provided the egg and sperm, the surrogate mother who carried the baby, and the parents who will raise the baby.

**The U.S. Food and Drug Administration has recently asked the specialists that perform this experimental procedure to submit it for FDA approval, so it is currently not available.

#17 on Jamie Grifo's list.

Now, since we had decided to use "18 Ways" in the title, I wanted to make absolutely sure this was an accepted list. Could PGD be considered a way to make a baby or merely a test performed before choosing a way? Should nuclear transfer and cloning be on the list? After all, they had produced animal babies but as yet no human babies. Another call to Dr. Grifo revealed that he stood by his list.

To be safe, I emailed the list to other specialists, and they came up with yet more ways to make a baby. Dr. Douglas Powers, scientific and laboratory director at Boston IVF, a fertility and IVF center, said that if you paired ICSI with numbers 12 through 16 on Grifo's list, you'd have five more ways. That brought us to 23.

Dr. Jacques Cohen, scientific director of the Institute for Reproductive Medicine and Science at Saint Barnabas Medical Center in Livingston, New Jersey, fired back an email in which he said "There are many more ways of making babies than 18. Can I add some more?" He listed several techniques that add to those mentioned by Grifo and Powers, and here they are, edited for clarity and numbered appropriately:

Assisted hatching: IVF or ICSI and opening the zona pellucida (embryo shell) to help the embryo hatch and increase its chances of successful implantation into the lining of the uterus.

#25 on Jacques Cohen's list.

Fragment removal: In addition to the procedure described in #24, removing from around the embryo's cells adverse fragments of cell debris, which are thought to possibly impair the development of the embryo.
Co-culture: Culturing the embryos on cells from the woman's reproductive tract (fallopian tubes and uterus). Helps reduce cytoplasmic fragments (see #25) and improve embryo quality.
Testicular Sperm Aspiration (TESA): Obtaining sperm for fertilization from men who previously were thought to have no sperm (azoospermic men) by extracting the cells from the testicle.
Single sperm freezing: By freezing one sperm cell in an empty shell of an animal egg so it can be retrieved after thaw. This is done for TESA (see #27) when there are only a few detectable spermatozoa, and the TESA was exploratory, so the egg collection can be dealt with later.
After maturing unripe eggs in vitro.
After freezing the unfertilized eggs.

At the end of his list, Cohen added "etc., etc."

Clearly, 18 is an arbitrary figure. Suffice it to say that couples who cannot conceive naturally have a doctor's bag full of potential options to choose from. Though they should choose carefully, specialists in the field stress. "While there are many ways one can produce a baby, one should always consider them in the context of their safety and efficacy," says Dr. Zev Rosenwaks of Cornell University. "This implies not only safeguarding against medical risks but also paying great attention to the emotional and social manifestations of the procedures involved." (For more information on assisted reproduction, see Resources.)

Sarah Holt produced the NOVA program "18 Ways to Make a Baby."

Photos: WGBH/NOVA

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