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The rising use of human reproductive technology and its

impact on women in the workforce
Tia Bentivegna

California Polytechnic State University, San Luis Obispo

English 148-03

Walters

May 9, 2018
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Introduction
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In this report, I will be studying the history of human reproductive technologies and examining
how their rising popularity in today’s society is contributing to a more
diverse workforce. The three methods of human reproductive
technology I will be analyzing for the purposes of this study are
artificial insemination (AI), in vitro fertilization (IVF) and egg
freezing, with a focus on IVF and egg freezing. Human reproductive
technology is not a novel discovery; moreover, its popularity and
universality is unique to the past ten years. The use of methods like
IVF and AI has accelerated over the past decade, with 1.6 percent of
all United States births—roughly 73,000 newborns—resulting from in
vitro fertilization or artificial insemination in 2015 alone. The United
States is not in the lead in popularizing this technology, however, as 5
percent of all Japanese births and an even greater 10 percent of all
Danish births were the product of reproductive technology also in 2015
(Cha).

The history and development behind AI is actually rooted in animals. Some of the first applications
of this technology were on dogs, rabbits, horses and poultry. Reproductive biologist Walter Heape
employed AI in animals and subsequently studied the correlation between seasonality and
reproduction. Heape’s work cultivated the growth of reproductive studies and allowed Cambridge
to become the “world centre” for such learning. The study and practice of AI on animals led to its
application on humans and the establishment of practices like gamete cryopreservation (cooling and
storing cells, tissues or organs at low temperatures to maintain their viability), ovarian stimulation
and cycle regulation, embryo (and egg) freezing and cloning. The utilization of frozen donor
samples and sperm washing made way for the growth of IVF and represent landmark achievements
in the inception and growth of human artificial insemination (Ombelet).

Now July 25, 1978 marks the date on which the world’s first baby to be conceived through
unnatural measures was born. Entering the world at a mere five pounds, 12 ounces, Louise Joy
Brown was conceived via in vitro fertilization at Oldham and District General Hospital in
Manchester, England. Parents Lesley and Peter Brown elected to engage in IVF treatment—
experimental at the time—following years of infertility as a result of blocked fallopian tubes. The
doctors performed a transvaginal oocyte retrieval (TVOR), otherwise known as oocyte retrieval
(OCR), in removing a mature egg from one of Lesley’s ovaries and fertilizing it in a laboratory
dish with Peter’s sperm. This process creates the embryo that is then transferred, or implanted, into
Lesley’s uterus several days later. After Louise’s successful birth, the Brown’s conceived a second
child years later also with the assistance of IVF. The Brown’s surrendered themselves to a host of
hurtful headlines and outsider attacks. Questions of ethics and legality arose for some; nonetheless,
the question that stood for many was whether or not the “test tube” babies would be capable of
naturally conceiving their own children. This question was happily answered in 1999 when their
second child, Natalie, conceived by natural means. In 2006, Louise too conceived and gave birth to
her son Cameron John Mullinder (Staff).

Each of these approaches to fertility assist in allowing women to fulfill their dreams of starting a
family on their time, not on biology’s time. And while more women are fulfilling the
requirements to serve in top-tier positions, are their dreams of starting a family being replaced?
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Are there only two routes for women upon receiving their college degree: career or family? In the
past, the answer was often yes. If the woman chose to pursue her career, her options regarding a
family—and even a husband—became limited. If the woman elected to start a family, she
invariably sacrificed her career aspirations for familial obligations. This is changing. Today’s
society is unveiling a new culture around the working woman, and a key component in this
narrative is human reproductive technology.

Methodology
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Materials
To collect primary research, a reputable source, Dr. Richard Schmidt, was interviewed. Schmidt
earned his undergraduate degree in engineering and biochemistry at Cal Poly, San Luis Obispo and
his medical degree at the Baylor College of Medicine located in Houston, Texas. He is one of two
practitioners at Nova IVF, a Bay Area fertility clinic.

To gather secondary research, the databases made available to Cal Poly students were examined for
pertinent information pertaining to the hypothesis and research question. SIRS Issues Researcher, a
database portal published by ProQuest that offers current, credible material on everything from social
issues and government policy to science and technology and arts and humanities, was used to research
and locate the initial question and subsequent information. After sufficient knowledge of the essence of
AI, IVF and egg freezing was gathered, the extensive, in-depth research into each form of reproductive
technology was performed. The four secondary sources used for research and analysis were two
peer-reviewed journals from The New England Journal of Medicine, a study from the Egyptian Journal of
Medical Human Genetics and an article published in the United States National Library of Medicine.

Subjects
As noted above, the interviewee was Dr. Richard Schmidt, a physician and one of two practitioners
at Nova IVF.

Step-by-Step Research Methods

The first step was interviewing Dr. Richard Schmidt. His practice focuses on IVF but also provides
services in egg freezing and artificial insemination; therefore, eight questions were proposed
inquiring about the history of IVF, how it has changed in the last two decades, how it is changing
the workforce, the use of egg freezing as well as the prevalence of artificial insemination. In
addition to interviewing a professional, online research was employed in comparing the responses of
the interviewee with the information yielded in that analysis.

Limitations of Methodology
The primary research was conducted in the form of an interview over the phone. The interviewee is
a professional in the field of fertility, and the questions asked of him were designed to acquire
information regarding the history of assisted fertility treatments, the growth of such treatments as
well as the advantages and disadvantages. The limitation that arises from conducting only one
interview is providing only one account of how fertility treatments have changed and the benefits
and drawbacks of such procedures. In other words, Schmidt could provide viewpoints varying from
those of other doctors in other areas; Schmidt is not representative of the entire population of
fertility doctors. Nevertheless, his responses are qualified, fact-based and backed by his years of
experience in fertility.
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The secondary research was conducted by reading a myriad of journals, articles and studies that provided
information on the background and growth of fertility treatments. As they are continually expanding,
there was a sufficient amount of information available, and there were no limitations to this methodology
of research.

Results
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Primary Research
The interviewee provided a great deal of information on all three forms of reproductive technology,
especially with regards to the growth of the procedures and the effect of this growth on the
workforce. Schmidt further defined the differences between in vitro fertilization and artificial
insemination. While both have advanced in the last two decades, one reigns supreme in its abilities
to yield a pregnancy: IVF. In vitro fertilization does not rely on the sperm to fertilize the egg and
create the embryo; rather, the fertilization occurs externally in a petri dish. Artificial insemination
takes the washed, concentrated sperm and
places it in the upper part of the uterus.
Provided that one of the three primary
reasons for infertility is a problem with the
male having a low sperm count or low
ability to swim (low motility), IVF serves as
a clear solution. Artificial insemination may
prove faulty in that the sperm is still
burdened with the need to swim through the
cervix to fertilize an egg in the woman’s
uterus. Schmidt reported that approximately
40 percent of the causes of infertility is due
to the male factor (male infertility or low
motility); 30 percent is due to the transport
factor (issues with the fallopian tubes); and
the last 30 percent is due to the egg factor
(the egg does not get released, is released at
a suboptimal level or is aged). In addition to this finding, the last five-to-ten years alone have
marked incredible accomplishments in the practice of fertility. Clinics have begun using genetic
testing of the embryo prior to implantation, otherwise known as genetic sequencing of the
chromosomes. According to Schmidt, this sequencing enables the doctor to take a biopsy from the
embryo on the fifth day of its development and remove four-to-six cells. The cells are then analyzed
for the chromosomal makeup. This procedure, in essence, allows one to locate the embryo with the
higher chance of creating a baby. Many of the embryos created are often deemed aneuploid,
meaning the embryo has an extra chromosome or two or is missing one or two chromosomes; these
embryos are not likely to cause a pregnancy and could quite possibly result in a miscarriage
following implantation. Alongside genetic testing, the techniques employed in freezing embryos
and eggs have changed “dramatically” in the last decade. The initial method—“slow freeze”—
removed water from the embryo, lowered the embryo in temperature and plunged it into liquid
nitrogen. Ill-fated, this method of freezing was coupled with a loss of over 50 percent of the
embryos. In stark contrast, today’s method of vitrification involves the dehydration of the embryo.
All of the water is rapidly removed in seven disparate solutions, and the embryo is flash froze into
the liquid nitrogen. Not only is this process more efficient, but it is yielding significant
improvements in the survival of embryos at a rate of 99 percent. Schmidt noted that the major
improvements in egg and embryo freezing are part and parcel in the advancement of women in the
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workforce. Much of this is due to multiple Bay Area companies now providing fertility benefits
connected to egg and embryo freezing, empowering women to take control of their career and their
capability of starting a family (Schmidt).

Literature Review
The interview with Dr. Schmidt provided a wealth of knowledge on several aspects of IVF.
Supplementing this interview and the information received, the results of the secondary research
were equally extensive. The first source researched was a peer-reviewed journal on the evolving
practice of frozen embryo transfer in comparison to its counterpart, fresh embryo transfer. The
journal analyzed a study contrasting the advantages and disadvantages of each form of embryo
transfer in the process of in vitro fertilization. The study was conducted on women with the
fertility-inhibiting polycystic ovarian syndrome (PCOS), a hormonal disorder causing enlarged
ovaries surrounded by small cysts on the edges.
Dr. Christos Coutifaris, M.D., Ph.D. reports that
women receiving frozen embryo transfer
(transfer after three days of freezing) had
success rates of 49.3 percent, in comparison to
women receiving fresh embryo transfer
(transfer at the three day “cleavage stage”) at
42.0 percent. Likewise, there was a
significantly lower rate of pregnancy loss and
complications in the group of women with
frozen embryos, at 22.0 percent, as to the group
with fresh, cleavage stage embryos, at 32.7
percent.
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Additional information provided in this study was the rate of ovarian hyperstimulation syndrome
(OHSS) amongst the two groups of women. OHSS is a condition in which the ovaries overreact to
the drugs used in IVF in order to stimulate egg growth; the ovaries produce too many egg sacs, or
follicles. While most cases have proven to be mild and not worth fretting over, this side-effect can
be severe and coupled with a serious illness or even death. The only instance in which frozen
embryo transfer proved faulty against fresh embryo
transfer was in the rate of preeclampsia—a rare,
possibly fatal pregnancy condition causing high blood
pressure and regularly resulting in complicated
childbirth. The rate of preeclampsia, or toxemia,
among the frozen embryo group was 4.4 percent and
among the fresh embryo group, 1.4 percent.
Nonetheless, this change from a favoring of frozen to
fresh embryo transfers was allegedly insignificant and
should not be a deciding factor in determining which
method of transfer is stronger and safer.

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The added advantages of fresh to frozen embryo transfer are the avoidance of increased financial
costs—frozen embryo transfer raises costs by a factor of five-to-ten—emotional costs—postponing
implantation and (possible) pregnancy by four-to-eight weeks—and physical costs—administration
of hormones, injections and office visits that customarily accompany an IVF procedure with a
frozen transfer (Coutifaris).
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While the aforementioned study presented ample support of frozen—or elective—embryo transfer,
an article written by Dr. Richard S. Legro, M.D. noted that more evidence needs to be collected in
determining which method prevails. Legro was adamant in advising researchers to follow the
process of IVF for each form of transfer from the initial
implantation to birth (or lack thereof). Countless studies
continue to omit the results of patients with poor oocyte
(immature, unfertilized egg) or embryo growth and
development. This omittance results in inconclusive,
skewed results in favor of one of the transfer methodologies
(Legro).

Furthering the analysis of egg and embryo freezing and

directly relating to one of Dr. Schmidt’s points on egg
freezing, Heidi Mertes examined the ever-evolving trend of
company-sponsored egg freezing, specifically in Silicon
Valley. The author for the Bioethics Institute Ghent at
Ghent University asserted that the overall practice seems
essential to the advancement of women’s reproductive
autonomy; however, Mertes also believed that there are
pros and cons to this practice. The pros were ostensible: relieving women of the pressure to pay for
egg freezing, raising the likelihood of storing higher-quality eggs by targeting the population of
women just entering the workforce and rewriting the intentions of women for egg freezing and for
starting families by giving them the opportunity to pursue their career aspirations first and to let life
happen second. Many of the cons of the study centralized on the issue that company compensation
for egg freezing could sacrifice family-friendly benefits already provided. Companies may offer
egg freezing either to (1) prolong the prospect of pregnant employees or (2) replace the
family-friendly benefits of maternal paid-leave. Mertes’s theory is that if more and more women in
their mid-20s are freezing their eggs, the ones entering their late thirties who begin taking
advantage of their banked eggs will represent a much smaller portion of the company and will fail
to warrant paid-leave and other familial benefits. She holds that the only circumstances in which
company-sponsored egg freezing is beneficial is when women understand the advantages,
disadvantages and limitations of the practice; women know that there is no pressure to take the
offer; and the offer itself has no detrimental effects on other family-friendly policies at work at the
corporation (Mertes).

Up to this point, most of the material gathered in the interview and the secondary research provided
the host of benefits to taking part in either egg freezing or the entire process of in vitro fertilization.
As with anything in life, though, there are risks to this route towards pregnancy and prolonged
families. The New England Journal of Medicine published a study examining the possibilities of
multiple births resulting from assisted reproductive technologies. These multiple gestation
pregnancies were the effects of transferring three or four embryos in an effort to cause a pregnancy
in just one cycle of treatment. The report stated that by 2011, 36 percent of twin births and a larger
77 percent of triplet and higher-order births resulted from fertility treatments; with that, many
clinics ceased transferring three or more embryos during IVF treatments. This proactive measure
assisted in the decline of triplet and higher-order births since 1998, its peak year. Some clinics were
skeptical in making this adjustment, but became more accepting of single embryo transfers as the
simultaneous rise in using 5-day, blastocyst stage embryos proved to be more implantable. The few
clinics that have neglected to take part in the precautionary switch to single embryo transfer
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attribute it to the competition among facilities for per-cycle pregnancy rates. Often, patients will
also elect to transfer more embryos when their finances cannot extend to cover the price of multiple
cycles of fertility. Nonetheless, this report asserted that less common fertility treatments such as
ovulation induction and ovarian stimulation are greater sources of multiple gestation pregnancies
when compared to traditional IVF treatments (Kulkarni).

Discussion
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The driving purpose of this study was to analyze the rising use of fertility treatments and to
examine how it is enabling women to reset their biological clocks. Much of the information
gathered in the primary research was supplemented and supported by that gathered in the secondary
research. Three major conclusions were drawn regarding the advancements in fertility treatments,
the variety of such treatments and the ventures of which each treatment entails.

Coupling the growing popularity of assisted reproductive technologies is the advancements in its
practice and procedures. Schmidt went into detail on the use of genetic testing of the embryo prior to
implantation, enabling doctors to determine which embryos will yield a successful, safe pregnancy
and which ones will likely result in a failed pregnancy and/or flawed chromosomal count. The Bay
Area practitioner also mentioned egg freezing as an expanding practice among many young women.
Three of the secondary sources furthered Schmidt’s responses in analyzing the concepts of embryo
transfer in in vitro fertilization and egg freezing. Both Schmidt and Mertes, the author on the study
regarding company-sponsored egg freezing, took note of corporations’ popularized practice of
providing fertility services to employees. As a partisan figure who benefits from Silicon Valley and
other Bay Area companies’ compensated fertility services, Schmidt spoke strictly of the benefits of
this practice, taking note of women’s empowerment to control their fertility and their familial
aspirations. As a bipartisan character to this study, Mertes unveiled the pros and cons of this
procedure. And though the holistic analysis is appreciated, the advantages reign supreme when
weighed against the disadvantages of financed egg freezing. Mertes listed that the only instance in
which it should be allowed is when women understand all of the benefits, risks and limitations of
the procedure, know that there is no pressure to accept the offer and, again, the offer itself does not
supplant already-existing family-friendly policies in place. In analyzing these assertions, one should
see that a woman graduating college and earning a position at a distinguished company like Google,
Apple or Facebook—several corporations providing this service—is qualified to research everything
egg freezing entails and to question her employers as to the repercussions—if they exist—to
accepting or rejecting the offer as well as the policies in place for her if she were to start a family at
any point in her time at the firm. Women’s presence in the workforce is growing not because
Fortune 500 companies feel they need to combat the inequitable distribution of males and females
serving at their organizations, but because these same companies are now recognizing that women
are as qualified, as capable, as competent as their male counterparts. With these qualifications, these
capabilities, this competence, are they not educated enough to question their employers as to the
details of their complementary egg-freezing package? Mertes’s claim should therefore be rejected
for the faulty foundation on which her assumption lies. In addition to disregarding women’s ability
to evaluate the benefits and costs to taking part in company-sponsored egg freezing, Mertes provides
little-to-no evidence or data that these packages are replacing family-friendly policies like paid
parental leave; likewise, she does not list any companies that have pressured or coerced their female
employees into freezing their eggs in order to prolong the possibilities of having pregnant
employees and, as a result, paid employee leave. It seems as though Mertes harbors a hesitant
attitude towards egg freezing packages without relying on any proof of her assumed faults in their
design.
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Two of the sources centralized on the comparable techniques of embryo transfer in using frozen
versus fresh embryos. One study analyzed by Dr. Christos Coutifaris, M.D., Ph.D. advocated for
the transfer of frozen as opposed to fresh embryos on account of their higher rates of pregnancy
and lower rates of embryo loss and ovarian hyperstimulation syndrome (OHSS). Coutifaris closed
his remarks, however, by noting that each case should be individualized and dependent upon the
patient. A second analysis was provided by Dr. Richard S. Legro in supporting Coutifaris’s closing
words and negating the misconception that frozen embryo transfer yields more benefits than its
counterpart. Legro’s belief was that studies are inconclusive and misinformed when they continue
to omit critical variables like subjects whose oocyte retrievals and embryo transfers prove faulty.

The final source revealed how IVF treatments create an increased risk of multiple birth pregnancy.
The study was retrospective in that it collected data dating back to the 1960s—prior to the inception
of assisted reproductive technologies—and up to the late 1990s to compare the rate of multiple birth
pregnancies conceived naturally and conceived by assisted means. Luckily, it was reported that it is
not IVF treatments that were the primary cause in rising twin, triplet and higher-order pregnancies,
but rather less common assisted fertility treatments like ovulation induction and ovarian stimulation
were more successful in yielding these dangerous, risk-laden pregnancies. Likewise, most fertility
clinics began taking proactive measures in protecting their patients’ safety over their own success
rates by limiting the embryo transfers to one-to-two in opposition to the previously employed
three-to-four embryo transfer.

Recommendations
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Human reproductive technology is a rising phenomenon that enables women to finally “have it
all.” Whether it is artificial insemination, in vitro fertilization or egg freezing, assisted fertility
treatments act as a catalyst for a woman’s career ambitions and family aspirations by allowing
her to secure her future with each. Be it freezing one’s eggs at the
beginning of one’s career or using those frozen eggs to start a
family at the height of one’s career, it is recommended that women
take advantage of the technology of today. The doctors have
reported the advancements, the benefits and drawbacks and the
availability and flexibility of such procedures. The studies have
revealed the success rates, the success stories and the successful
lives in which women are now able to partake on account of
assisted reproductive technology. Because societal norms of
women being mothers in the kitchen coupled with husbands in the
corporate skyscrapers are a fading phenomenon; because it is now
an option to accomplish one’s objectives as a businesswoman and
as a mother, the only question left is,
“Are you ready to have it all?”
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Works Cited

Cha, Ariana Eunchung. “Changing the Face of Families.” SIRS Issues Researcher, ProQuest, 22 Oct.

2017, sks.sirs.com/webapp/article?artno=401454&type=ART.

Coutifaris, Christos. “‘Freeze Only’ - An Evolving Standard in Clinical In Vitro Fertilization | NEJM.”

New England Journal of Medicine, Oxford University Press, 11 Aug. 2016,

www.nejm.org/doi/full/10.1056/NEJMe1606213.

Kulkarni, Aniket D., et al. “Fertility Treatments and Multiple Births in the United States | NEJM.” New

England Journal of Medicine, Oxford University Press, 5 Dec. 2013,

www.nejm.org/doi/full/10.1056/NEJMoa1301467.

Legro, Richard S. “Introduction: Evidence-Based in Vitro Fertilization Treatment of Fresh versus

Frozen Embryo Transfer: Peeling Away the Layers of the Onion.” Egyptian Journal of Medical

Human Genetics, Elsevier, 13 July 2016,

www.sciencedirect.com/science/article/pii/S0015028216613869.

Mertes, Heidi. “Does Company-Sponsored Egg Freezing Promote or Confine Women’s Reproductive

Autonomy?” Advances in Pediatrics., U.S. National Library of Medicine, 24 May 2015,

www.ncbi.nlm.nih.gov/pmc/articles/PMC4554384/.

Ombelet, W., and J. Van Robays. “Artificial Insemination History: Hurdles and Milestones.” Advances

in Pediatrics., U.S. National Library of Medicine, 2015,

www.ncbi.nlm.nih.gov/pmc/articles/PMC4498171/.

Schmidt, Richard. Personal Interview. 29 April 2018.

Staff, History.com. “World's First Test Tube Baby Born.” History.com, A & E Networks, 28 July 2010,

www.ncbi.nlm.nih.gov/pmc/articles/PMC4498171/.
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Appendix
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Interview
Q1: How has IVF changed in the last five-to-ten years? Last fifteen-to-twenty years?
The biggest change in the past five-to-ten years is the start of the use of genetic testing of the embryo. It is
called genetic sequencing of the chromosomes. What we have the ability to do now is to take a biopsy
from the embryo. It’s typically done on day five of embryo development, which we call the embryo at
that point the blastocyst, and we remove four-to-six cells from the embryo, and we can analyze the cells
for the chromosomal makeup. We can basically find the embryo that has the higher chance of creating a
baby because most of the embryos that we do create, even in very young women, are called aneuploid. An
aneuploid embryo is like a down syndrome: it has an extra chromosome or an extra two or missing one or
two or three or more. Those embryos either don’t implant and cause a pregnancy, or they implant and
cause a miscarriage. We’ve started to use that genetic testing not on every patient, but about a third of the
patients will have genetic testing, especially the older patients who have such a high rate of what we call
aneuploide, which is very abnormal (like I said, genetic makeup of the embryo). This can facilitate their
getting pregnant, especially if there are a lot of embryos to choose from, because you can’t just put the
embryo in the uterus and just cross your fingers that you don’t get too many or that you have a good one.
At some point, when you have enough embryos, it may be better to test them to see which one is the best
one to transfer. In addition to that, the technique for freezing embryos and eggs has changed dramatically
in the past five-to-ten years. There was a method called “slow-freeze.” That was a method [in which] the
water would be removed from the embryo, and then over a two-to-four hour time frame, the water would
be taken down in temperature, and then ultimately plunged into liquid nitrogen to freeze. Unfortunately,
this created a lot of problems with thawing, and we lost a lot of embryos in the thawing process—greater
than 50 percent of the embryos. Now we have a technique called vitrification. Vitrification is the
dehydration of the embryo, where we remove all the water, and that’s done rapidly in about seven
different solutions, where we take out all of the water and then we flash freeze it into liquid nitrogen. The
process is much faster, and the success rate is phenomenal. We have a 99 percent survival rate. This has
been wonderful for egg freezing. For women who want to freeze their eggs, the “slow-freeze” uniformly
was a very poor technique for freezing eggs, and we would lose over 70 percent of eggs. Now the eggs
survive extremely well with the vitrification method. How’s it changed over the fifteen-to-twenty years?
Not only the ultrasound equipment, the stimulatory medications, the ability to rapidly monitor hormones
has really changed the way we approach patients. It’s also the knowledge of the window of implantation
for embryos, increasing the chance for pregnancy because we’re transferring the embryos right at the
same time. These are major advances that have happened in the past twenty years. IVF, 30 years ago, was
extremely crude, and the success rate was very low. We were looking at success rates that were in the
single digits when IVF first started, and this is for young women. Now we can take a single embryo, and
if it’s [with] genetic testing, we can have a 60-70 percent success rate with a single embryo transfer. Even
if we don’t do the genetic testing, the success rate for women under the age of 35 for a single embryo
approaches 40-50 percent, and that’s in comparison to that single digit probability that we had 15-20 years
ago. There’s been a huge change in the techniques and the culture media and the cryopreservation—
everything that’s been positive for patients. That’s what we’ve seen in the past 15-20 years.
Q2: What, from your perspective, are the most common reasons for which women use IVF and
assisted reproductive procedures?
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The most common reason is extended infertility. We have patients who will arrive at our clinic with over
two years of trying to conceive. That’s two years of unprotected innercourse and a lack of a pregnancy.
Why is that? Most of the time in the over 35 age group, it’s related to aging eggs, so a greater number of
eggs of what we call aneuploid. For patients under the age of 35, it’s usually because the sperm or the
fallopian tubes don’t function as well as they should. The reason IVF was created back in the ‘70s was for
women who had fallopian tube damage or missing both of their fallopian tubes. That was the advent of
why needed IVF, and the start of who we were treating, but it’s turned into the treatment of all types of
fertility. You can crudely break down fertility into three categories: (1) there’s a fallopian tube problem,
so it’s what we call a transport problem; or (2) there’s a male factor, which is the sperm is either low in
numbers or low in its ability to swim, which is what we call low motility; or (3) it just can’t enter into the
egg because it doesn’t have chemicals in its acrosomal cap. Male infertility accounts for about 40 percent
of the causes in general. The transport of the tube factors 30 percent. The last one is the egg factor, and
that could be a combination of things. It could be that the egg doesn’t get released or ovulation or that the
egg that’s being released is suboptimal, and that’s just aging egg quality. That accounts for 30 percent.
Those are the three main reasons why a couple would seek IVF care. Again, under age 35, it’s more
related to male factor and tubal disease, where over the age of 35, it’s related to the aging of the egg—
that’s the most common reason. There are women who are seeking IVF procedures like women who are
single who want to preserve their fertility, and the ideal age for preserving fertility is between 28 and 34.
There’s very high quality eggs, and that has the greatest potential for creating a baby later on. We do egg
freezing on women over the age of 34 all the time, because they can afford it now, and they’re ready to
still save some eggs. That is a component of the patients that’ll come in. Then again, another component
is the esoteric ones like sexual dysfunction. The husband has erectile dysfunction, but he’s able to
masturbate. These are small percentages of why people would come in. More commonly now, as I
mentioned egg freezing, is becoming much more common because it’s socially acceptable, and it’s
offered by many insurances.
Q3: Do you believe IVF has changed the way women can approach the workforce? In other words,
do you believe it is allowing more women to work longer in their career and know that they will
most likely still be able to start a family later on?
Absolutely. This is huge in the high tech industry and just the Bay Area in general where more and more
companies are providing the fertility benefit, which includes egg freezing. Women are coming into this
knowing they need to up their chances for the family they want to have, and this is absolutely giving
women the upper hand in managing their own fertility choices—not having to be roped into an
unnecessary relationship, not having kids in a situation that is less than ideal. [IVF] is definitely
empowering women to have more reproductive choice.
Q4: What are the biggest benefits to using such procedures?
Using procedures like IVF of course, some couples would be incapable of having their own child. A
benefit is allowing them to have their own genetic child. For some patients, it’s their own child or nothing
at all. We do always offer other options such as adoption. The majority of patients that we see would be
unable to have their own child due to one of those three factors that I mentioned, so it really is allowing
them to have a family they wouldn’t be capable of having. The biggest benefit of egg freezing is you’re
preserving your fertility, and you’re empowering your population.
Q5: What is the typical age range for your patients?
The average age of patients coming into Nova, and in general in the fertility world, is about 37. There are
younger patients who have been trying for many years that come in, and there are older patients who have
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only been trying for three months, but they know that they don’t have much time left. The typical age is
about 37.
Q6: What is the typical demographic for your patients, or is it fairly widespread?
The typical demographic for our patients prior to this being covered by its own insurances, it was usually
the middle-to-upper class because they had the money to afford this very expensive procedure. Since
there’s been more coverage now, even in places like Starbucks, the demographic has changed. We do see
all walks of life, most certainly from the software engineer to the tech executive to somebody working in
the coffeeshop. It’s still a preponderance of couples who are earning a very good income, and they are
definitely mid-to-mid upper class. The racial demographic in the Bay Area is very widespread—many
Indians, many Asians, many Hispanics, many whites. The racial background is varied.
Q7: What are the disadvantages, if any, of using IVF?
Of course, IVF has some small risks. They don’t really have an assignment of that risk, but there is a
small chance that some rare, borderline ovarian tumors can be provoked by the use of fertility drugs. It’s
very, very weak studies that have shown this. There is a concern that that could be a long term problem
for women. That is such a rare thing that we really don’t look at IVF as presenting any long-term
complications for patients. We do know that IVF itself, especially in the subfertile population, there
seems to be a slightly higher risk for birth defects. Now if the overall birth defect rate is 2-4% for
anybody naturally conceiving, we’re talking about 2.1-4.1%, so it’s a very slight number, but there is a
slight increased chance of birth defects with IVF. The biggest disadvantage are multiple pregnancies.
When patients don’t transfer a single embryo, and they transfer more than one, having a multiple
pregnancy is much more complicated than a singleton gestation. It increases the risk for preterm delivery.
It increases the risk for maternal complications like gestational diabetes and high blood pressure of
pregnancy or what we call preeclampsia. These are real; these are real complications of pregnancy. And
so, twins are—or any other combination of multiples—is just not a healthy pregnancy for mom or for
babies. The risk of delivering a child prematurely and having cerebral palsy is about 8-10 times higher
with a twin pregnancy than it is a singleton pregnancy. This is stuff that we just have to be mindful of.
When I talk to my patients, and they want to transfer two embryos, there’s a high chance for pregnancy
and a high chance for twins, I say, “Is it worth it just to increase your chance for pregnancy at the expense
of potentially raising two special needs children?” I am point blank with them, and I just try to explain to
them that this is not a way to go just because you’re desperate in wanting to get pregnant. You have to be
smart about how you get pregnant and raising twins is infinitely more difficult than raising one. Like I
said, if there ends up being problems, and they’re special needs, that’s going to change your life forever.
That’s a disadvantage, the multiple pregnancy.
Q8: What is the difference between artificial insemination and in vitro fertilization?
Artificial insemination is simply taking the sperm, and [the doctors] wash the sperm, concentrate the
sperm, and put the sperm through the cervix and up into the upper part of the uterus. With artificial
insemination, it’s a much less powerful treatment than IVF. Normally, what we say is that it would take
between four and six cycles of artificial insemination to equal what success rate you would get in one IVF
cycle. The artificial insemination still requires fallopian tubes to be perfectly functioning, and it actually
requires the sperm to do the fertilization in the fallopian tube, which for some sperm, can be quite a
difficult feat. In the in vitro fertilization, the fertilization happens in the petri dish, so it’s very easy for the
sperm to fertilize, and a woman doesn’t need her fallopian tubes because we’re taking the eggs out and
mixing the eggs and the sperm together and then putting the embryo into the uterus. Of course the
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difference of that is also the cost. The cost of an intrauterine insemination is somewhere between one
fourth and one sixth the cost of an IVF cycle. It has one fourth to one sixth the success rate.

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www.thedailybeast.com/apple-and-facebook-are-right-to-offer-egg-freezing.

Venugopal, Ramya. “Why the Apple and Facebook Offer to Pay for Egg Freezing May Not Be a Bad

Thing.” YourStory: Indian Startup Stories, YourStory Media, 21 Oct. 2014,

yourstory.com/2014/10/apple-facebook-egg-freeze/.