Infertility and Reproductive Technology

Reproductive technology is the term used to describe the range of medical treatments available to assist couples to conceive. The majority of people seeking assisted conception technologies are infertile. Infertility means being unable to conceive a baby naturally after at least 12 months of regular, unprotected sexual intercourse. It affects approximately 15% of Australian couples of reproductive age. The causes can lie equally with a woman or a man and in 20% of couples infertility is unexplained or 'idiopathic' (1).

Previously there were only two remedies available for infertile couples: remaining childless or adopting a baby. Whilst remaining childless is a legitimate choice made by a number of couples, many men and women experience a strong desire to have a child. The inability to have a child can be devastating and involve a lengthy process of loss and grief.

Since the late 1970s, significant scientific and medical advances in reproductive technology have changed the way women can have children, and even definitions of motherhood and fatherhood. Reproductive technology, however, does have its drawbacks. The success rate is relatively low and the treatments can be both financially and emotionally draining. There are also ongoing debates about the ethical, moral and legal dimensions of reproductive technology.

Reproductive technology is an important issue for women because it relates directly to their bodies, their health and to their role in society.

Technologies available

The current reproductive technologies include:

• Artificial insemination (AI) - involves the woman having sperm from either her partner or a donor injected into her vagina, cervix, uterus or fallopian tubes.
• In Vitro Fertilisation (IVF) - means literally fertilisation in a glass. In a laboratory, sperm and eggs are put together in sterile dishes or tubes. After fertilisation occurs the embryo or embryos are transferred to the uterus. This treatment was first developed for women with serious damage to their fallopian tubes. There are several types of IVF, depending on whether the woman or man is the cause of the infertility and how severe it is.
• Intracytoplasmic Single Sperm Injection (ICSI) - involves the retrieval of sperm directly from the epididymis or the testes and injecting this single sperm into an egg in the laboratory. The embryo is then used in an IVF procedure.
• Surrogacy - involves a woman bearing a child for another woman/couple. Surrogacy is often separated into commercial (where the bearer of the child  is paid for her services) and altruistic (where the bearer receives no payment). In Australia, surrogacy is governed by state laws so there are variations in each state.

Success rates

The success of reproductive technologies depends on a number of factors including the cause of infertility, the age of the woman, whether fresh or thawed embryos are used and the number of embryos transferred back to the uterus/fallopian tubes. It is important that couples are aware of particular procedures' success rates so they have a clear idea of their chances of taking home a baby.

Some facts and figures

• The success of reproductive technologies has improved in the last ten years. In 2006, there were 9 277 live deliveries in Australia and New Zealand compared to 2 765 in 1996 (2).
• Success rates differ depending on the use of fresh or thawed embryos (19.6% live deliveries per treatment cycle compared to 15.5%) (3) and the woman's age (a woman aged 30-34 had a 27.5% chance of a live delivery per initiated autologous fresh cycle compared to only a 19.1% and 7.1% chance in women aged 35-39 and 40-44, respectively) (4).
• In 2006, multiple pregnancies occurred in 12% of all assisted conception births (5). However, overall the percentage of triplets or higher order deliveries have decreased over the last decade. In 1993, 2% of deliveries were of triplets or higher order multiples but this has declined to only 0.3% of deliveries in 2006 (5).
• In 2006, the average birthweight of assisted conception babies was 3 110g. This is less than the average birth weight for all Australian babies. The high incidence of multiple births in assisted conception accounts for much of this difference (6).
• The perinatal death rate for all assisted conception births in 2006 was higher than that for all Australian births, 17.5 per 1 000 compared to 10.2 per 1 000 (7)
  

Short and long term health effects

The majority of reproductive technologies are complex treatments involving the use of drugs and surgery. More is known about the short term hazards than the long term effects to a woman's health. Complications in the short term include problems associated with overstimulated ovaries, the complications (albeit small) associated with a general anaesthetic and surgery, and an increased likelihood of a caesarean birth. There are risks to the baby as well. These include an increased likelihood of premature birth and/or multiple birth and the associated consequences of these outcomes (experiencing sickness after the birth, hospitalisation in the first year, impairment and disability) (8).

Concerns have also been raised regarding a possible association between the use of fertility drugs and an increased risk of cancer of the reproductive organs. There is a need for long term studies that follow women who have taken fertility drugs for many years to determine if their cancer risk is increased. A recent study of the use of fertility drugs and ovarian cancer did not find a convincing associationbetween the two (9).

Access to reproductive technology: costs and sexual preference

For people without private health insurance, the out of pocket costs (costs after Medicare refund) for reproductive technologies can be considerable. Variations to treatment such as ICSI, embryo freezing and embryo storage incur additional fees.

The issue of access to reproductive technologies has been the subject of ongoing debate. A single woman won a court case against the Victorian Infertility Treatment Act, which restricts fertility procedures to married women and women in heterosexual de facto relationships. This issue has stimulated community debate about who has the right to access fertility procedures, who makes a good parent and what are the rights of the child? It has been argued that reproductive technologies should be restricted to heterosexual couples who are infertile and that a child should grow up with a mother and a father. Others have suggested that lesbians and single women should have equal rights to fertility procedures, irrespective of their circumstances and sexual preference.

Some final questions

Leaps in technology have created questions that our society is not yet ready or able to address in full. Questions that remained unanswered include:

• What are the rights of the embryo? Embryos that have been frozen and stored have been the subject of individual court cases between divorcing couples and between the state and would-be parents. Storage guidelines have been developed in Australia with state-based limits on the length of time embryos can be stored for. In addition, surplus embryos are now being considered for use in stem cell research.
• What are the rights of a child born by donor insemination or donor egg who wants to know his or her biological father/mother? Many children born from donor insemination are now at the age when they wish to find more about their biological parents. However, many donors want their donor anonymity preserved.
• Is it ethical to select the sex of the child through the separation of male- determining sperm from female-determining sperm? This issue has been a particular concern in countries like India and China where having a male child is culturally desirable. It is feared that the technology will be used to conceive only male children.
• Is it ethical to use reproductive technology to have a child that is a compatible organ donor for an ill sibling? What impact might this knowledge have on the donor child?

References

This student factsheet is one of a series produced by Women's Health Queensland Wide. They have been developed in response to students' most frequently asked questions and reflect a range of topics examined by high school and tertiary students. It has been reviewed by our Editorial Committee. This factsheet is designed for student assignment purposes and, therefore, may not be an appropriate source of information for personal use.

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Last Modified: July 3, 2009