Various alternatives have been developed to help couples overcome the problem of infertility. Artificial insemination is one option to be considered in certain instances. In this procedure, semen is mechanically introduced into the woman’s vagina or cervix

Conceiving Children: process and Choice

or, in some cases, directly into her uterus, a procedure called intrauterine insemina­tion. If the man is not producing adequate viable sperm or if a woman does not have a male partner, artificial insemination with a donor’s semen is another option. More than a million people who are alive today in the United States were conceived by donor insemination (Egan, 2012).

Perhaps the most unique pregnancy by artificial insemination is that of the "preg­nant man," Thomas Beatie. Thomas was born female but had sex reassignment proce­dures including testosterone supplementation and chest reconstructive surgery. He is legally recognized as a male. However, he did not alter his female genitals and repro­ductive organs. When his wife, Nancy, was unable to conceive, the couple decided that he would try to become pregnant. He stopped his testosterone supplementation, used semen purchased via the Internet for artificial insemination, and conceived on the second insemination. Their healthy baby girl, Susan, was born in July 2008. They wanted more children so Thomas became pregnant two more times, and they now have three children.

A surrogate mother is a woman who is willing to be artificially inseminated by the male partner of a childless heterosexual, lesbian, or gay couple or to undergo in vitro fertilization using eggs and sperm from a couple. She carries the pregnancy to term, delivers the child, and gives it to the couple for adoption. In the last 30 years, surrogate mothers in the United States have given birth to approximately 25,000 children, and surrogate births rose to 1,000 in 2007, compared to 260 in 2006 (Ginty, 2008b).

Surrogacy can be done anonymously through an attorney or privately by arrange­ment between the woman and the couple. Some states have made surrogacy illegal, while others permit it but allow only nominal payment to cover medical and incidental expenses (Apel, 2011). In the few states that allow surrogate mothers to be compen­sated, they typically receive a fee between $20,000 and $30,000. Individuals and couples from European and Middle Eastern countries where surrogacy is illegal travel to the United States and India for surrogates. Surrogacy in India costs 10% of what it costs in the United States and generates $445 million in yearly revenues (Bates, 2010).

The techniques of extrauterine conception are referred to as assisted reproductive technology (ART). The world’s first test-tube baby was born in England in 1978. More than 2 million women and couples worldwide have children conceived through IVF, and in the United States about 48,000 women each year deliver babies that were conceived in a laboratory of one of 430 reproductive technology centers (Evans, 2009). In in vitro fertilization (IVF) the ovaries are stimulated by hormonal fertility drugs to produce multiple ova. The mature eggs are removed from the woman’s ovary and are fertilized in a laboratory dish by her partner’s sperm. After 2 or 3 days several fertilized eggs are then introduced into the woman’s uterus. Excess embryos are often frozen so that if the first implantation does not take place, the procedure can be repeated. If this procedure is successful, at least one egg will implant and develop. Research had found that couples initially seeking medical help for infertility tend to overestimate the success rates of treatment (van den Boogaard et al., 2011). The success rate of live births from IVF is between 50% and 72%. Live births are twice as likely when the mother is under age 35 (Boyd, 2009). Research on ways to increase the pregnancy rate from IVF is ongoing (Devroey et al., 2009).

Variations on IVF involve transferring fertilized ova to a fallopian tube rather than to the uterus, a procedure known as

zygote intrafallopian transfer (ZIFT). In gamete intrafallopian transfer (GIFT),

the sperm and ova are placed directly in the fallopian tube, where fertilization normally occurs.

Donated ova can be used for IVF when the woman does not have ovaries, does not produce her own ova, or has a heritable genetic disease. Donation of ova is analogous to donor artificial insemination. Donors are usually women in their 20s, a sister or friend of the infertile woman, or another woman undergoing IVF who donates her ova to another woman wanting the IVF procedure. In cases in which both partners are infer­tile, IVF can be done with both donated sperm and donated ova.