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Long ago, if you struggled to conceive a child, you either pursued adoption or just remained childless. But advances in reproductive technology over the past 200 years have allowed parents-to-be more options.
Netflix's newest documentary, Our Father, raises a lot of ethical questions about fertility treatments and how they work. The film follows Indiana fertility specialist Dr. Donald Cline, who inseminated unwitting patients with his own semen instead of donor semen. Years later, nearly 100 of Cline's biological children begin to find each other through DNA tests like 23 and Me and online databases, confused by the sudden realization that they were all related to the doctor who helped their mothers get pregnant.
These people had a lot of questions about how this whole thing was even able to happen in the first place. And while the "secret insemination" thing is pretty disturbing, it's not an altogether new concept in the world of assisted reproduction.
But let's go back to where it all started and take a look at what this technology is, how it has changed over the years, and how it's stayed the same:
What is assisted reproductive technology?
Assisted reproductive technology (ART) is an umbrella term that’s used to describe treatments and procedures that try to achieve a pregnancy, per the National Institutes of Health (NIH). And around the globe, roughly 148 million people struggle with infertility, the World Health Organization reports.
Let's start with the basics. While there are multiple ways to address infertility and get pregnant, there are three main methods of ART:
Intrauterine insemination (IUI). This method is the one used in Our Father, and requires semen to be inserted into the uterus to try to fertilize the egg. In the doc, it's revealed that Cline uses his own semen instead of the donor semen into his patients. Usually, this method involves the use of a small catheter to inject semen into the uterus.
In vitro fertilization (IVF). During an IVF procedure, the eggs and sperm are incubated together in a lab to create an embryo. The viable, healthy embryos can then be implanted in the uterus where they will (hopefully) result in a pregnancy.
Third-party-assisted ART. This includes several options, like sperm donation, egg donation, using a surrogate or gestational carrier, and embryo donation.
How long have fertility treatments been around?
For a long time, actually. But the early years of ART are pretty horrific.
Some of the first experiments were performed by Dr. J. Marion Sims, who is still credited as the father of modern gynecology despite his gruesome and brutal practices. Sims experimented on enslaved African American women in Montgomery, Alabama, around 1855, trying to see if he could artificially inseminate them, per PBS. Specifically, Sims inseminated dozens of infertile enslaved women to try to get them pregnant. His experiments produced only one viable pregnancy that ended in miscarriage.
In 1884, the first recorded case of artificial insemination was overseen by Philadelphia doctor William Pancoast, who once again violated his patient by injecting sperm from a medical student into her while she was under anesthesia, per PBS. The woman, who had been struggling with infertility and had been undergoing surgery to "fix" that issue, gave birth to a baby boy nine months later. The twist? Pancoast never told the woman that he had inseminated her with another man's sperm during the procedure, and he only told her husband years later.
In 1934, Harvard scientist Gregory Pincus conducted IVF experiments on rabbits. He was vilified and wasn’t granted tenure.
About three decades later, in 1969, Dr. Robert Edwards pioneered the in vitro fertilization technique and went on to win the Nobel Prize for his work in 2010. By 1978, Louise Joy Brown—the world’s first IVF baby—was born. Many, many more followed.
What is the difference between artificial insemination (IUI) and in vitro fertilization?
IUI involves injecting semen into the uterus in an attempt to fertilize the egg. IVF is a little more complicated. It involves harvesting eggs after many rounds of hormone treatments, fertilizing the eggs in a lab, letting them grow for a certain number of days (often five), and either implanting them in the uterus or freezing them for future implantation.
How has reproductive assistance technology and processes changed since the 1800s?
While IVF is still relatively new on the scene and has undergone significant changes over the years, the mechanics of IUI has not changed much from its early days. Overall, the process itself has become more mainstream. And these days, it's done with people’s consent.
Only recently has egg freezing through IVF become more popular. Between 2009 and 2017, the number of people freezing their eggs grew by a factor of 23, per The Guardian. A new flash-freezing technique called vitrification adopted by fertility practices in the late 2000s is to thank for this, The New York Times reported.
The whole process has also become more affordable. In a 1994 story by the Times, the average cost of a "test tube baby" was $72,000 (with inflation, that would be roughly $139,600 in 2022). Yet, by 2019, one round of IVF was reported to cost between $12,000 and $25,000 depending on medications and add-ons. While it can still be prohibitively expensive, more and more insurance companies are covering fertility treatments these days.
Additionally, the overall process of harvesting eggs, fertilizing them, and implanting them for IVF has seen much better outcomes thanks to new medications that help generate more follicles for harvesting. Doctors have also had better success growing healthy embryos in the lab thanks to the uniformity of the commercially produced substances the cells grow in, according to a Missouri medical journal article from 2017.
What are the origins of sperm donation?
Some of the first reports of sperm donation date back to Pancoast’s experiment back in the 1880s. (Remember the doc who used his medical student's sperm without the woman's consent?) The practice grew in popularity during the Baby Boom after World War II, although parents usually kept it a secret, according to The New Atlantis.
Estimates show that up to 10,000 children were born from sperm donations in 1979. Now, that number is up to 60,000, largely as a result of family planning efforts by gay couples and single mothers, per The Atlantic. And during the pandemic, The New York Times reported that there was a, um, sperm shortage in the $4 billion sperm banking industry, with some banks even stating they'd had record-breaking sales.
These days, most sperm banks have their own rules surrounding the identification of the donor, since there aren't any national legal precedents set up to deal with the issue, per The Atlantic. Some are stricter about anonymity than others.
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