1. Nicholas Bakaler, “U.S. Fertility Rate Reaches a Record Low,” New York Times, July 3, 2017.
2. According to the National Survey of Family Growth (NSFG), from 2011 to 2015, 12.1 percent of all women, or approximately 7.3 million women, experienced problems getting pregnant or carrying a baby to term and 14.2 percent of all married women in that period were categorized as infertile, down from 16.2 percent in 2002. See Key Statistics from National Survey of Family Growth at https://www.cdc.gov/nchs/nsfg/key_statistics/i.htm#infertility, accessed December 10, 2017. See also a CDC Infertility White Paper entitled “A Public Health Focus on Infertility Prevention, Detection, and Management” at https://www.cdc.gov/reproductivehealth/infertility/whitepaper-pg1.htm.
3. Ibid. Nearly 2 percent of women of childbearing age had medical visits in a twelve-month period ending in 2002. See A. Chandra, G. M. Martinez, W. D. Mosher, et al., “Fertility, Family Planning, and Reproductive Health of U.S. Women: Data from the 2002 National Survey of Family Growth,” National Center for Health Statistics, Vital and Health Statistics 23, no. 25 (December 2005): 1–160.
According to the NSFG, from 2001 to 2015, 12 percent of women aged fifteen to forty-four, or 7.3 million women, and 17 percent of women aged twenty-five to forty-four (6.9 million women) in the United States had received infertility services. See A. Chandra, C. E. Copen, and E. H. Stephen, “Infertility Service Use in the United States: Data from the National Survey of Family Growth, 1928–2010,” Centers for Disease Control and Prevention, US Department of Health and Human Services, National Health Statistics Reports, no. 73 (January 22, 2014).
1. For a detailed description of the evolution of the use of hormones, see Debora L. Spar, The Baby Business (Cambridge, MA: Harvard Business Review Press, 2006), 18–21.
2. Quoted in Barbara Seaman, “Is This Any Way to Have a Baby?,” O, The Oprah Magazine, February 2004. Available online, with the permission of the author, on Evidence-Based Perspectives on Hot Women’s Health Issues, https://gilliansanson.wordpress.com/2004/02/07/is-this-any-way-to-have-a-baby-by-barbara-seaman/.
3. Shady Grove Fertility, “Clomid for Infertility: What You Need to Know,” July 13, 2016, https://www.shadygrovefertility.com/blog/treatments-and-success/clomid-for-infertility/.
4. Andrea Manzi-Davies, “Helena Bonham Carter: ‘I would have tried anything, even IVF,’ ” The Telegraph, October 15, 2007, https://www.telegraph.co.uk/women/womens-health/3351623/Helena-Bonham-Carter-I-would-have-tried-anything-even-IVF.html.
5. According to Christine Lee, MD, who also holds a PhD in developmental biology and an MS in biomolecular organization and serves as lab director of ConceiveEasy, the incidence of twins is approximately 8 to 10 percent for clomiphene pregnancies. Christine Lee, “What are the Chances of Having Twins with Clomid?”, February 19, 2014, https://www.conceiveeasy.com/get-pregnant/what-are-the-chances-of-having-twins-with-clomid-2/. The ASRM advises patients that of women who achieve pregnancy with clomiphene citrate, approximately 5 to 12 percent bear twins. See American Society for Reproductive Medicine, Multiple Pregnancy and Birth: Twins, Triplets, and High-order Multiples: A Guide for Patients, 2012, http://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/fact-sheets-and-info-booklets/multiple-pregnancy-and-birth-twins-triplets-and-high-order-multiples-booklet/.
6. Irene Moy and Geraldine Ekpo, “Clomiphene Citrate Use for Ovulation Induction: When, Why, and How?,” Contemporary OB/GYN, April 1, 2011, http://contemporaryobgyn.modernmedicine.com/contemporary-obgyn/news/clinical/clinical-pharmacology/clomiphene-citrate-use-ovulation-induction-wh?page=full. Although the cause of ovarian hyperstimulation syndrome (OHSS) is not fully understood, having a high level of human chorionic gonadotropin (HCG) introduced into a woman’s system had been established to play a role. While mild to moderate OHSS is more common and usually goes away after about a week, approximately 1 to 2 percent of women undergoing ovarian stimulation develop a severe form of OHSS, which can be life-threatening. Injectable fertility medications are more likely to cause OHSS than Clomid. See Mayo Clinic, “Ovarian Hyperstimulation Syndrome,” accessed December 10, 2017, http://www.mayoclinic.org/diseases-conditions/ovarian-hyperstimulation-syndrome-ohss/symptoms-causes/dxc-20263586.
7. Mark Fainaru-Wada and Lance Williams, “Giambi admitted taking steroids,” SFGate, December 2, 2004, https://www.sfgate.com/sports/article/Giambi-admitted-taking-steroids-2631890.php.
8. Moy and Ekpo, “Clomiphene Citrate Use,” and Shady Grove Fertility, “Clomid for Infertility.”
9. Ibid.
10. E. Hughes, J. Brown, J. J. Collins, and P. Vanderkerchove, “Clomiphene Citrate for Unexplained Subfertility in Women,” Cochrane Database of Systematic Reviews, no.1 (January 20, 2010): article ID CD000057.
11. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, “Revised 2003 Consensus on Diagnostic Criteria and Long-term Health Risks Related to Polycystic Ovary Syndrome,” Fertility and Sterility 81, no. 1 (January 2004):19–25.
12. American Congress of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins—Gynecology, “ACOG Practice Bulletin No. 108: Polycystic Ovary Syndrome,” Obstetrics & Gynecology 114, no. 4 (October 2009): 936–49. Reaffirmed 2015, https://www.acog.org/Resources-And-Publications/Practice-Bulletins-List.
13. National Institutes of Health, “New Treatment Increases Pregnancy Rate for Women with Infertility Disorder,” news release, July 9, 2014, https://www.nih.gov/news-events/news-releases/new-treatment-increases-pregnancy-rate-women-infertility-disorder. R. F. Casper and M. F. Mitwally, “Review: Aromatase Inhibitors for Ovulation Induction,” Journal of Clinical Endocrinology and Metabolism 91, no. 3 (March 2006): 760–71.
14. NIH, “New Treatment.” The study, which had fifty-seven collaborators, was conducted by the Reproductive Medicine Network of NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). R. S. Legro, R. G. Brzyski, M. P. Diamond, et al., “Letrozole versus Clomiphene for Infertility in the Polycystic Ovary Syndrome. New England Journal of Medicine 371 (2014): 119–29.
15. Ibid. See also Shirley S. Wang, “Study Shows Letrozole’s Efficacy in Boosting Pregnancy Chances,” Wall Street Journal, July 9, 2014, https://www.wsj.com/articles/study-shows-letrozoles-efficacy-in-boosting-pregnancy-chances-1404939604.
16. NIH, “New Treatment.”
1. Richard Sherbahn, “Anti-Mullerian Hormone Testing of Ovarian Reserve,” Advanced Fertility Center of Chicago, accessed December 10, 2017, http://www.advancedfertility.com/amh-fertility-test.htm.
2. See “What Is anti-Müllerian Hormone (AMH)?” in Shady Grove Fertility, “Fertility Facts: Anti-Müllerian Hormone (AMH) Can Help Predict Your Ovarian Reserve,” June 23, 2017, https://www.shadygrovefertility.com/blog/diagnosing-infertility/fertility-facts-anti-mullerian-hormone-amh-can-help-predict-your-ovarian-reserve/.
3. Sherbahn, “Anti-Mullerian Hormone Testing.”
1. Quoted in Colette Bouchez, “The Ancient Art of Infertility Treatment,” WebMD Feature, October 13, 2003, https://www.webmd.com/infertility-and-reproduction/features/ancient-art-of-infertility-treatment#1.
2. A study in Tel Aviv found that acupuncture and herbs used in conjunction with IUI increased the IUI success rate from 39.4 percent to 65.5 percent. K. Sela, O. Lehavi, A. Buchan, et al., “Acupuncture and Chinese Herbal Treatment for Women Undergoing Intrauterine Insemination,” European Journal of Integrative Medicine 3, no. 2 (June 2011): e77–81.
A meta-analysis of seven trials found that acupuncture treatments on the same day as embryo transfer increased the odds of clinical pregnancy by 65 percent. E. Manheimer, G. Zhang, L. Udoff, et al., “Effects of Acupuncture on Rates of Pregnancy and Live Birth Among Women Undergoing In Vitro Fertilization: Systematic Review and Meta-analysis,” BMJ 336, no. 7,643 (March 8, 2008): 545–49. See also Serena Gordon, “Acupuncture May Boost Pregnancy Success Rates,” U.S. News & World Report, January 27, 2012, online edition, https://health.usnews.com/health-news/family-health/womens-health/articles/2012/01/27/acupuncture-may-boost-pregnancy-success-rates.
3. See Randine Lewis, The Infertility Cure: The Ancient Chinese Wellness Program for Getting Pregnant and Having Healthy Babies, reprint ed. (Boston: Little, Brown, 2005); Gordon, “Acupuncture May Boost”; Pacific College of Oriental Medicine, “How Does Acupuncture for Fertility Work? Increase Chance of Conception without Side Effects,” updated September 4, 2017, http://www.pacificcollege.edu/news/blog/2015/04/17/how-does-acupuncture-fertility-work-increase-chance-conception-without-side.
4. Jane Gregorie, interview with the author, March 22, 2016.
5. L. E. Hullender Rubin, M. S. Opsahl, K. E. Wiemer, et al., “Impact of Whole Systems Traditional Chinese Medicine on In Vitro Fertilization Outcomes,” Reproductive BioMedicine Online 30, no. 6 (June 2015): 602–12. See also Lewis, Infertility Cure.
6. The American Board of Oriental and Reproductive Medicine (ABORM) was founded to establish and maintain high standards among practitioners; as a result, members submit to a voluntary certification process. ABORM maintains an extensive database of certified specialists on their website (www.aborm.org), which extends far beyond US borders, not only to Canada but also to Switzerland, Australia, and New Zealand as well.
7. Randine Lewis, “The High FSH Craze,” http://fertilefoods.com/the-high-fsh-craze/.
8. Jane Gregorie, interview with the author, March 22, 2016.
9. Elizabeth Stener-Victorin conducted breakthrough studies on reducing hypertension in the uterine artery. E. Stener-Victorin, U. Waldenström, S. A. Andersson, and M. Wikland, “Reduction of Blood Flow Impedance in the Uterine Arteries of Infertile Women with Electro-acupuncture,” Human Reproduction 11, no. 6 (June 1996): 1314–17.
10. J. Johansson and E. Stener-Victorin, “Polycystic Ovary Syndrome: Effect and Mechanisms of Acupuncture for Ovulation Induction,” Evidence-Based Complementary and Alternative Medicine 2013 (2013): 16 pages, article ID 762615.
11. Gordon, “Acupuncture May Boost.”
12. P. C. Magarelli, D. K. Cridennda, and M. Cohen, “Changes in Serum Cortisol and Prolactin Associated with Acupuncture During Controlled Ovarian Hyperstimulation in Women Undergoing In Vitro Fertilization–Embryo Transfer Treatment,” Fertility and Sterility 92, no. 6 (December 2009): 1870–9.
13. See, for example, J. Pei, E. Strehler, U. Noss, et al., “Quantitative Evaluation of Spermatozoa Ultrastructure After Acupuncture Treatment for Idiopathic Male Fertility,” Fertility and Sterility 84, no. 1 (July 2005): 141–47.
14. Elizabeth Palermo, “What Is Acupuncture?” LiveScience, June 21, 2017, https://www.livescience.com/29494-acupuncture.html.
15. Quoted in Rachel Gurevich, “How Does Acupuncture Help Fertility? Ancient and Modern Theories on Why Acupuncture May Improve Fertility,” Verywell, updated December 1, 2016, https://www.verywell.com/how-does-acupuncture-help-fertility-1959899.
16. Palermo, “What Is Acupuncture?”
17. Dr. Chang also advocates that acupuncture appears to have a neuroendocrine effect, strengthening a three-way axis between the hypothalamus and the pituitary glands (two areas of the brain involved with hormone production) and the ovaries, which ultimately impacts egg production and possibly ovulation.
18. Hua Liu, Jian-Yang Xu, Lin Li, et al., “fMRI Evidence of Acupoints Specificity in Two Adjacent Acupoints,” Evidence-Based Complementary and Alternative Medicine 2013 (2013): 5 pages, article ID 932581.
19. Sela et al., “Acupuncture and Chinese Herbal Treatment.”
20. Pei et al., “Quantitative Evaluation.”
21. G. Franconi, L. Manni, L. Aloe, et al., “Acupuncture in Clinical and Experimental Reproductive Medicine: A Review,” Journal of Endocrinological Investigation 34, no. 4 (April 2011): 307–11.
22. Ibid. Also, in 2002, a group of German researchers discovered that adding acupuncture to the traditional IVF treatment protocols substantially increased pregnancy success, finding that nearly half of women receiving just two twenty-five-minute sessions of acupuncture, one prior to having the fertilized embryos transferred into their uteri, and one directly afterward, had success getting pregnant, compared to just over a quarter of those who received no acupuncture treatments. W. E. Paulus, M. Zhang, E. Strehler, et al., “Influence of Acupuncture on the Pregnancy Rate in Patients Who Undergo Assisted Reproduction Therapy,” Fertility and Sterility 77, no. 4 (April 2002): 721–24; S. Dieterle, G. Ying, W. Hatzmann, and A. Neuer, “Effect of Acupuncture on the Outcome of In Vitro Fertilization and Intracytoplasmic Sperm Injection: A Randomized, Prospective, Controlled Clinical Study,” Fertility and Sterility 85, no. 5 (May 2006): 1347–51.
Yet the research is not entirely clear. Although a meta-analysis of seven trials found that acupuncture treatments on the same day as embryo transfer increased the odds of clinical pregnancy by 65 percent (Manheimer et al., “Effects of Acupuncture”), later trials indicated that similar protocols of acupuncture treatments on the day of embryo transfer did not improve pregnancy rates compared with control groups. Y. C. Cheong, S. Dix, E. Hung Yu Ng, et al., “Acupuncture and Assisted Reproductive Technology,” Cochrane Database of Systematic Reviews, no. 7 (July 26, 2013): article ID CD006920. A small American study that duplicated the German methodology did not find any improvement in pregnancy rates with acupuncture.
23. Quoted in Gordon, “Acupuncture May Boost.”
24. For instance, a group of clinicians and researchers in Oregon designed the first comprehensive study to compare the results of IVF cycles carried out in conjunction with whole-systems TCM against the IVF results of cycles paired with just two acupuncture treatments on the day of embryo transfer and cycles that involved only the usual IVF care without any TCM intervention. Hullender Rubin et al., “Impact of Whole Systems.” Their findings that an increased number of acupuncture treatments led to greater pregnancy and live birth outcomes echo the results of earlier studies on specific outcomes resulting from repetitive acupuncture sessions. For example, blood flow to the uterus was found to improve with eight electroacupuncture sessions (Stener-Victorin et al., “Reduction of Blood Flow”), serum cortisol and prolactin were increased with a corresponding increase in IVF outcomes after nine electroacupuncture sessions (Magarelli et al., “Changes in Serum Cortisol”), and women with polycystic ovaries experienced improved menstrual regularity and reduced androgen levels after fourteen electro-acupuncture treatments (E. Jedel, F. Labrie, A. Oden, et al., “Impact of Electro-acupuncture and Physical Exercise on Hyperandrogenism and Oligo/Amenorrhea in Women with Polycystic Ovary Syndrome: A Randomized Controlled Trial,” American Journal of Physiology-Endocrinology and Metabolism 300, no. 1 (January 2011): e37–45.
1. For further information on toxoplasmosis and its potential effects on pregnancy, see the CDC, Parasites-Toxoplasmosis (Toxoplasma infection) at https://www.cdc.gov/parasites/toxoplasmosis/gen_info/pregnant.html.
2. One study found the frequency of chromosomal abnormalities to be 69.4 percent. M. Ohno, T. Maeda, and A. Matsunobu, “A Cytogenetic Study of Spontaneous Abortions with Direct Analysis of Chorionic Villi,” Obstetrics & Gynecology 77, no. 3 (March 1991): 394–98. Another study found that 70 to 90 percent of miscarriages occur due to chromosomal abnormalities. See IVF1, “Miscarriage History Raises Risk for Baby Chromosome Abnormalities,” July 30, 2008, http://www.ivf1.com/miscarriage-risk/. For a more detailed discussion of the role of chromosomal abnormalities in miscarriage, please see chapter 8 and its notes.
1. A typical round of IUI in the United States costs anywhere from $500 to $1,000 (up to $2,500 to $4,000, with medications and ultrasound monitoring); expensive, but a drop in the bucket when compared to $12,000 to $25,000 for an IVF cycle.
1. “What people worry about is that this is the first step on the road to Gattaca [referring to gender selection],” said Dr. Matt Wynia, the director of the University of Colorado Center for Bioethics and Humanities. “Letting parents choose the height, eye color, IQ, etc. When you start thinking about those things being very expensive, you can imagine some future world in which only the wealthy can have a healthy, tall baby made to order,” quoted in Jaclyn Allen, “Boy or Girl? More and More Colorado Parents Are Choosing Their Baby’s Gender,” Denver Channel, updated May 13, 2017, http://www.thedenverchannel.com/money/science-and-tech/boy-or-girl-more-and-more-colorado-parents-are-chosing-their-babys-gender. See also “Chrissy Teigen and John Legend Already Know the Gender of Their Second Baby—and Here’s How,” Vogue, November 21, 2017, https://www.vogue.com/article/chrissy-teigen-ivf-gender-selection-controversy-explained; and M. L. McGowan, and R. R. Sharp, “Justice in the Context of Family Balancing,” Science, Technology & Human Values 38, no. 2 (March 1, 2013): article ID 10.1177/0162243912469412.
2. Margot Peppers, “The Rise of ‘Social’ Surrogacy: The Women Choosing Not to Carry Their Own Babies for Fear of Hurting Their Careers or Ruining Their Bodies, Daily Mail (UK), April 16, 2014, http://www.dailymail.co.uk/femail/article-2606101/the-rise-social-surrogacy-the-women-choosing-not-carry-babies-fear-hurting-careers-ruining-bodies.html#ixzz4t4OcD1ca. See also Sarah Elizabeth Richards, “Should a Woman Be Allowed to Hire a Surrogate Because She Fears Pregnancy Will Hurt Her Career?,”Elle, April 17, 2014, http://www.elle.com/life-love/a14424/birth-rights/.
3. Critics fear the successful birth of a baby with three genetic parents, in a procedure performed to eliminate the possibility of passing on Leigh syndrome, an inherited genetic disorder, “could open the door to the creation of so-called designer babies.” Rob Stein, “New York Fertility Doctor Says He Created Baby With 3 Genetic Parents,” All Things Considered, NPR News, September 27, 2016, http://www.npr.org/sections/thetwo-way/2016/09/27/495668299/new-york-fertility-doctor-says-he-created-baby-with-3-genetic-parents.
4. Olivia Blair, “Chrissy Teigen Defends Selecting Gender of Her Baby During IVF After Backlash,” The Independent (UK), February 24, 2016, http://www.independent.co.uk/news/people/chrissy-teigen-john-legend-baby-ivf-a6893621.html.
5. Interestingly, although many women I have spoken with shared this feeling, it is certainly not universal. Diana felt that the hardest part was getting herself and her husband to a fertility clinic; she was relieved to just follow their instructions. Paula, on the other hand, had quite a different reaction to her first visit to a nationally recognized fertility specialist. “It was just a load of BS,” she told me, still indignant years later, recalling her response to the diagnosis and advice she received. “I decided I was just going to wait and see what happened.”
6. The first baby conceived with IVF using preimplantation genetic testing was born in 1990, and the technology has progressed dramatically in the last ten to fifteen years. For a more detailed discussion of the evolution of preimplantation genetic testing, see chapter 7, and Jason Franasiak and Richard T. Scott Jr., “A Brief History of Preimplantation Genetic Diagnosis and Preimplantation Genetic Screening,” Virtual Academy of Genetics, http://www.ivf-worldwide.com/cogen/oep/pgd-pgs/history-of-pgd-and-pgs.html.
7. I had thought at the time that the Puregon contained synthetic FSH but have since learned that the solution for injection contains the active substance follitropin beta, produced by genetic engineering of a Chinese hamster ovary (CHO) cell line. See http://www.medicines.org.uk/emc/medicine/15946.
8. Also known as Pregnyl, Ovidrel, Novarel and others, all brand names for human chorionic gonadotropin (HCG).
9. Anna Magee, “Why Are So Many British Women Travelling Abroad for Fertility Treatment?,” The Telegraph (UK), March 28, 2015, http://www.telegraph.co.uk/women/mother-tongue/11482483/fertility-treatment-why-british-women-are-travelling-abroad.html. M. Rezazadeh Valojerdi, P. Eftekhari-Yazdi, L. Karimian, et al., “Vitrification Versus Slow Freezing Gives Excellent Survival, Post Warming Embryo Morphology and Pregnancy Outcomes for Human Cleaved Embryos,” Journal of Assisted Reproduction and Genetics 26, no. 6 (June 2009), 347–54.
1. I injected 250 IUs of Puregon daily, up from 150 IUs.
2. At the time, Dr. Ashby referred to it as preimplantation genetic diagnosis (PGD) a more common term for both types of technology in 2004. As the technology has evolved, the terminology has correspondingly become more specific, and the type of genetic testing she was referring to is now known as PGS. In order to avoid confusion, I refer to PGS, here and throughout, as it is generally used in 2017. A more detailed discussion of PGS and PGD can be found later in this chapter in the section entitled “Preimplantation Genetic Diagnosis (PGD) and Screening (PGS)”.
3. For this cycle, I was prescribed Puregon, a form of FSH, plus Menopur, synthetic FSH combined with LH, as opposed to just FSH.
4. Viagra has been shown to increase the thickness of the uterine lining by increasing blood flow and estrogen delivery to the lining. See Geoffrey Sher, “Viagra as a Treatment to Thicken Uterine Lining,” April 11, 2016, http://drgeoffreysherivf.com/viagra-treatment-thicken-uterine-lining/; R. D. Firouzabadi, R. Davar, F. Hojjat, and M. Mahdavi, “Effect of sildenafil citrate on endometrial preparation and outcome of frozen-thawed embryo transfer cycles: a randomized clinical trial,” Iranian Journal of Reproductive Medicine 11, no. 2 (February 2013): 151–58.
5. Dr. Gillian Lockwood, the medical director of Midland Fertility Services, quoted in Magee, “British Women Travelling.”
6. FertilityIQ, “Finding an IVF Doctor Is Total Hell,” accessed December 11, 2017, https://www.fertilityiq.com/fertilityiq-data-and-notes/finding-an-ivf-doctor-is-total-hell.
7. Dr. Laura Rienzi, “How to Improve Embryos’ Quality in the IVF Lab,” presentation at the 24th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI), Amsterdam, Netherlands, November 11, 2016.
8. Q. Lai, H. Zhang, G. Zhu, et al., “Comparison of the GnRH Agonist and Antagonist Protocol on the Same Patients in Assisted Reproduction During Controlled Ovarian Stimulation Cycles,” International Journal of Clinical and Experimental Pathology 6, no. 9 (August 15, 2013):1903–10.
9. Richard Sherbahn and Michelle Catenacci, “High Live Birth Rates in IVF High Responders Using Either a Lupron Trigger Alone (Agonist Trigger) or Using a Dual Trigger if Intensive Luteal Support Is Given,” research study presented by Richard Sherbahn, MD, at the 70th Annual Meeting of the American Society for Reproductive Medicine, Honolulu, October 2014.
10. A 2007 study indicated that early embryos were no better off in the uterus than in the incubator. G. Sher, L. Keskintepe, M. Keskintepe, et al., “Oocyte Karyotyping by Comparative Genomic Hybrydization Provides a Highly Reliable Method for Selecting ‘Competent’ Embryos, Markedly Improving In Vitro Fertilization Outcome: A Multiphase Study,” Fertility and Sterility 87, no. 5 (May 2007): 1033–40.
11. At one top clinic in Chicago, for example, 68.9 percent of women aged thirty-eight to forty became pregnant and 52 percent had a live birth following a blastocyst transfer, as opposed to a 40.9 percent pregnancy rate and 27.4 percent birth rate resulting from an embryo transfer. Among women just a couple of years older, aged forty-one to forty-two, the blastocyst transfers resulted in a 59.5 percent pregnancy and 37 percent live birth rate, as compared to 24.6 percent and 15.8 percent, respectively, for those who had an embryo transfer. Richard Sherbahn, “IVF Success Rates with 5 Day Blastocyst Transfers at the Advance Fertility Center of Chicago,” Advanced Fertility Center of Chicago, accessed December 11, 2017, www.advancedfertility.com/blastocystpregnancyrates.htm.
12. John Rock, “Conception in a Watch Glass,” New England Journal of Medicine 217, no. 678 (October 21, 1937).
13. A. H. Handyside, E. H. Kontogianni, K. Hardy, and R. M. Winston, “Pregnancies from Biopsied Human Preimplantation Embryos Sexed by Y-specific DNA Amplification,” Nature 344, no. 6,268 (April 19, 1990): 768–70.
14. A. H. Handyside, J. G. Lesko, J. J. Tarin, et al., “Birth of a Normal Girl After In Vitro Fertilization and Preimplantation Diagnostic Testing for Cystic Fibrosis,” New England Journal of Medicine 327, no. 13 (September 24, 1992): 905–9.
15. Ibid.
16. Mark Hughes, “Current and Future Molecular Diagnostic Technologies for PGS and PGD,” presentation at ART World Congress, October 13, 2016.
17. Ibid.
18. L. Rienzi, A. Capalbo, M. Stoppa, et al., “No Evidence of Association Between Blastocyst Aneuploidy and Morphokinetic Assessment in a Selected Population of Poor-Prognosis Patients: A Longitudinal Cohort Study,” Reproductive BioMedicine Online 30, no. 1 (January 2015): 57–66; R. R. Angell, A. A. Templeton, and R. J. Aitken, “Chromosome Studies in Human In Vitro Fertilization,” Human Genetics 72, no. 4 (April 1986): 333–39.
19. See S. Mastenbroek, M. Twisk, J. van Echten-Arends, et al., “In Vitro Fertilization with Preimplantation Genetic Screening,” New England Journal of Medicine, no. 357 (2007): 9–17.
20. Ibid.
21. Santiago Munné and Dagan Wells, “Detection of Mosaicism at Blastocyst Stage with the Use of High-Resolution Next-Generation Sequencing,” Fertility and Sterility 107, no. 5 (May 2017): 1085–91.
22. S. Munné, “Preimplantation Genetic Diagnosis for Aneuploidy and Translocations Using Array Comparative Genomic Hybridization,” Current Genomics 13, no. 6 (September 2012): 463–70. The first baby conceived in the UK after using aCGH was born in 2010. University of Oxford, “First IVF Babies Born Using New Chromosome Counting Technique,” February 4, 2011, http://www.ox.ac.uk/news/2011-02-04-first-ivf-babies-born-using-new-chromosome-counting-technique.
23. Analysis of 15,033 embryos biopsied showed 47.3 percent to be normal (euploid), 39 percent to be abnormal (aneuploid), and 13.7 percent to be mosaic, with nearly 5 percent of the mosaics showing low levels of mosaicism and therefore treated as normal, and just under 9 percent showing high levels of abnormality. Ibid. A further analysis of data from Reprogenetics and Genesis Genetics through March 2016 regarding 33,236 embryos showed a range of mosaic embryos from 11 percent to 22 percent, depending on the age group, and a range of aneuploidy embryos from 16 percent to 42 percent. Approximately 30 percent of blastocyst-stage embryos are mosaic. Munné and Wells, “Detection of Mosaicism.”
24. Hughes, “Molecular Diagnostic Technologies” presentation. Similarly, an embryo indicated as normal using aCGH was found to be a high-level mosaic, with 70 percent of its cells having trisomy 16. Santiago Munné, “An Appraisal of PGS Outcome-Data from the Two Largest PGS Providers,” presentation at ART World Congress, October 13, 2016.
25. Ibid.
26. E. Greco, M. G. Minasi, and F. Florentino, “Healthy Babies After Intrauterine Transfer of Mosaic Aneuploid Blastocysts,” New England Journal of Medicine no. 373 (2015): 2089–90.
27. Reprogenetics and Recombine, a company founded by Dr. Munné that provides carrier screening tests for couples planning to conceive, were acquired in 2015 and 2016, respectively, by CooperSurgical, and are now part of CooperGenomics, where Dr. Munné serves as chief scientific officer.
28. Stephen S. Hall, “A New Last Chance: There Could Soon Be a Baby-Boom Among Women Who Thought They’d Hit an IVF Dead End,” The Cut, New York Magazine, September 17, 2017, https://www.thecut.com/2017/09/ivf-abnormal-embryos-new-last-chance.html.
29. Ibid.
30. Evidence that mosaic embryos implant less than those that are euploid comes from a recent study in which mosaic embryos, as determined with the use of hrNGS, resulted in 30.1 percent initial implantations and 15.4 percent ongoing pregnancies, significantly less than a well-matched nonmosaic euploid control group (55.8 percent implantations, 46.2 percent ongoing pregnancies). Another study showed a miscarriage rate of 55.6 percent for blastocysts classified as mosaic, versus 17.2 percent for euploid control samples (Munné and Wells, “Detection of Mosaicism”).
31. Ibid.
32. Pasquale Patrizio, head of fertility medicine at Yale University, and Sherman Silber of St. Luke’s Hospital in St. Louis, quoted in Hall, “New Last Chance.”
33. Z. Yang, J. Liu, G. S. Collins, et al., “Selection of Single Blastocysts for Fresh Transfer Via Standard Morphology Assessment Alone and with Array CGH for Good Prognosis IVF Patients: Results from a Randomized Pilot Study,” Molecular Cytogenetics 5, no. 1 (May 2, 2012): 24; R. T. Scott, K. M. Upham, E. J. Forman, et al., “Blastocyst Biopsy with Comprehensive Chromosome Screening and Fresh Embryo Transfer Significantly Increases In Vitro Fertilization Implantation and Delivery Rates: A Randomized Controlled Trial,” Fertility and Sterility 100, no. 3 (September 2013): 697–703; E. J. Forman et al., “In Vitro Fertilization with Single Euploid Blastocyst Transfer: A Randomized Controlled Trial,” Fertility and Sterility 100, no. 1 (July 2013): 100–7.
34. E. M. Dahdouh, J. Balayla, and J. A. Garcia-Velasco, “Impact of Blastocyst Biopsy and Comprehensive Chromosome Screening Technology on Preimplantation Genetic Screening: A Systematic Review of Randomized Controlled Trials,” Reproductive BioMedicine Online 30, no. 3 (March 2015): 281–89; E. Lee, P. Illingworth, L. Wilton, and G. M. Chambers, “The Clinical Effectiveness of Preimplantation Genetic Diagnosis for Aneuploidy in All 24 Chromosomes (PGD-A): Systematic Review,” Human Reproduction 30, no. 2 (February 2015): 473–83.
35. J. Chang, S. L. Boulet, G. Jeng, et al., “Outcomes of In Vitro Fertilization with Preimplantation Genetic Diagnosis: An Analysis of the United States Assisted Reproductive Technology Surveillance Data, 2011–2012,” Fertility and Sterility 105, no. 2 (February 2016): 394–400.
36. G. Murugappan, L. Shahine, C. Perfetto, et al., “Intent to Treat Analysis of In Vitro Fertilization and Preimplantation Genetic Screening Versus Expectant Management in Patients with Recurrent Pregnancy Loss,” Human Reproduction 31, no. 8 (August 1, 2016): 1668–74.
37. SART 2014 National Summary Report, https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx.
38. G. L. Harton, S. Munné, M. Surrey, et al., “Diminished Effect of Maternal Age on Implantation after Preimplantation Genetic Diagnosis with Array Comparative Genomic Hybridization,” Fertility and Sterility 100, no. 6 (December 2013):1695–703.
39. SART 2014; Munné “Appraisal of PGS Outcome-Data” presentation.
40. Jacques Cohen, “Design and quality control of future IVF laboratories,” presentation at 2016 ART World Congress, October 14, 2016.
1. Kate Wighton, “Miscarriage and Ectopic Pregnancy May Trigger Post-Traumatic Stress Disorder,” Imperial College London, November 2, 1016, http://www3.imperial.ac.uk/newsandeventspggrp/imperialcollege/newssummary/news_1-11-2016-17-15-45.
2. March of Dimes, “Miscarriage,” http://www.marchofdimes.org/complications/miscarriage.aspx.
3. For an exceptional examination of miscarriage, see Jon Cohen, Coming to Term: Uncovering the Truth About Miscarriage (New Brunswick, NJ: Rutgers University Press, 2007). The statistics cited herein can be found on page 16.
4. Mark Hughes, “Molecular Diagnostic Technologies” presentation.
5. Together with Lord Robert Winston and Dr. Alan Handyside.
6. Murugappan et al., “Intent to Treat Analysis.”
7. See chapter 13, particularly “Improving Egg Quality through Hormones: The Pregmama Story,” for an in-depth discussion of research into improving egg quality.
8. Diethylstilbestrol, a synthetic estrogen known as DES, became a popular treatment for the prevention of miscarriage from the late 1940s to the early 1970s, despite a lack of controlled studies demonstrating its efficacy or serious investigation of its safety for mother or child. Amid mounting concern about both, in 1971, the FDA advised doctors to stop prescribing DES to pregnant women. Beginning in the 1970s, significant research emerged revealing a troubling number of serious problems: DES caused clear cell adenocarcinoma in some women who took it; uterine abnormalities in as many as a third of the daughters born to mothers who took it, which led to devastatingly high miscarriage and infertility rates; an increased risk of breast cancer among mothers who took it; and rubbing salt in the wound, actually increased the risk of miscarriage in mothers who took it. For a thorough examination of the history and effects of DES, see Jon Cohen, Coming to Term, 116–29.
9. While a certain genetic problem called a “balanced translocation” in either parent is also known to cause recurrent miscarriage, there is unfortunately no treatment for this condition, and intended parents who are diagnosed with this are advised to seek genetic counseling.
10. Jon Cohen, Coming to Term, 113.
11. R. Rai, M. Backos, F. Rushworth, and L. Regan, “Polycystic Ovaries and Recurrent Miscarriage—A Reappraisal,” Human Reproduction 15, no. 3 (March 1, 2000): 612–15.
12. J. X. Wang, M. J. Davies, and R. J. Norman, “Polycystic Ovarian Syndrome and the Risk of Spontaneous Abortion Following Assisted Reproduction Technology Treatment,” Human Reproduction 16 (2001): 2606–9.
13. R. S. Legro, H. X. Barnhart, W. D. Schlaff, et al., “Clomiphene, Metformin, or Both for Infertility in the Polycystic Ovary Syndrome,” New England Journal of Medicine, February 356, no. 6 (2007): 551–66.
14. E. Moll, P. M. Bossuyt, J. C. Korevaar, et al., “Effect of Clomifene Citrate Plus Metformin and Clomifene Citrate Plus Placebo on Induction of Ovulation in Women with Newly Diagnosed Polycystic Ovary Syndrome: Randomised Double Blind Clinical Trial,” BMJ 332, no. 7,556 (Jun 24):1485.
15. E. Vanky, S. Stridsklev, R. Heimstad, et al., “Metformin versus Placebo from First Trimester to Delivery in Polycystic Ovary Syndrome: A Randomized, Controlled Multicenter Study,” Journal of Clinical Endocrinology & Metabolism 95, no. 12 (December 2010): e448–55.
16. V. De Leo, M. C. Musacchio, P. Piomboni, et al., “The Administration of Metformin During Pregnancy Reduces Polycystic Ovary Syndrome Related Gestational Complications,” European Journal of Obstetrics and Gynecology and Reproductive Biology 157, no. 1 (July 2011): 63–66. See also F. H. Nawaz, R. Khalid, T. Naru, and J. Rizvi, “Does Continuous Use of Metformin throughout Pregnancy Improve Pregnancy Outcomes in Women with Polycystic Ovarian Syndrome?,” Journal of Obstetrics and Gynaecology Research 34, no. 5 (October 2008): 832–37.
17. T. B. Mesen and S. L. Young, “Progesterone and the Luteal Phase: A Requisite to Reproduction,” Obstetrics and Gynecology Clinics of North America 42, no. 1 (March 2015): 135–51; P. Miller and M. Soules, “Luteal Phase Deficiency: Pathophysiology, Diagnosis and Treatment,” Global Library of Women’s Medicine, May 2009.
18. Jon Cohen, Coming to Term, 108.
19. R. M. Oates-Whitehead, D. Haas, and J. Carrier, “Progesterone for Preventing Miscarriage,” Cochrane Database of Systematic Reviews, no. 4 (October 20, 2003): article ID CD003511. Updated by D. M. Haas and P. S. Ramsey, “Progesterone for Preventing Miscarriage,” Cochrane Database of Systematic Reviews, no. 2 (April 16, 2008): article ID CD003511, and D. M. Haas and P. S. Ramsey, “Progesterone for Preventing Miscarriage,” Cochrane Database of Systematic Reviews, no. 10 (October 31, 2013): article ID CD003511.
20. A. Coomarasamy, H. Williams, E. Truchanowicz, et al., “PROMISE: First-Trimester Progesterone Therapy in Women with a History of Unexplained Recurrent Miscarriages—a Randomised, Double-Blind, Placebo-Controlled, International Multicentre Trial and Economic Evaluation,” Health Technology Assessment 20, no. 41 (May 2016): 1–92.
21. Mayo Clinic, “Cervical Cerclage,” March 17, 2015, http://www.mayoclinic.org/tests-procedures/cervical-cerclage/basics/definition/prc-20012949.
22. S. M. Althuisius, G. A. Dekker, P. Hummel, and H. P. van Gejin, “Cervical Incompetence Prevention Randomized Cerclage Trial: Emergency Cerclage with Bed Rest versus Bed Rest Alone,” American Journal of Obstetrics & Gynecology 189, no. 4 (October 2003): 907–10.
23. See A. O. Rust, R. O. Atlas, K. J. Jones, et al., “A Randomized Trial of Cerclage versus No Cerclage among Patients with Ultasonographically Detected Second-Trimester Peterm Dilation of the Internal Os,” American Journal of Obstetrics & Gynecology 183 (October 2000): 830–85; A. J. Drakeley, D. Roberts, and Z. Alfirevic, “Cervical Cerclage for Prevention of Preterm Delivery: Meta-analysis of Randomized Trials,” Obstetrics & Gynecology 102, no. 3 (September 2003): 621–27.
24. V. Berghella, T. J. Rafael, J. M. Szychowski, et al., “Cerclage for Short Cervix on Ultrasonography in Women with Singleton Gestations and Previous Preterm Birth: A Meta-analysis,” Obstetrics & Gynecology 117, no. 3 (March 2011): 663–71.
25. T. J. Rafael, V. Berghella, and Z. Alfirevic, “Cervical Stitch (Cerclage) for Preventing Preterm Birth in Multiple Pregnancy,” Cochrane Database of Systematic Reviews, no. 9 (September 2014): article ID CD009166.
26. APS Support UK, “About APS—Pregancy,” accessed December 11, 2017, http://www.aps-support.org.uk/about-aps/pregnancy.php.
27. R. S. Rai, L. Regan, K. Clifford, et al., “Immunology: Antiphospholipid Antibodies and β2-Glycoprotein-I in 500 Women with Recurrent Miscarriage: Results of a Comprehensive Screening Approach, Human Reproduction 10, no. 8 (August 1, 1995): 2001–5.
28. R. Rai, H. Cohen, M. Dave, and L. Regan, “Randomised Controlled Trial of Aspirin and Aspirin Plus Heparin in Pregnant Women with Recurrent Miscarriage Associated with Phospholipid Antibodies (or Antiphospholipid Antibodies),” BMJ 314, no 7,706 (January 25, 1997):253–57.
29. Megan Brooks, “Pravastatin Shows Promise in Pregnant Women with Antiphospholipid Syndrome,” Reuters Health, August 1, 2016, https://www.consultant360.com/story/pravastatin-shows-promise-pregnant-women-antiphospholipid-syndrome.
30. Reproductive Immunology Associates, “Miscarriages Can Be Prevented,” accessed December 11, 2017, http://www.rialab.com/fertility-services/reproductive-immunology/multiple-miscarriages-can-be-prevented.php; Braverman IVF & Reproductive Immunology, “Patients with 5 or more miscarriages have an outstanding 80% chance of having a successful pregnancy with our treatment protocols (all pregnancies delivered or currently past 20 weeks). A review of 30 cases at Braverman IVF & Reproductive Immunology,” posted on June 23, 2015, http://www.preventmiscarriage.com/patients-with-5-or-more-miscarriages-have-an-out.html.
31. Jon Cohen, Coming to Term, 64–66.
32. Peter Castro and Giovanna Breu, “Injection of Hope,” People, October 28, 1996, http://people.com/archive/injection-of-hope-vol-46-no-18/.
33. Jerry Adler, Susan Katz, Elisa Williams, and Vicki Quade, “Learning from the Loss,” Newsweek, March 24, 1986, 66.
34. B. Stray-Pedersen and S. Stray-Pedersen, “Etiologic Factors and Subsequent Reproductive Performance in 195 Couples with a Prior History of Habitual Abortion,” American Journal of Obstetrics & Gynecology 148, no. 2 (January 15, 1984):140–46. See also Jon Cohen, Coming to Term, 175–77.
35. H. S. Liddell, N. S. Pattison, and A. Zanderigo, “Recurrent Miscarriage—Outcome After Supportive Care in Early Pregnancy,” Australian and New Zealand Journal of Obstetrics and Gynaecology 31, no. 4 (November 1991): 320–22.
36. C. Ober, T. Karrison, R. Odem, et al., “Mononuclear-cell immunisation in prevention of recurrent miscarriages: a randomised trial,” The Lancet 354, no. 9176 (July 31, 1999): 365–69.
37. Department of Health and Human Services, Public Health Service, Food and Drug Administration, “Lymphocyte Immune Therapy (LIT) Letter,” January 30, 2002, https://wayback.archive-it.org/7993/20170406072912/https://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/ucm105848.htm.
38. A. Moffett, L. Regan, and P. Braude, “Natural Killer Cells, Miscarriage, and Infertility,” BMJ 329, no. 7,477 (November 27, 2004): 1283–85.
39. L. F. Wong, T. Porter, and J. R. Scott, “Immunotherapy for Recurrent Miscarriage,” Cochrane Database of Systematic Reviews, no. 10 (2014): article ID CD000112.
40. Geoffrey Sher, “IVIG & Intralipid Therapy in IVF: Interpreting Natural Killer Cell Activity for Diagnosis and Treatment,” Doctors Blog, Sher Fertility, https://haveababy.com/fertility-information/ivf-authority/ivig-intralipid-therapy-in-ivf-natural-killer-cell-activity-for-diagnosis-and-treatment. In the interest of full disclosure, my daughter, Alexandra, was conceived under the care of Dr. Batzofin at Sher Fertility, although without immunology treatment.
41. Braverman IVF & Reproductive Immunology, “IVIG Treatment for Miscarriages” accessed December 11, 2017, http://www.preventmiscarriage.com/intravenous-immunoglobulin-ivig-.html.
42. Alan E. Beer, Julia Kantecki, and Jane Reed, Is Your Body Baby Friendly?: “Unexplained” Infertility, Miscarriage & IVF Failure (Leesburg, VA: AJR Publishing, 2006), 4.
43. A. J. Wilcox, C. R. Weinberg, J. F. O’Connor, et al., “Incidence of Early Loss of Pregnancy,” New England Journal of Medicine 319, no. 4 (July 28, 1988) 189–94; R. M. Lee and R. M. Silver, “Recurrent Pregnancy Loss: Summary and Clinical Recommendations,” Seminars in Reproductive Medicine 18, no. 4 (2000): 433–40. See also “Getting Pregnant—Pregnancy After Miscarriage: What You Need to Know,” Mayo Clinic, http://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/pregnancy-after-miscarriage/art-20044134; “After a Miscarriage: Getting Pregnant Again,” American Pregnancy Association, http://americanpregnancy.org/pregnancy-loss/after-miscarriage-getting-pregnant-again/.
1. E. Scott Sills, ed., Handbook of Gestational Surrogacy: International Clinical Practice and Policy Issues (Cambridge, UK: Cambridge University Press, 2016), 1.
2. W. H. Utian, L. A. Sheean, J. M. Goldfarb, and R. Kiwi, “Successful Pregnancy After In Vitro Fertilization and Embryo Transfer from an Infertile Woman to a Surrogate,” New England Journal of Medicine 313, no. 21 (November 21, 1985):1351–52.
3. For a detailed exploration of laws in different countries, see Sills, Handbook.
4. The Surrogacy Experience, “U.S. Surrogacy Laws by State,” http://www.thesurrogacyexperience.com/u-s-surrogacy-law-by-state.html.
5. Alexandra Sifferlin, “Battle Over Paid Surrogacy Opens New Front,” Time, January 28, 2015, http://time.com/3666606/battle-over-paid-surrogacy-opens-new-front/; Anemona Hartocollis, “And Surrogacy Makes 3: In New York, a Push for Compensated Surrogacy,” New York Times, February 19, 2014, https://www.nytimes.com/2014/02/20/fashion/In-New-York-Some-Couples-Push-for-Legalization-of-Compensated-Surrogacy.html?_r=0.
6. Quoted in A. S. Persky, “Reproductive Technology and the Law,” Washington Lawyer, July/August 2012, https://www.dcbar.org/bar-resources/publications/washington-lawyer/articles/july-august-2012-reproductive-tech.cfm.
7. Ibid.
1. Jacqueline Mroz, “One Sperm Donor, 150 Offspring,” New York Times, September 5, 2011, http://www.nytimes.com/2011/09/06/health/06donor.html?_r=0. For an excellent discussion of this and other aspects of sperm donation, see Jacqueline Mroz, Scattered Seeds: In Search of Family and Identity in the Sperm Donor Generation (Berkeley, CA: Seal Press, 2017).
2. Mroz, “One Sperm Donor.”
3. Mroz, Scattered Seeds, 177.
4. A. Tanaka, M. Nagayoshi, I, Tanaka, et al., “Controversy Over Rights of Children Born from Oocyte Donations, Is Full Disclosure of Donor’s Identity Necessary?,” Fertility and Sterility 104, no. 3 (September 2015): e231
5. Kristen Riggan, “Regulation (or Lack Thereof) of Assisted Reproductive Technologies in the U.S. and Abroad,” Center for Bioethics & Human Dignity, March 4, 2011, https://cbhd.org/content/regulation-or-lack-thereof-assisted-reproductive-technologies-us-and-abroad. See also Mroz, Scattered Seeds, 164.
6. D. A. Greenfeld and S. C. Klock, “Disclosure Decisions among Known and Anonymous Oocyte Donation Recipients,” Fertility and Sterility 81, no. 6 (June 2004): 1565–71.
7. Dr. Joan Manheimer, interview with the author, April 1, 2016.
8. Nancy Hass, “To Tell, or Not to Tell, Your Egg Donor Baby?” Elle, August 20, 2015, http://www.elle.com/life-love/sex-relationships/news/a29904/whose-life-is-it-anyway/.
9. Quoted in Hass, “To Tell.”
10. Wendy Kramer, “The Ethical Sperm Bank: An All-Open Sperm Bank. An Idea Whose Time Has Come,” The Blog, Huffington Post, July 22, 2015, updated July 22, 2016, https://www.huffingtonpost.com/wendy-kramer/the-ethical-sperm-bank-an_b_7841180.html.
11. Donor Sibling Registry statistics, as of October 13, 2017, found at https://donorsiblingregistry.com.
12. Mroz, “One Sperm Donor.” See also Mroz, Scattered Seeds, chapter 8.
13. Wendy Kramer, “A Brief History of Donor Conception,” The Huffington Post, May 10, 2016, https://www.huffingtonpost.com/wendy-kramer/a-brief-history-of-donor-conception_b_9814184.html; Mroz, Scattered Seeds, 79–85.
14. Mroz, Scattered Seeds, 77–78, 89–103.
15. At the Sperm Bank of California, which tracks its donor-conceived births, 60 percent of the children are born to lesbian parents and 20 percent to single mothers. Mroz, Scattered Seeds, 109.
16. Tamar Lewin, “Sperm Banks Accused of Losing Samples and Lying About Donors,” New York Times, July 21, 2016, https://www.nytimes.com/2016/07/22/us/sperm-banks-accused-of-losing-samples-and-lying-about-donors.html?_r=0.
17. Ibid.
18. Ibid.
19. Theresa Boyle, “U.S. Sperm Bank Admits It Doesn’t Verify Donor Information,” The Star, April 9, 2015, https://www.thestar.com/life/health_wellness/2015/04/09/us-sperm-bank-sued-by-canadian-couple-says-it-didnt-verify-donor-information.html.
20. Mroz, Scattered Seeds, 176–77.
21. “Success Stories,” Donor Sibling Registry, https://donorsiblingregistry.com/success-stories.
22. Mroz, Scattered Seeds, 56–63.
23. Hass, “To Tell.”
1. Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas, and West Virginia. See “Coverage by State,” Resolve: The National Infertility Association, accessed December 11, 2017, http://resolve.org/what-are-my-options/insurance-coverage/coverage-state/.
2. Arkansas, Hawaii, Maryland, and Texas. Ibid.
3. The Fertility Clinic Success Rate and Certification Act of 1992 (FCSRCA, or Public Law 102-493) requires that clinics performing ART annually provide data for all procedures performed to the CDC. The CDC is required to use these data to report and publish clinic-specific success rates and certification of embryo laboratories.
4. US Department of Health and Human Services Centers for Disease Control and Prevention, 2006 Assisted Reproductive Technology Success Rates: National Summary and Fertility Clinic Reports (Atlanta: CDC, 2008).
5. See Riggan, “Regulation (or Lack Thereof).”
6. PBS Frontline interview with Dr. Mark Sauer, accessed December 11, 2017, http://www.pbs.org/wgbh/pages/frontline/shows/fertility/interviews/sauer.html.
7. See J. Johnston, M. K. Gusmano, and P. Patrizio, “Preterm Births, Multiples, and Fertility Treatment: Recommendations for Changes to Policy and Clinical Practices,” Fertility and Sterility 102, no. 1 (July 2014): 36–39.
8. Ibid, 36.
9. Ibid, 38.
10. Sumathi Reddy, “Fertility Study Warns of Risks from Multiple Births,” Wall Street Journal, April 28, 2014, https://www.wsj.com/articles/fertility-study-warns-of-risks-from-1398726124; Bernice Yeung and Jonathan Jones, “When Pregnancy Dreams Become IVF Nightmares,” Reveal: from the Center for Investigative Reporting, https://www.revealnews.org/article/when-pregnancy-dreams-become-ivf-nightmares/.
11. Quoted in Yeung and Jones, “Pregnancy Dreams.”
12. The Ethics Committee of the American Society for Reproductive Medicine, “Financial Compensation of Oocyte Donors,” Fertility and Sterility 88, no. 1 (August 2007): 305.
13. US Department of Health and Human Services Centers for Disease Control and Prevention, 2013 Assisted Reproductive Technology National Summary Report (Atlanta: CDC, 2015).
14. Defendants’ Motion to Dismiss Plaintiff’s First Amended Class Action Complaint, Kamakahi v. Am. Soc’y for Reprod. Med., 305 F.R.D. 164 (N.D. Cal. 2015) (No. 11–cv–01781–JCS), 2011.
15. Quoted in Lewin, “Sperm Banks Accused.”
16. Tamar Lewin, “Egg Donors Challenge Pay Rates, Saying They Shortchange Women,” New York Times, October 16, 2015, https://www.nytimes.com/2015/10/17/us/egg-donors-challenge-pay-rates-saying-they-shortchange-women.html.
17. Lindsay Kamakahi, Justine Levy, Chelsea Kimmel, and Kristin Wells.
18. Class Action Complaint, Kamakahi v. Am. Soc’y for Reprod. Med., 305 F.R.D. 164 (N.D. Cal. 2015) (No. 11–cv–01781–JCS), 2011.
19. The settlement also provides for payment to plaintiffs’ lawyers in the amount of $1.5 million, and compensation to each of the four named plaintiffs in the amount of $5,000. See Jacob Gershman, “Fertility Industry Group Settles Lawsuit Over Egg Donor Price Caps,” Wall Street Journal, February 3, 2016, https://blogs.wsj.com/law/2016/02/03/fertility-industry-group-settles-lawsuit-over-egg-donor-price-caps/; Melissa LaFreniere, “Egg Donors Get Price Cap Removed in Class Action Lawsuit Settlement,” Top Class Actions, February 2, 2016, https://topclassactions.com/lawsuit-settlements/lawsuit-news/327105-egg-donors-get-price-cap-removed-in-class-action-lawsuit-settlement/. The current ASRM guidelines can be found at http://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/ethics-committee-opinions/financial_compensation_of_oocyte_donors-pdfmembers.pdf.
20. Quoted in Lewin, “Egg Donors Challenge.”
21. R. H. Reindollar, M. M. Regan, P. J. Neumann, et al., “A Randomized Clinical Trial to Evaluate Optimal Treatment for Unexplained Infertility: The Fast Track and Standard Treatment (FASTT) Trial,” Fertility and Sterility 94, no. 3 (August 2010): 888–99.
22. American Cancer Society, “What Are the Risk Factors for Ovarian Cancer?,” accessed December 17, 2017, https://www.cancer.org/cancer/ovarian-cancer/causes-risks-prevention/risk-factors.html; F. Tomao, G. Lo Russo, G. P. Spinelli, et al., “Fertility Drugs, Reproductive Strategies and Ovarian Cancer Risk,” Journal of Ovarian Research, no. 7 (2014): 51.
23. Quoted in Michael Ollove, “Lightly Regulated In Vitro Fertilization Yields Thousands of Babies Annually,” Washington Post, April 13, 2015, https://www.washingtonpost.com/national/health-science/lightly-regulated-in-vitro-fertilization-yields-thousands-of-babies-annually/2015/04/13/f1f3fa36-d8a2-11e4-8103-fa84725dbf9d_story.html?utm_term=.026bd065d982. Debra Mathews of the Johns Hopkins Berman Institute of Bioethics agrees that “assisted reproduction has grown up as a medical services business, not under the auspices of medical research.”
24. For a discussion of early attempts to cure infertility, see Spar, Baby Business, 17–24.
25. Paul Ramsey, Fabricated Man: The Ethics of Genetic Control (New Haven, CT: Yale University Press, 1970), 138.
26. Quoted in Ollove, “Lightly Regulated.”
27. “Obama Overturns Bush Policy on Stem Cell,” CNN News, March 9, 2009, http://www.cnn.com/2009/POLITICS/03/09/obama.stem.cells/; H. Wolinsky, “The Pendulum Swung. President Barack Obama Removes Restrictions on Stem-Cell Research, but Are Expectations Now Too High?” EMBO Reports 10, no. 5 (May 2009): 436–39.
28. Megan Kearl, “Dickey-Wicker Amendment, 1996,” The Embryo Project Encyclopedia, https://embryo.asu.edu/pages/dickey-wicker-amendment-1996.
29. E. R. Myers, D. C. McCrory, A. A. Mills, et al., “Effectiveness of Assisted Reproductive Technology (ART),” Evidence Report/Technology Assessment, no. 167 (May 2008):1–195.
30. See chapter 14, notes 17–19.
1. Marketdata Enterprises, “U.S. Fertility Clinics & Infertility Services: An Industry Analysis,” October 2013, https://www.marketdataenterprises.com/wp-content/uploads/2014/01/Infertility%20Services%20Mkt%202013%20TOC.pdf.
2. See Rene Letourneau, “Global Infertility Drugs, Devices Market to Approach $4.8B in 2017,” Healthcare Finance, October 3, 2012; Cat Zakrzewski, “VCs See Opportunity in Growing Fertility Market,” Wall Street Journal, February 7, 2017, https://www.wsj.com/articles/vcs-see-opportunity-in-growing-fertility-market-1486470601.
3. According to the ASRM. See http://www.reproductivefacts.org/faqs/frequently-asked-questions-about-infertility/q06-is-in-vitro-fertilization-expensive/.
4. According to FertilityIQ. See https://www.fertilityiq.com/cost.
5. Ibid.
6. Ibid.
7. P. Katz, J. Showstack, J. Smith, et al., “Costs of Infertility Treatment: Results from an 18-Month Prospective Cohort Study,” Fertility and Sterility 95, no. 3 (March 1, 2011): 915–21.
8. See chapter 11, note 1.
9. Katz et al., “Costs of Infertility Treatment.”
10. Fertility lenders such as CapexMD offer loans through participating fertility clinics.
11. See FertilityIQ, “Paying for IVF with a Loan or Credit Card,” accessed December 11, 2017, https://www.fertilityiq.com/cost/paying-for-ivf-with-a-loan-or-credit-card.
12. Attain IVF, “Multi-Cycle Programs Overview,” accessed December 11, 2017, http://attainivf.attainfertility.com/attain-ivf-flex-plan-overview. Attain IVF offers its Muti-Cycle Programs exclusively through clinics and physicians within the nationwide network of IntegraMed Fertility.
13. ARC Fertility, “The ARC Success Program,” accessed December 11, 2017, https://www.arcfertility.com/arc-treatment-packages/the-arc-success-program/. ARC Fertility operates through a nationwide network of doctors and clinics, offering referrals, treatment packages—such as the ARC Success Program and ARC Cycle Plus Programs—and financing options, through ARC Fertility Financing.
14. See FertilityIQ, “IVF Refund and Package Programs,” accessed December 11, 2017, https://www.fertilityiq.com/cost/ivf-refund-and-package-programs.
15. Ibid.
16. Dean Kirby, “Couples to Get ‘Money Back Guarantee’ on IVF treatment,” Manchester Evening News (UK), July 31, 2014, http://www.manchestereveningnews.co.uk/news/greater-manchester-news/money-back-failed-ivf-fertility-7545779.
17. See Access Fertility homepage, www.accessfertility.co.uk.
18. Ginia Bellafonte, “Baby-Making by Lottery,” New York Times, April 27, 2017, https://www.nytimes.com/2017/04/27/nyregion/zhang-fertility-center-lottery.html.
19. Frontline interview with Sauer.
20. Quoted in “The Fertility Race: The Fertility Industry—Business Is Prospering,” American RadioWorks, American Public Media, accessed December 11, 2017, http://americanradioworks.publicradio.org/features/fertility_race/part3/section1.shtml.
21. Quoted in Spar, Baby Business, 46.
22. Ibid, 50.
23. See Fred Decker, “The Salaries of Fertility Doctors,” Houston Chronicle, accessed December 11, 2017, http://work.chron.com/salaries-fertility-doctors-3463.html.
24. Frontline interview with Sauer.
25. Fertility Authority, “IVF Success Rates May Be Misleading,” accessed December 11, 2017, https://www.fertilityauthority.com/articles/ivf-success-rates-may-be-misleading; V. A. Kushnir, A. Vidali, D. H. Barad, and N. Gleicher, “The Status of Public Reporting of Clinical Outcomes in Assisted Reproductive Technology,” Fertility and Sterility 100, no. 3 (September 2013): 736–41.
26. CDC, 2013 Assisted Reproductive Technology, 5.
27. “IVF Success Rates May be Misleading.”
28. Press Association, “Fertility Treatments ‘Threaten Our Humanity,’ Warns Robert Winston,” The Guardian, May 5, 2014, https://www.theguardian.com/science/2014/may/05/fertility-treatments-threaten-humanity-winston. Lord Winston was formerly president of the British Association for the Advancement of Science.
29. F. Bissonette, S. J. Phillips, J. Gunby, et al., “Working to Eliminate Multiple Pregnancies: A Success Story in Québec,” Reproductive BioMedicine Online 23, no. 4 (October 2011): 500–4.
30. This view is supported by a paper that came out of a March of Dimes–supported research project that involved a comprehensive review of medical, policy, and ethics literature and a workshop with leading clinicians, professional association leaders, patient advocates, and insurance industry representatives. See Johnston et al., “Preterm Births.”
31. Survey by Mercer Health and Benefits LLC, “Employer Experience with, and Attitudes Toward, Coverage of Infertility Treatment,” May 31, 2006, http://familybuilding.resolve.org/site/DocServer/Mercer_-_Resolve_Final_report.pdf?docID=4361.
32. See Johnston et al., “Preterm Births,” 37.
33. E. G. Hughes and D. Dejean “Cross-border Fertility Services in North America: A Survey of Canadian and American Providers,” Fertility and Sterility 94, no. 1 (June 2010): e16–19.
34. See Maria Finoshina, “Fertility Tourists Eye Russia,” RT News, December 13, 2010, https://www.rt.com/news/fertility-tourists-eye-russia/; Tom Parfitt, “Why Infertility Treatment Is Booming in Ukraine,” The Guardian, May 22, 2009, https://www.theguardian.com/world/2009/may/22/infertility-treatment-ukraine; www.fertilityclinicsabroad.com; www.fertility.treatmentabroad.com.
35. Business Wire, “Russia In Vitro Fertilization—Opportunity Analysis and Industry Forecast, 2014–2022—Research and Markets,” August 24, 2017, http://www.businesswire.com/news/home/20170824005481/en/Russia-Vitro-Fertilization—-Opportunity-Analysis-Industry.
36. At the Fertility Institutes, a group of clinics in Los Angeles, New York, and Mexico, nearly 90 percent of their patients come for family balancing. Sumathi Reddy, “Fertility Clinics Let You Select Your Baby’s Sex,” Wall Street Journal, Aug 17, 2015, https://www.wsj.com/articles/fertility-clinics-let-you-select-your-babys-sex-1439833091.
37. For further background on Enid’s story, see Persky, “Reproductive Technology,” 1–2.
1. Analysis of 15,033 embryos biopsied showed 47.3 percent to be normal (euploid), 39 percent to be abnormal (aneuploid), and 13.7 percent to be mosaic, with nearly 5 percent of the mosaics showing low levels of mosaicism and therefore treated as normal, and just under 9 percent showing high levels of abnormality (Reddy, “Fertility Clinics”). A further analysis of data from Reprogenetics and Genesis Genetics through March 2016 regarding 33,236 embryos showed a range of mosaic embryos from 11 percent to 22 percent depending on age group, and a range of aneuploidy embryos from 16 percent to 42 percent.
2. Munné, “Appraisal of PGS Outcome-Data” presentation.
3. Ibid.
4. Santiago Munné, “Aneuploidy in Embryos: Variability Between Centers, Between Patients, and Between Cycles of the Same Patients,” presentation at CoGen First World Congress on Controversies in Preconception, Preimplantation, and Prenatal Genetic Diagnosis: How Will Genetics Drive the Future?,” September 25–27, 2015, http://www.ivf-worldwide.com/cogen/oep/pgd-pgs/aneuploidy-in-embryos-variability-between-centers,-between-patients-and-between-cycles-of-the-same-patients.html.
5. S. I. Nagaoka, T. J. Hassold, and P. A. Hunt, “Human Aneuploidy: Mechanisms and New Insights into an Age-Old Problem,” Nature Reviews Genetics 13, no. 7 (June 18, 2012): 493–504; E. Fragouli, S. Alfarawati, N. N. Goodall, et al., “The Cytogenetics of Polar Bodies: Insights into Female Meiosis and the Diagnosis of Aneuploidy,” Molecular Human Reproduction 17, no. 5 (May 2011): 286–95.
6. A. H. Handyside, M. Montag, M. C. Magli, et al., “Multiple Meiotic Errors Caused by Predivision of Chromatids in Women of Advanced Maternal Age Undergoing In Vitro Fertilisation,” European Journal of Human Genetics 20, no. 7 (July 2012): 742–47; A. S. Gabriel, et al., “Array Comparative Genomic Hybridisation on First Polar Bodies Suggests That Non-disjunction Is Not the Predominant Mechanism Leading to Aneuploidy in Humans,” Journal of Medical Genetics 48, no. 7 (July 2011): 433–37; R. R. Angell, “Predivision in Human Oocytes at Meiosis I: A Mechanism for Trisomy Formation in Man,” Human Genetics 86, no. 4 (February 1991):383–87; J. M. Fisher, J. F. Harvey, N. E. Morton, and P. A. Jacobs, “Trisomy 18: Studies of the Parent and Cell Division of Origin and the Effect of Aberrant Recombination on Nondisjunction,” American Journal of Human Genetics 56, no. 3 (March 1995): 669–75; M. Bugge, A. Collins, M. Petersen, et al., “Non-Disjunction of Chromosome 18,” Human Molecular Genetics 7, no. 4 (April 1, 1998): 661–69; A. Kuliev and Y. Verlinsky, “Meiotic and Mitotic Nondisjunction: Lessons from Preimplantation Genetic Diagnosis,” Human Reproduction Update 10, no. 5 (September-October 2004): 401–7.
7. Nagaoka et al., “Human Aneuploidy.” Errors can also occur during subsequent stages of mitosis, when a single cell divides into two identical daughter cells.
8. P. A. Hunt and T. J. Hassold, “Human Female Meiosis: What Makes a Good Egg Go Bad?,” Trends in Genetics 24, no. 2 (February 2008): 86–93.
9. R. M. Winston and K. Hardy, “Are We Ignoring Potential Dangers of In Vitro Fertilization and Related Treatments?” Nature Cell Biology 4, supplement (October 2002): S14–18 and Nature Medicine 8, supplement (October 2002): S14–18.
10. Ibid.
11. E. B. Baart, E. Martini, M. J. Eijkemans, et al., “Milder Ovarian Stimulation for In-vitro Fertilization Reduces Aneuploidy in the Human Preimplantation Embryo: A Randomized Controlled Trial,” Human Reproduction 22, no. 4 (April 2007): 980–88.
12. C. Rubio, A. Mercader, P. Alamá, et al., “Prospective Cohort Study in High Responder Oocyte Donors Using Two Hormonal Stimulation Protocols: Impact on Embryo Aneuploidy and Development,” Human Reproduction 25, no. 9 (September 2010): 2290–97.
13. F. Ubaldi, L. Rienzi, E. Baroni, S. Ferrero, et al., “Hopes and Facts About Mild Ovarian Stimulation,” Reproductive BioMedicine Online 14, no. 6 (June 2007): 675–81.
14. G. N. Allahbadia, “Stimulation and Aneuploidy: Why Are Milder Stimulation Protocols Better?,” IVF Lite 3, no. 2 (October 14, 2016): 41–5.
15. Keiichi Kato, “Natural-Cycle IVF: 10-Year Experience,” presentation at 2016 ART World Congress, October 13, 2016.
16. V. V. Grabar and A. V. Stefanovich, “Aneuploidies in Oocytes Used in IVF Programs,” Georgian Medical News, no. 237 (December 2014): 7–12.
17. Cited in Nicholas Kristof, “Contaminating Our Bodies with Everyday Products,” New York Times, November 28, 2015, https://www.nytimes.com/2015/11/29/opinion/sunday/contaminating-our-bodies-with-everyday-products.html.
18. For a detailed discussion of folate, the B vitamins and CoQ10, see Rebecca Fett, It Starts with the Egg (New York: Franklin Fox, 2016), 101–12.
19. I. M. Ebish, C. M. Thomas, W. H. Peters, et al., “The importance of Folate, Zinc and Antioxidants in the Pathogenesis and Prevention of Subfertility,” Human Reproduction Update 12, no. 2 (March–April): 163–74.
20. See, for example, A. J. Gaskins, S. L. Mumford, J. E. Chavarro, et al., “The Impact of Dietary Folate Intake on Reproductive Function in Premenopausal Women: A Prospective Cohort Study,” K. A. O’Connor, ed. PLoS ONE 7, no. 9 (2012): e46276; I. Dudás, M. Rockenbauer, and A. E. Czeizel, “The Effect of Preconceptional Multivitamin Supplementation on the Menstrual Cycle,” Archives of Gynecology and Obstetrics 256, no. 3 (1995): 115.
21. J. C. Boxmeer, R. M. Brounds, J. Lindemans, et al., “Preconception Folic Acid Treatment Affects the Microenvironment of the Maturing Oocyte in Humans,” Fertility and Sterility 89, no. 6 (June 2008):1766–70.
22. A. Turi, S. R. Giannubilo, F. Brugè, et al., “Coenzyme Q10 Content in Follicular Fluid and Its Relationship with Oocyte Fertilization and Embryo Grading,” Archives of Gynecology and Obstetrics 285, no. 4 (April 2012): 1173–76.
23. J. Van Blerkom, “Mitochondrial Function in the Human Oocyte and Embryo and Their Role in Developmental Competence,” Mitochondrion 11, no. 5 (September 2011): 797–813.
24. Y. Bentov, N. Esfandiari, E. Burstein, and R. F. Casper, “The Use of Mitochondrial Nutrients to Improve the Outcome of Infertility Treatment in Older Patients,” Fertility and Sterility 93, no. 1 (January 2010): 272–75; A. Ben-Meir, E. Burstein, A. Borrego-Alvarez, et al., “Coenzyme Q10 Restores Oocyte Mitochondrial Function and Fertility During Reproductive Aging,” Aging Cell 14, no. 5 (October 2015): 887–95.
25. M. Susiarjo, T. J. Hassold, E. Freeman, and P. A. Hunt, “Bisphenol A Exposure In Utero Disrupts Early Oogenesis in the Mouse,” PLoS Genetics 3, no. 1 (January 2007): e5; P. Allard and M. P. Colaiácovo, “Bisphenol A Impairs the Double-Strand Break Repair Machinery in the Germline and Causes Chromosome Abnormalities,” Proceedings of the National Academy of Sciences 107, no. 47 (November 23, 2010): 20405–10; J. Peretz, R. K. Gupta, J. Singh, et al., “Bisphenol A Impairs Follicle Growth, Inhibits Steroidogenesis, and Downregulates Rate-Limiting Enzymes in the Estradiol Biosynthesis Pathway,” Toxicological Sciences 119, no. 1 (January 2011): 209–17.
26. V. Y. Fujimoto, D. Kim, F. S. vom Saal, et al., “Serum Unconjugated Bisphenol A Concentrations in Women May Adversely Influence Oocyte Quality During In Vitro Fertilization,” Fertility and Sterility, 95, no. 5 (April 2011): 1816–19.
27. S. R. Ehrlich, P. L. Williams, S. A. Missmer, et al., “Urinary Bisphenol A Concentrations and Implantation Failure among Women Undergoing In Vitro Fertilization,” Fertility and Sterility 92, no. 3, supplement (September 2009): S136.
28. M. S. Bloom, D. Kim, F. S. Vom Saal, et al., “Bisphenol A Exposure Reduces the Estradiol Response to Gonadotropin Stimulation During In Vitro Fertilization,” Fertility and Sterility 96, no. 3 (September 2011): 672–77.e2; E. Mok-Lin, S. Ehrlich, P. L. Williams, et al., “Urinary Bisphenol A Concentrations and Ovarian Response Among Women Undergoing IVF,” International Journal of Andrology 33, no. 2 (April 2010): 385–93.
29. R. B. Lathi, C. A. Liebert, K. F. Brookfield, et al., “Conjugated Bisphenol A in Maternal Serum in Relation to Miscarriage Risk,” Fertility and Sterility 102, no. 1 (July 2014):123–28.
30. M. Sugiura-Ogasawara, Y. Ozaki, S. Sonta, et al., “Exposure to Bisphenol A Is Associated with Recurrent Miscarriage,” Human Reproduction 20, no. 8 (August 2005): 2325–29.
31. Nagaoka et al., “Human Aneuploidy,” 502.
32. Roger Highfield, “IVF Success Rate Is Too Low, Says Lord Winston,” The Telegraph, June 9, 2008, http://www.telegraph.co.uk/news/science/science-news/3343919/IVF-success-rate-is-too-low-says-Lord-Winston.html.
33. Bart C. J. M. Fauser, “Relevance of embryo competence for successful IVF, and role of GCSF,” presentation at the 24th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI), Amsterdam, November 11, 2016.
34. M. A. Santos, E. W. Kuijk, and N. S. Macklon, “The Impact of Ovarian Stimulation for IVF on the Developing Embryo,” Reproduction 139, no. 1 (January 2010): 23–34.
35. Jacques Cohen, “MRT and PGD As a First-Line Treatment for Mitochondrial Disorders,” presentation at the 24th World Congress on Controversies in Obstetrics, Gynecology & Infertility (COGI), November 12, 2016.
36. M. F. Verberg, M. J. Eijkemans, N. S. Macklon, et al., “The Clinical Significance of the Retrieval of a Low Number of Oocytes Following Mild Ovarian Stimulation for IVF: A Meta-analysis,” Human Reproduction Update 15, no. 1 (January-February 2009): 5–12.
37. Rubio et al., “Prospective Cohort Study.”
38. Grabar and Stefanovich, “Aneuploidies in Oocytes Used.”
39. G. N. Allahbadia, “Have We Finally Written the Obituary for Conventional IVF?,” IVF Lite 1, no. 1 (2014): 1–5.
40. J. J. Zhang, Z. Merhi, M. Yang, et al., “Minimal Stimulation IVF versus Conventional IVF: A Randomized Controlled Trial,” American Journal of Obstetrics & Gynecology 214, no. 1 (January 2016): 96.e1–8.
41. Kato, “Natural-Cycle IVF” presentation.
42. Dr. Bernstein served as a lead investigator in these studies, using humanlike models of midlife female mice. She performed initial studies with Professor Duane Kraemer and colleagues at Texas A&M University, then with University of Maryland School of Medicine professors Istvan Merchenthaler and Charles Chaffin, and research assistant Amelia Mackenzie. See L. R. Bernstein, A. C. Mackenzie, S. J. Lee, et al., “Activin Decoy Receptor ActRIIB:Fc Lowers FSH and Therapeutically Restores Oocyte Yield, Prevents Oocyte Chromosome Misalignments and Spindle Aberrations, and Increases Fertility in Midlife Female SAMP8 Mice,” Endocrinology 157, no. 3 (March 2016): 1234–47.
43. Pregmama, “About,” http://www.datlof.com/2Pregmama/about.cfm.
44. Lori R. Bernstein, “Hormone Normalization Therapy Comprising Administration of Aromatase Inhibitor, Follicle Stimulating Hormone, Luteinizing Hormone, Human Chorionic Gonadotropin, Gonadotropin Hormone Releasing Hormone and/or Progesterone,” US Patent application No. US9,056,072 B2, filed June 16, 2015.
1. Fertility Authority, “New York Infertility Insurance Mandate,” accessed December 11, 2017, https://www.fertilityauthority.com/costs/insurance-coverage/new-york-infertility-insurance-mandate. New York Consolidated Laws, Insurance, Sections 3221 and 4303.
2. See Infertility Resources, “Pharmacies,” http://www.ihr.com/infertility/provider/pharmacy.html, for a list of domestic and international pharmacies.
3. What to Expect, “Fertility Treatments—Jobs with Infertility Coverage,” accessed December 11, 2017, http://www.whattoexpect.com/forums/fertility-treatments/topic/jobs-with-infertility-coverage-51.html.
4. Laura Lorenzetti, “These 11 Companies Offer 100% Healthcare Coverage,” Fortune, March 11, 2015, http://fortune.com/2015/03/11/companies-offer-all-healthcare-coverage/.
5. FertilityIQ, “The FertilityIQ Family Builder Workplace Index: 2017–2018,” accessed December 10, 2017, https://www.fertilityiq.com/fertilityiq-data-and-notes/fertilityiq-best-companies-to-work-for-family-builder-workplace-index-2017-2018.
6. Shelby Livingston, “Fertility Treatment Costs Scare Off Employers,” Business Insurance, January 17, 2016, http://www.businessinsurance.com/article/20160117/NEWS03/160119856/fertility-treatment-costs-scare-off-employers-but-those-who-offer.
7. Anna Medaris Miller, “Should You Travel Abroad for IVF?,” U.S. News & World Report, December 15, 2015; Fertility Treatment Abroad, “IVF Prices: What Is the Cost of Fertility Treatment Abroad?,” accessed December 11, 2017, http://fertility.treatmentabroad.com/costs. See also www.patientsbeyondborders.com.
8. Robert Winston, “Robert Winston: ‘I Do Have a Very Dark Side,’ ” The Telegraph, August 15, 2008, http://www.telegraph.co.uk/news/features/3637695/Robert-WinstonI-do-have-a-very-dark-side.html.
9. FertilityIQ, “About us,” accessed March 1, 2018, https://www.fertilityiq.com/who-we-are.
10. FertilityIQ, “FertilityIQ Data & Notes,” accessed December 11, 2017, https://www.fertilityiq.com/fertilityiq-data-and-notes.
11. Tamar Lewin, “Industry’s Growth Leads to Leftover Embryos, and Painful Choices,” New York Times, June 17, 2015, https://www.nytimes.com/2015/06/18/us/embryos-egg-donors-difficult-issues.html?_r=0.
12. Nick Loeb, “Sofía Vergara’s Ex-Fiancé: Our Frozen Embryos Have a Right to Live,” New York Times, April 29, 2015, https://www.nytimes.com/2015/04/30/opinion/sofiavergaras-ex-fiance-our-frozen-embryos-have-a-right-to-live.html.
13. Reber v. Reiss, 42 A.3d 1131 (Pa. Super. Ct. 2012); Angie Leventis Lourgos, “Judge Gives Embryos to Woman Over Objection from Ex-boyfriend,” Chicago Tribune, May 16, 2014, http://www.chicagotribune.com/news/local/breaking/chi-judge-gives-embryos-to-woman-over-objection-from-exboyfriend-20140516-story.html.
14. The eight states that permit embryonic stem cell research as of 2016 are California, Connecticut, Illinois, Iowa, Maryland, Massachusetts, New Jersey, and New York. States that restrict or ban it include Florida, Indiana, Kentucky, North Dakota, Ohio, Oklahoma, and South Dakota. For a complete list, see National Conference of State Legislatures, “Embryonic and Fetal Research Laws,” January 1, 2016, http://www.ncsl.org/research/health/embryonic-and-fetal-research-laws.aspx.
15. Andrew Vorzimer, “Get Pregnant with Built-On Spec Embryos or Get Your Money Back!,” The Spin Doctor, http://www.eggdonor.com/blog/2012/11/20/pregnant-built-spec-embryos-money/.
16. Lewin, “Industry’s Growth.”
17. Stein, “New York Fertility Doctor.”
18. Charlotte Pritchard, “The Girl with Three Biological Parents,” BBC News Magazine, September 1, 2014, http://www.bbc.com/news/magazine-28986843.
19. Conor Gaffey, “Three-Person Baby Born in Ukraine After Doctors Use Novel Technique,” Newsweek, January 18, 2017, http://www.newsweek.com/three-person-baby-born-ukraine-after-doctors-use-novel-technique-543878.
20. The CRISPR-Cas9 is a two-part molecular scissors comprising a DNA-cutting protein called Cas9 and a short piece of RNA that guides the protein to a gene that scientists want to snip.
21. T. H. Saey, “New Era of Human Embryo Gene Editing Begins,” Science News 190, no. 9 (October 29, 2016): 15. See also E. Callaway, “Gene-editing Research in Human Embryos Gains Momentum,” Nature 532, no. 7,599 (April 21, 2016): 289–90.
22. Myers et al., “Effectiveness of Assisted Reproductive Technology (ART).”
23. Eliza Barclay, “Scientists Successfully Used CRISPR to Fix a Mutation That Causes Disease. This Is Huge,” Vox, August 2, 2017, https://www.vox.com/science-and-health/2017/8/2/16083300/crispr-heart-disease.