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New variations on the original technique are multiplying almost as fast as the test-tube population. Already it is possible for Reproductive Endocrinologist Martin Quigley of the Cleveland Clinic to speak of "oldfashioned IVF" (in which a woman's eggs are removed, fertilized with her husband's sperm and then placed in her uterus). "The modern way," he notes, "mixes and matches donors and recipients" (see chart page 49). Thus a woman's egg may be fertilized with a donor's sperm, or a donor's egg may be fertilized with the husband's sperm, or, in yet another scenario, the husband and wife contribute their sperm and egg, but the resulting embryo is carried by a third party who is, in a sense, donating the use of her womb. "The possibilities are limited only by your imagination," observes Clifford Grobstein, professor of biological science and public policy at the University of California, San Diego. Says John Noonan, professor of law at the University of California, Berkeley: "We really are plunging into the Brave New World."
Though the new technologies have raised all sorts of politically explosive ethical questions, the demand for them is rapidly growing. Reason: infertility, which now affects one in six American couples, is on the rise (see box page 50). According to a study by the National Center for Health Statistics, the incidence of infertility among married women aged 20 to 24, normally the most fertile age group, jumped 177% between 1965 and 1982. At the same time, the increasing use of abortion to end unwanted pregnancies and the growing social acceptance of single motherhood have drastically reduced the availability of children for adoption. At Catholic Charities, for instance, couples must now wait seven years for a child. As a result, more and more couples are turning to IVF. Predicts Clifford Stratton, director of an in-vitro lab in Reno: "In five years, there will be a successful IVF clinic in every U.S. city."
It is a long, hard road that leads a couple to the in-vitro fertilization clinic, and the journey has been known to rock the soundest marriages. "If you want to illustrate your story on infertility, take a picture of a couple and tear it in half," says Cleveland Businessman James Popela, 36, speaking from bitter experience. "It is not just the pain and indignity of the medical tests and treatment," observes Betty Orlandino, who counsels infertile couples in Oak Park, Ill. "Infertility rips at the core of the couple's relationship; it affects sexuality, self-image and selfesteem. It stalls careers, devastates savings and damages associations with friends and family."