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'''Fertilisasi ''in vitro''''' atau '''pembuahan ''in vitro''''' ({{lang-en|in vitro fertilisation, IVF}}), atau sering disebut '''bayi tabung''', adalah suatu proses [[pembuahan]] [[sel telur]] oleh [[Spermatozoid|sel sperma]] di luar tubuh sang wanita: ''[[in vitro]]'' ("di dalam gelas kaca"). Proses ini melibatkan pemantauan dan stimulasi proses ovulasi seorang wanita, mengambil suatu [[ovum]] atau sel-sel telur dari [[ovarium]] (indung telur) wanita itu dan membiarkan sperma membuahi sel-sel tersebut di dalam sebuah medium cair di laboratorium. Sel telur yang telah dibuahi ([[zigot]]) dikultur selama 2–6 hari di dalam sebuah medium pertumbuhan dan kemudian dipindahkan ke [[rahim]] wanita yang sama ataupun wanita yang lain, dengan tujuan menciptakan keberhasilan [[kehamilan]].
 
Teknik-teknik IVF dapat digunakan dalam berbagai jenis situasi, dan merupakan salah satu teknik dalam [[teknologi reproduksi dengan bantuan]] untuk penanganan [[infertilitas]]. Teknik-teknik IVF juga digunakan dalam [[surogasi]] kehamilan, yang dalam kasus ini sel telur yang telah dibuahi ditanam di dalam rahim 'titipan' wanita lain sehingga anak yang dilahirkan secara genetik tidak terkait dengan wanita tersebut. Dalam beberapa situasi, sel-sel sperma atau sel-sel telur donasi dapat digunakan. Sejumlah negara melarang atau sebaliknya melakukan regulasi ketersediaan pengerjaan IVF sehingga menimbulkan [[wisata fertilitas]]. Pembatasan atas ketersediaan IVF misalnya karena biaya dan usia untuk menghasilkan suatu kehamilan yang sehat dalam jangka waktu normal. Karena biaya prosedur ini, IVF kebanyakanumumnya diupayakan hanya setelah pilihan lain yang lebih murah telah gagal.
 
Kelahiran seorang "bayi tabung" pertama yang berhasil, yaitu [[Louise Brown]], terjadi pada tahun 1978. Louise Brown dilahirkan sebagai hasil dari siklus alami IVF tanpa stimulasi. [[Robert G. Edwards]] mendapat penghargaan [[Nobel Fisiologi atau Kedokteran]] pada tahun 2010, fisiolog yang terlibat dalam pengembangan proses ini bersama dengan [[Patrick Steptoe]]; Steptoe tidak memenuhi syarat untuk dipertimbangkan karena Penghargaan Nobel tidak diberikan secara anumerta.<ref>{{en}} {{cite news
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| last=Moreton
| date=14 January 2007}}</ref> Dengan [[donasi sel telur]] dan IVF, wanita yang melewati masa reproduktifnya atau telah mengalami [[menopause]] masih dapat hamil. [[Adriana Iliescu]] sempat memegang rekor sebagai wanita tertua yang melahirkan dengan menggunakan IVF dan sel telur dari donasi, ketika ia melahirkan pada tahun 2004 di usianya yang ke-66 tahun, sebelum rekornya terlampaui pada tahun 2006. Setelah menggunakan IVF, dikatakan bahwa banyak pasangan dapat hamil tanpa perawatan kesuburan.<ref>{{en}} {{Cite news|title = After IVF, some couples get pregnant without help|url = http://www.reuters.com/article/2012/05/03/us-after-ivf-pregnant-idUSBRE84212L20120503|newspaper = Reuters|date = 2012-05-03|access-date = 2015-11-05}}</ref> Pada tahun 2012, diperkirakan bahwa lima juta anak telah lahir di seluruh dunia menggunakan IVF dan teknik reproduksi berbantu lainnya.<ref>{{en}} {{Cite journal|last=Adamson|first=G.D.|last2=Tabangin|first2=M.|last3=Macaluso|first3=M.|last4=Mouzon|first4=J. de|title=The number of babies born globally after treatment with the assisted reproductive technologies (ART)|url=http://linkinghub.elsevier.com/retrieve/pii/S0015028213025867|journal=Fertility and Sterility|volume=100|issue=3|doi=10.1016/j.fertnstert.2013.07.1807}}</ref>
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== Penggunaan medis ==
IVF may be used to overcome [[female infertility]] where it is due to problems with the [[fallopian tube]]s, making [[in vivo fertilisation|fertilisation ''in vivo'']] difficult. It can also assist in [[male infertility]], in those cases where there is a defect in [[sperm quality]]; in such situations [[intracytoplasmic sperm injection]] (ICSI) may be used, where a sperm cell is injected directly into the egg cell. This is used when sperm has difficulty penetrating the egg, and in these cases the partner's or a donor's sperm may be used. ICSI is also used when sperm numbers are very low. When indicated, the use of ICSI has been found to increase the success rates of IVF.
 
According to the British [[NICE guidelines]], IVF treatment is appropriate in cases of [[unexplained infertility]] for women that have not conceived after 2 years of regular unprotected sexual intercourse.<ref>[http://guidance.nice.org.uk/CG156 Fertility: assessment and treatment for people with fertility problems]. [[NICE guidelines|NICE clinical guideline]] ;– Issued: February 2013</ref> This rule does not apply to all countries. (See [[infertility]].)
== Proses ==
{{unreferenced section|date=1 Desember 2016}}
Pasangan menikah yang dalam waktu tertentu belum juga mendapatkan keturunan, banyak menjadikan bayi tabung sebagai solusi. Program pembuahan dalam tabung ini memang membawa harapan bagi mereka yang mengalami masalah kesuburan. Namun tidak semua orang paham mengenai bayi tabung dan bagaimana proses bayi tabung tersebut.
 
IVF is also considered suitable in cases where any of its expansions is of interest, that is, a procedure that is usually not necessary for the IVF procedure itself, but would be virtually impossible or technically difficult to perform without concomitantly performing methods of IVF. Such expansions include [[preimplantation genetic diagnosis]] (PGD) to rule out presence of [[genetic disorder]]s, as well as [[egg donation]] or [[surrogacy]] where the woman providing the egg isn't the same who will carry the pregnancy to term. Further details in the [[#Expansions|Expansions]]-section below.
Secara sederhana, bayi tabung diartikan sebagai proses pembuahan sel telur dan sperma di luar tubuh ibu. Dalam bahasa Latin bayi tabung dikenal dengan istilah in vitro vertilization, yang berarti 'pembuahan dalam gelas atau tabung.'
 
=== Tingkat keberhasilan ===
Proses bayi tabung sendiri diawali dengan konsultasi dan seleksi pasien, di mana baik suami dan istri akan diperiksa sampai dengan ada indikasi untuk mengikuti program bayi tabung. Jika memang diindikasikan, baru bisa masuk dan mengikuti program bayi tabung.
IVF success rates are the percentage of all IVF procedures which result in a favourable outcome. Depending on the type of calculation used, this outcome may represent the number of confirmed pregnancies, called the [[pregnancy rate]], or the number of live births, called the [[live birth rate]]. The success rate depends on variable factors such as maternal age, cause of infertility, embryo status, reproductive history and lifestyle factors.
 
Maternal age: Younger candidates of IVF are more likely to get pregnant. Women older than 41 are more likely to get pregnant with a donor egg.<ref name="mayoclinic.org">{{Cite web|title = In vitro fertilization (IVF) Results - Mayo Clinic|url = http://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/basics/results/prc-20018905|website = www.mayoclinic.org|accessdate = 2015-11-05}}</ref>
Proses bayi tabung selanjutnya adalah, melakukan stimulasi atau merangsang indung telur untuk memastikan banyaknya sel telur. Secara alami sel telur memang hanya ada satu, namun dalam program bayi tabung, perlu lebih dari satu sel telur untuk memperoleh embrio.
 
Reproductive history: Women who have been previously pregnant are in many cases more successful with IVF treatments then those who have never been pregnant.<ref name="mayoclinic.org"/>
Proses bayi tabung yang ke tiga adalah, pemantauan pertumbuhan folikel atau cairan berisi sel telur di dalam indung telur melalui ultrasonografi. Pemantauan pertumbuhan folikel ini bertujuan untuk melihat apakah sel telur sudah cukup matang untuk dipanen atau belum. Baru kemudian mematangkan sel telur, dengan cara menyuntikan obat agar siap dipanen.
 
====Live birth rate====
Proses bayi tabung selanjutnya adalah, melakukan pengambilan sel telur untuk kemudian di proses di laboratorium. Pada hari yang sama, akan dilakukan pengambilan sperma suami. Jika tidak ada masalah, pengambilan dilakukan dengan cara bermasturbasi. Namun bila ditemukan kendala, maka akan dilakukan operasi pengambilan sperma melalui buah zakar.
The live birth rate is the percentage of all IVF cycles that lead to a live birth. This rate does not include [[miscarriage]] or [[stillbirth]] and multiple-order births such as twins and triplets are counted as one pregnancy. A 2012 summary compiled by the Society for Reproductive Medicine which reports the average IVF success rates in the United States per age group using non-donor eggs compiled the following data:<ref name="2012 Clinic Summary Report">{{cite web|title=2012 Clinic Summary Report|url=https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=0|work=Society for Reproductive Medicine|accessdate=2014-11-06}}</ref>
 
{| class="wikitable"
Setelah proses di atas selesai, maka langkah selanjutnya adalah melakukan pembuahan atau fertilisasi di dalam media kultur di laboratorium, sehingga menghasilkan embrio. Baru setelah embrio terbentuk, akan dilakukan proses transfer embrio kembali ke dalam rahim agar terjadi kehamilan. Jika ada sisa embrio lebih, maka akan disimpan untuk proses kehamilan berikutnya.
|-
! !! <35 !! 35-37 !! 38-40 !! 41-42 !! >45
|-
| Pregnancy rate|| 46.7 || 37.8 || 29.7 || 19.8 || 8.6
|-
| Live birth rate || 40.7 || 31.3 || 22.2 || 11.8 || 3.9
|}
 
In 2006, Canadian clinics reported a live birth rate of 27%.<ref name=canadians/> Birth rates in younger patients were slightly higher, with a success rate of 35.3% for those 21 and younger, the youngest group evaluated. Success rates for older patients were also lower and decrease with age, with 37-year-olds at 27.4% and no live births for those older than 48, the oldest group evaluated.<ref name=r1>{{cite web|url=http://www.cdc.gov/art/ART2006/section1.htm|archiveurl=https://web.archive.org/web/20090331150713/http://www.cdc.gov/art/ART2006/section1.htm|archivedate=2009-03-31|publisher=[[Centers for Disease Control and Prevention]]|title=2006 Assisted Reproductive Technology (ART) Report: Section 2|accessdate=25 March 2009}}</ref> Some clinics exceeded these rates, but it is impossible to determine if that is due to superior technique or patient selection, because it is possible to artificially increase success rates by refusing to accept the most difficult patients or by steering them into oocyte donation cycles (which are compiled separately). Further, pregnancy rates can be increased by the placement of several embryos at the risk of increasing the chance for multiples.
Baru kemudian proses bayi tabung memasuki fase luteal untuk mempertahankan dinding Rahim dengan memberikan Progesterone. Biasanya dokter akan memberi obat selama 15 hari pertama untuk mempertahankan dinding rahim ibu agar terjadi kehamilan. Proses terakhir adalah melakukan pemeriksaan apakah telah terjadi kehamilan atau belum, baik dengan pemeriksaan darah maupun USG.
 
The live birth rates using donor eggs are also given by the SART and include all age groups using either fresh or thawed eggs.<ref name="2009 Clinic Summary Report">{{cite web|title=2009 Clinic Summary Report|url=https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=0|work=Society for Reproductive Medicine|accessdate=14 July 2011}}</ref>
 
{| class="wikitable"
|-
! !! Fresh donor egg embryos !! Thawed donor egg embryos
|-
| Live birth rate || 55.1 || 33.8
|}
 
Because not each IVF cycle that is started will lead to oocyte retrieval or embryo transfer, reports of live birth rates need to specify the denominator, namely IVF cycles started, IVF retrievals, or embryo transfers. The Society for Assisted Reproductive Technology (SART) summarised 2008-9 success rates for US clinics for fresh embryo cycles that did not involve donor eggs and gave live birth rates by the age of the prospective mother, with a peak at 41.3% per cycle started and 47.3% per embryo transfer for patients under 35 years of age.
 
IVF attempts in multiple cycles result in increased cumulative live birth rates. Depending on the demographic group, one study reported 45% to 53% for three attempts, and 51% to 71% to 80% for six attempts.<ref>[http://www.npr.org/templates/story/story.php?storyId=99654924 Study: Sixth Time May Be Charm For In Vitro] by Patti Neighmond. ''Day to Day'', National Public Radio. 21 January 2009.</ref>
 
====Pregnancy rate====
Pregnancy rate may be defined in various ways. In the United States, the pregnancy rate used by the Society for Assisted Reproductive Technology and the Centers for Disease Control (and appearing in the table in the Success Rates section above) are based on fetal heart motion observed in ultrasound examinations.
 
The 2009 summary compiled by the Society for Reproductive Medicine included the following data for the United States:<ref name="2009 Clinic Summary Report"/>
 
{| class="wikitable"
|-
! !! <35 !! 35-37 !! 38-40 !! 41-42
|-
| Pregnancy rate|| 47.6 || 38.9 || 30.1 || 20.5
|}
 
In 2006, Canadian clinics reported an average pregnancy rate of 35%.<ref name=canadians>Branswell, Helen (15 December 2008) [http://web.archive.org/web/20090318062752/http://www.theglobeandmail.com/servlet/story/RTGAM.20081215.wivf1215/BNStory/National/?page=rss&id=RTGAM.20081215.wivf1215 Success rate climbs for in vitro fertilization]. The Canadian Press.</ref> A French study estimated that 66% of patients starting IVF treatment finally succeed in having a child (40% during the IVF treatment at the centre and 26% after IVF discontinuation). Achievement of having a child after IVF discontinuation was mainly due to [[adoption]] (46%) or [[spontaneous pregnancy]] (42%).<ref>{{cite journal |vauthors=de La Rochebrochard E, Quelen C, Peikrishvili R, Guibert J, Bouyer J | title = Long-term outcome of parenthood project during in vitro fertilization and after discontinuation of unsuccessful in vitro fertilization | journal = Fertil. Steril. | volume = 92 | issue = 1 | pages = 149–56 | year = 2008 | pmid = 18706550 | doi = 10.1016/j.fertnstert.2008.05.067 }}</ref>
 
====Predictors of success====
The main potential factors that influence pregnancy (and live birth) rates in IVF have been suggested to be [[maternal age]], duration of infertility or subfertility, [[basal FSH|bFSH]] and number of oocytes, all reflecting [[Ovary#Function|ovarian function]].<ref>{{cite journal |vauthors=van Loendersloot LL, van Wely M, Limpens J, Bossuyt PM, Repping S, van der Veen F | title = Predictive factors in in vitro fertilization (IVF): a systematic review and meta-analysis | journal = Human Reproduction Update | volume = 16 | issue = 6 | pages = 577–589 | year = 2010 | pmid = 20581128 | doi = 10.1093/humupd/dmq015 }}</ref> Optimal woman’s age is 23–39 years at time of treatment.<ref name=nice/>
 
[[File:Triple-line endometrium.jpg|thumb|A [[triple-line endometrium]] is associated with better IVF outcomes.<ref name="ZhaoZhang2012">{{cite journal|last1=Zhao|first1=Jing|last2=Zhang|first2=Qiong|last3=Li|first3=Yanping|title=The effect of endometrial thickness and pattern measured by ultrasonography on pregnancy outcomes during IVF-ET cycles|journal=Reproductive Biology and Endocrinology|volume=10|issue=1|year=2012|page=100|issn=1477-7827|doi=10.1186/1477-7827-10-100}}</ref>]]
[[Biomarker (medicine)|Biomarkers]] that affect the pregnancy chances of IVF include:
* [[Antral follicle count]], with higher count giving higher success rates.<ref name=Broer2012>{{cite journal |vauthors=Broer SL, van Disseldorp J, Broeze KA, Dolleman M, Opmeer BC, Bossuyt P, Eijkemans MJ, Mol BW, Broekmans FJ | title = Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy: An individual patient data approach | journal = Human Reproduction Update | volume = 19 | issue = 1 | pages = 26–36 | year = 2012 | pmid = 23188168 | pmc = | doi = 10.1093/humupd/dms041 }}</ref>
* [[Anti-Müllerian hormone]] levels, with higher levels indicating higher chances of pregnancy,<ref name=Broer2012/> as well as of live birth after IVF, even after adjusting for age.<ref name="IliodromitiKelsey2014">{{cite journal|last1=Iliodromiti|first1=S.|last2=Kelsey|first2=T. W.|last3=Wu|first3=O.|last4=Anderson|first4=R. A.|last5=Nelson|first5=S. M.|title=The predictive accuracy of anti-Mullerian hormone for live birth after assisted conception: a systematic review and meta-analysis of the literature|journal=Human Reproduction Update|volume=20|issue=4|year=2014|pages=560–570|issn=1355-4786|doi=10.1093/humupd/dmu003|pmid=24532220}}</ref>
* Factors of [[semen quality]] for the sperm provider.
* Level of [[DNA fragmentation]]<ref>{{cite journal |vauthors=Simon L, Brunborg G, Stevenson M, Lutton D, McManus J, Lewis SE | title = Clinical significance of sperm DNA damage in assisted reproduction outcome | journal = Hum Reprod | volume = 25 | issue = 7 | pages = 1594–608 | date = May 2010 | pmid = 20447937 | doi = 10.1093/humrep/deq103 }}</ref> as measured e.g. by [[Comet assay]], [[advanced maternal age]] and [[semen quality]].
* Women with ovary-specific [[FMR1]] genotypes including ''het-norm/low'' have significantly decreased pregnancy chances in IVF.<ref name="Gleicher 2010">{{cite journal |vauthors=Gleicher N, Weghofer A, Lee IH, Barad DH | title = FMR1 Genotype with Autoimmunity-Associated Polycystic Ovary-Like Phenotype and Decreased Pregnancy Chance | journal = PLoS ONE | volume = 5 | issue = 12 | pages = e15303 | year = 2010 | pmid = 21179569 | pmc = 3002956 | doi = 10.1371/journal.pone.0015303 }}</ref>
* Progesterone elevation (PE) on the day of [[final maturation (IVF)|induction of final maturation]] is associated with lower pregnancy rates in IVF cycles in women undergoing ovarian stimulation using GnRH analogues and gonadotrophins.<ref name=Venetis>{{cite journal |vauthors=Venetis CA, Kolibianakis EM, Bosdou JK, Tarlatzis BC | title = Progesterone elevation and probability of pregnancy after IVF: A systematic review and meta-analysis of over 60 000 cycles | journal = Human Reproduction Update | volume = 19 | issue = 5 | pages = 433–457 | year = 2013 | pmid = 23827986 | pmc = | doi = 10.1093/humupd/dmt014 }}</ref> At this time, compared to a progesterone level below 0.8&nbsp;ng/ml, a level between 0.8 and 1.1&nbsp;ng/ml confers an [[odds ratio]] of pregnancy of approximately 0.8, and a level between 1.2 and 3.0&nbsp;ng/ml confers an odds ratio of pregnancy of between 0.6 and 0.7.<ref name=Venetis/> On the other hand, progesterone elevation does not seem to confer a decreased chance of pregnancy in frozen–thawed cycles and cycles with egg donation.<ref name=Venetis/>
* Characteristics of cells from the [[cumulus oophorus]] and the [[membrana granulosa]], which are easily aspirated during [[oocyte retrieval]]. These cells are closely associated with the oocyte and share the same microenvironment, and the rate of expression of certain genes in such cells are associated with higher or lower pregnancy rate.<ref>{{cite journal |vauthors=Fragouli E, Lalioti MD, Wells D | title = The transcriptome of follicular cells: Biological insights and clinical implications for the treatment of infertility | journal = Human Reproduction Update | volume = 20 | issue = 1 | pages = 1–11 | year = 2013 | pmid = 24082041 | pmc = 3845680 | doi = 10.1093/humupd/dmt044 }}</ref>
* An endometrial thickness (EMT) of less than 7&nbsp;mm decreases the pregnancy rate by an [[odds ratio]] of approximately 0.4 compared to an EMT of over 7&nbsp;mm. However, such low thickness rarely occurs, and any routine use of this parameter is regarded as not justified.<ref name="KasiusSmit2014">{{cite journal|last1=Kasius|first1=A.|last2=Smit|first2=J. G.|last3=Torrance|first3=H. L.|last4=Eijkemans|first4=M. J. C.|last5=Mol|first5=B. W.|last6=Opmeer|first6=B. C.|last7=Broekmans|first7=F. J. M.|title=Endometrial thickness and pregnancy rates after IVF: a systematic review and meta-analysis|journal=Human Reproduction Update|volume=20|issue=4|year=2014|pages=530–541|issn=1355-4786|doi=10.1093/humupd/dmu011}}</ref>
 
Other [[Risk factor|determinants]] of outcome of IVF include:
* [[Tobacco smoking]] reduces the chances of IVF producing a live birth by 34% and increases the risk of an IVF pregnancy miscarrying by 30%.<ref name=dh2009>[http://web.archive.org/web/20110103051232/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_101070 Regulated fertility services: a commissioning aid&nbsp;– June 2009]. Department of Health UK. 18 June 2009</ref>
* A [[body mass index]] (BMI) over 27 causes a 33% decrease in likelihood to have a live birth after the first cycle of IVF, compared to those with a BMI between 20 and 27.<ref name=dh2009/> Also, pregnant women who are obese have higher rates of [[miscarriage]], [[gestational diabetes]], [[hypertension]], [[thromboembolism]] and problems during [[childbirth|delivery]], as well as leading to an increased risk of fetal [[congenital abnormality]].<ref name=dh2009/> Ideal body mass index is 19–30.<ref name=nice/>
* [[Salpingectomy]] or [[laparoscopic]] tubal occlusion before IVF treatment increases chances for women with [[hydrosalpinges]]<ref name=nice>[http://www.webcitation.org/5rhjtxNOs Nice.org] {{Cite book|title=Fertility: Assessment and Treatment for People with Fertility Problems |publisher=RCOG Press |location=London |year=2004 |isbn=1-900364-97-2 |oclc= }}</ref><ref name=Farquhar2013/>
* Success with previous pregnancy and/or live birth increases chances<ref name=nice/>
* Low alcohol/caffeine intake increases success rate<ref name=nice/>
* The number of embryos transferred in the treatment cycle.<ref name=ii2011>[http://www.ivf-infertility.com/ivf/standard/factors/couples.php Factors affecting IVF success&nbsp;– February 2011], from IVF-infertility.com</ref>
* [[Embryo quality]]
* Some studies also suggest the [[autoimmune disease]] may also play a role in decreasing IVF success rates by interfering with proper implantation of the embryo after transfer.<ref name="Gleicher 2010"/>
 
Aspirin is sometimes prescribed to women for the purpose of increasing the chances of conception by IVF, but there is insufficient evidence to show that it actually works.<ref name="pmid21833951">{{cite journal |vauthors=Siristatidis CS, Dodd SR, Drakeley AJ | title = Aspirin for in vitro fertilisation | journal = Cochrane Database Syst Rev | volume = | issue = 8 | pages = CD004832 | year = 2011 | pmid = 21833951 | doi = 10.1002/14651858.CD004832.pub3 }}</ref><ref>{{cite journal |vauthors=Groeneveld E, Broeze KA, Lambers MJ, Haapsamo M, Dirckx K, Schoot BC, Salle B, Duvan CI, Schats R, Mol BW, Hompes PG | title = Is aspirin effective in women undergoing in vitro fertilization (IVF)? Results from an individual patient data meta-analysis (IPD MA) | journal = Human Reproduction Update | volume = 17 | issue = 4 | pages = 501–509 | year = 2011 | pmid = 21422062 | pmc = | doi = 10.1093/humupd/dmr007 }}</ref>
 
A 2013 [[systematic review|review]] and [[metaanalysis]] of [[randomised controlled trial]]s of [[acupuncture]] as an [[adjuvant therapy]] in IVF found no overall benefit, and concluded that an apparent benefit detected in a subset of published trials where the control group (those not using acupuncture) experienced a lower than average rate of pregnancy requires further study, due to the possibility of [[publication bias]] and other factors.<ref>{{cite journal |vauthors=Manheimer E, van der Windt D, Cheng K, Stafford K, Liu J, Tierney J, Lao L, Berman BM, Langenberg P, Bouter LM | title = The effects of acupuncture on rates of clinical pregnancy among women undergoing in vitro fertilization: A systematic review and meta-analysis | journal = Human Reproduction Update | volume = 19 | issue = 6 | pages = 696–713 | year = 2013 | pmid = 23814102 | pmc = 3796945 | doi = 10.1093/humupd/dmt026 }}</ref>
 
A [[Cochrane review]] came to the result that endometrial injury performed in the month prior to [[Controlled ovarian hyperstimulation|ovarian hyperstimulation]] appeared to increase both the live birth rate and clinical pregnancy rate in IVF compared with no endometrial injury. However, there was a lack of data reported on the rates of adverse outcomes such as miscarriage, multiple pregnancy, pain and/or bleeding.<ref name=Farquhar2013>{{cite journal |vauthors=Farquhar C, Rishworth JR, Brown J, Nelen WL, Marjoribanks J | title = Assisted reproductive technology: an overview of Cochrane Reviews | journal = Cochrane Database Syst Rev | volume = 8 | issue = | pages = CD010537 | year = 2013 | pmid = 23970457 | doi = 10.1002/14651858.CD010537.pub2 }}</ref>{{Update inline|reason=Updated version https://www.ncbi.nlm.nih.gov/pubmed/25532533|date=June 2016}}
 
For women, intake of [[antioxidant]]s (such as [[N-acetyl-cysteine]], [[melatonin]], [[vitamin A]], [[vitamin C]], [[vitamin E]], [[folic acid]], [[myo-inositol]], [[zinc]] or [[selenium]]) has not been associated with a significantly increased [[live birth rate]] or clinical [[pregnancy rate]] in IVF according to [[Cochrane review]]s.<ref name=Farquhar2013/> On the other hand, oral antioxidants given to the men in couples with male factor or unexplained subfertility resulted in significantly higher live birth rate in IVF.<ref name=Farquhar2013/>
 
A [[Cochrane review]] in 2013 came to the result that there is no evidence identified regarding the effect of pre-conception lifestyle advice on the chance of a live birth outcome.<ref name=Farquhar2013/>
 
== Sejarah ==
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=== Otonomi dan kepemilikan jaringan ===
Bagi mereka yang meyakini bahwa kehidupan manusia dimulai sejak saat pembuahan, keyakinan ini juga mengungkapkan bahwa hak asasi manusia telah diberikan pada saat itu. Apabila hak asasi manusia telah ada dalam tahap embrionik ini, maka terdapat tambahan isu etika yang timbul dari proses manipulasi embrio di dalam ranah kepemilikan [[jaringan]]. Dalam jangka panjang, jika ditanamkan atau diimplantasikan ke dalam seorang wanita dan lahir, embrio tersebut menjadi seorang dewasa dan harus hidup dengan modifikasi genetik yang dipilih baginya melalui proses IVF. Dalam keadaan selulernya, tidak mungkin ia memberikan persetujuan kehendak untuk tindakan manipulasi gen. Hal ini menyebabkan pengambilan keputusan dilakukan oleh orang tuanya. Kepemilikan orang tua, yang dianggap sah, atas embrio hanya dalam jangka waktu singkat dan berarti bahwa mereka memegang kendali atas masa depan biologis sang embrio. Persetujuan kehendak atas kepemilikan jaringan telah menjadi isu selama puluhan tahun dan dapat berdampak hukum. Dalam kasus [[Henrietta Lacks]], para peneliti tidak memiliki persetujuan pasien untuk menggunakan jaringannya dalam penelitian genetik, dan hal ini menyebabkan banyak masalah hukum seputar hak keluarganya untuk mendapatkan keuntungan dari penggunaan sel-selnya.<ref>{{en}} Skloot, Rebecca. (2010). ''The Immortal Life of Henrietta Lacks.'' New York: Crown.</ref> <!--
 
===Profit desire of the industry===
Many people do not oppose the IVF practice itself (i.e. the creating of a pregnancy through "artificial" ways) but are highly critical of the current state of the present day industry. Such individuals argue that the industry has now become a multibillion-dollar industry, which is widely unregulated and prone to serious abuses in the desire of practitioners to obtain profit. For instance, in 2008, a California physician transferred 12 embryos to a woman who gave birth to octuplets (see [[Suleman octuplets]]). This has made international news, and had led to accusations that many doctors are willing to seriously endanger the health and even life of women in order to gain money. Robert Winston, professor of fertility studies at Imperial College London, had called the industry "corrupt" and "greedy" saying that "One of the major problems facing us in healthcare is that IVF has become a massive commercial industry," and that "What has happened, of course, is that money is corrupting this whole technology", and accused authorities of failing to protect couples from exploitation "The regulatory authority has done a consistently bad job. It's not prevented the exploitation of women, it's not put out very good information to couples, it's not limited the number of unscientific treatments people have access to".<ref>{{cite news| url=http://www.guardian.co.uk/science/2007/may/31/medicineandhealth.health | location= London | work = The Guardian | first=Alok | last=Jha | title=Winston: IVF clinics corrupt and greedy | date= 31 May 2007}}</ref> The IVF industry can thus be seen as an example of what social scientists are describing as an increasing trend towards a market-driven construction of health, medicine and the human body.<ref>Dumit, J. (2012) Drugs for Life: How Pharmaceutical Companies Define Our Health. Duke University Press: Durham</ref>
 
As the science progresses, the industry is further driven by money in that researchers and innovators enter into the fight over patents and intellectual property rights. The [[Copyright Clause]] in the US Constitution protects innovator’s rights to their respective work in attempts to promote scientific progress. Essentially, this lawful protection gives incentive to the innovators by providing them a temporary monopoly over their respective work. In the IVF industry, already incredibly expensive for patients, patents risk even higher prices for the patients to receive the procedure as they have to also cover the costs of protected works. For example, company 23andMe has patented a process used to calculate probability of gene inheritance.<ref>DeFrancesco, L. (2014). [http://www.nature.com/nbt/journal/v32/n1/full/nbt0114-8.html 23andMe's designer baby patent.] Nature biotechnology, 32(1), 8-8.</ref> While this innovation could help many, the company retains sole right to administer it and thus does not have economic competition. Lack of economic competition leads to higher prices of products.
 
=== Keuntungan yang diharapkan dari industri ini ===
The industry has been accused of making unscientific claims, and distorting facts relating to infertility, in particular through widely exaggerated claims about how common infertility is in society, in an attempt to get as many couples as possible and as soon as possible to try treatments (rather than trying to conceive naturally for a longer time). This risks removing infertility from its social context and reducing the experience to a simple biological malfunction, which not only ''can'' be treated through bio-medical procedures, but ''should'' be treated by them.<ref>Dietrich, H (1986, May). "IVF: what can we do?" Paper presented to the Liberation or Loss? conference, Canberra.</ref><ref name="pmid11649236">{{cite journal | author = Warren MA | title = IVF and women's interests: an analysis of feminist concerns | journal = Bioethics | volume = 2 | issue = 1 | pages = 37–57 | year = 1988 | pmid = 11649236 | doi = 10.1111/j.1467-8519.1988.tb00034.x }}</ref> Indeed, there are serious concerns about the overuse of treatments, for instance Dr Sami David, a fertility specialist and one of the pioneers of the early days of the IVF treatments, has expressed disappointment over the current state of the industry, and said many procedures are unnecessary; he said: "It's being the first choice of treatment rather than the last choice. When it was first opening up in late 1970s, early 80s, it was meant to be the last resort. Now it's a first resort. I think that's an injustice to women. I also think it can harm women in the long run."<ref>{{cite news| date = 2009-08-12 | url = http://www.cbsnews.com/stories/2009/08/12/earlyshow/health/main5236035.shtml | work=CBS News | title= Is In Vitro Fertilization Being Overused?}}</ref> IVF thus raises ethical issues concerning the abuse of bio-medical facts to ‘sell’ corrective procedures and treatments for conditions that deviate from a constructed ideal of the ‘healthy’ or ‘normal’ body i.e., fertile females and males with reproductive systems capable of co-producing offspring.
Banyak orang yang tidak menentang praktik IVF (yakni menciptakan kehamilan melalui cara "buatan") tetapi sangat kritis terhadap keadaan sekarang industri ini. Mereka berpendapat bahwa industri ini telah menjadi suatu industri yang bernilai miliaran dolar, tanpa regulasi secara luas dan rawan terhadap pelanggaran-pelanggaran serius yang dilakukan para praktisinya untuk memperoleh keuntungan. Sebagai contoh, pada tahun 2008, seorang dokter California memindahkan 12 embrio ke seorang wanita yang kemudian melahirkan bayi kembar delapan (lih. [[Bayi kembar delapan Suleman]]). Kasus ini menjadi berita internasional, dan telah menyebabkan tuduhan bahwa banyak dokter yang rela untuk membahayakan kesehatan dan bahkan kehidupan seorang wanita demi memperoleh uang. [[Robert Winston]], profesor studi fertilitasi di [[Imperial College London]], menyebut industri ini "korup" dan "serakah" dengan mengatakan kalau, "Salah satu masalah utama yang kita hadapi dalam perawatan kesehatan adalah bahwa IVF telah menjadi suatu industri komersial yang besar," dan, "Apa yang telah terjadi, tentu saja, adalah bahwa uang mengorupsi seluruh teknologi ini," dan menuduh pihak berwenang gagal melindungi pasangan-pasangan dari eksploitasi: "Pihak otoritas telah melakukan suatu pekerjaan buruk secara konsisten. [Mereka] tidak mencegah eksploitasi kaum wanita, [mereka] tidak memberikan informasi yang sangat baik kepada pasangan-pasangan, [mereka] tidak membatasi jumlah perlakuan-perlakuan yang tidak ilmiah yang dapat diakses orang-orang."<ref>{{en}} {{cite news| url=http://www.guardian.co.uk/science/2007/may/31/medicineandhealth.health | location= London | work = The Guardian | first=Alok | last=Jha | title=Winston: IVF clinics corrupt and greedy | date= 31 May 2007}}</ref> Industri IVF karenanya dapat dipandang sebagai salah satu contoh dari apa yang dideskripsikan para ilmuwan sosial sebagai suatu tren yang mengalami peningkatan menuju suatu pengembangan kesehatan, ilmu kedokteran, dan tubuh manusia, yang digerakkan oleh pasar.<ref>{{en}} Dumit, J. (2012) Drugs for Life: How Pharmaceutical Companies Define Our Health. Duke University Press: Durham</ref>
 
Seiring dengan perkembangan ilmu pengetahuan, industri ini semakin digerakkan oleh uang karena para peneliti dan inovator masuk ke dalam perebutan hak-hak paten dan hak-hak kekayaan intelektual. [[Klausul Hak Cipta]] dalam Konstitusi AS melindungi hak-hak inovator atas hasil karya mereka masing-masing dalam upaya untuk mempromosikan kemajuan ilmu pengetahuan. Pada dasarnya, perlindungan hukum ini memberikan insentif kepada para inovator dengan menyediakan mereka suatu monopoli sementara atas hasil karya mereka masing-masing. Dalam industri IVF, yang sudah sangat mahal bagi pasien, hak-hak paten berisiko membuat harga-harga yang lebih tinggi bagi pasien untuk mendapatkan prosedur ini karena mereka juga harus menanggung biaya-biaya dari hasil karya yang dilindungi. Sebagai contoh, perusahaan [[23andMe]] telah mematenkan suatu proses yang digunakan untuk mengalkulasi probabilitas warisan gen.<ref>{{en}} DeFrancesco, L. (2014). [http://www.nature.com/nbt/journal/v32/n1/full/nbt0114-8.html 23andMe's designer baby patent.] Nature biotechnology, 32(1), 8-8.</ref> Kendati inovasi ini mungkin membantu banyak orang, perusahaan tersebut tetap memiliki hak tunggal untuk mengelolanya dan dengan demikian tidak ada persaingan ekonomis. Tidak adanya kompetisi ekonomis mengakibatkan harga produk yang lebih tinggi.
===Pregnancy past menopause===
Although menopause is a natural barrier to further conception, IVF has allowed women to be pregnant in their fifties and sixties. Women whose uteruses have been appropriately prepared receive embryos that originated from an egg of an egg donor. Therefore, although these women do not have a genetic link with the child, they have an emotional link through pregnancy and childbirth. In many cases the genetic father of the child is the woman's partner. Even after menopause the uterus is fully capable of carrying out a pregnancy.<ref>{{cite journal | author = Parks JA | title = A closer look at reproductive technology and postmenopausal motherhood | journal = CMAJ | volume = 154 | issue = 8 | pages = 1189–91 | year = 1996 | pmid = 8612255 | pmc = 1487687 }}</ref>
 
Industri ini dituduh membuat klaim-klaim yang tidak ilmiah, dan mendistorsi fakta-fakta seputar infertilitas (ketidaksuburan, kemandulan), khususnya melalui banyak klaim berlebihan mengenai seberapa umum kasus infertilitas di dalam masyarakat, dalam suatu upaya untuk mendapatkan sebanyak mungkin pasangan yang dengan segera mencoba menggunakan IVF (daripada mengupayakan untuk hamil secara alami dalam waktu yang lebih lama). Hal ini berisiko menghapus infertilitas dari konteks sosialnya dan mereduksi pengalaman atas suatu malfungsi biologis sederhana, yang sebenarnya ''dapat'' diobati melalui prosedur-prosedur [[biomedis]] tetapi menjadi ''harus'' menggunakan perawatan dari mereka.<ref>{{en}} Dietrich, H (1986, May). "IVF: what can we do?" Paper presented to the Liberation or Loss? conference, Canberra.</ref><ref name="pmid11649236">{{en}} {{cite journal | author = Warren MA | title = IVF and women's interests: an analysis of feminist concerns | journal = Bioethics | volume = 2 | issue = 1 | pages = 37–57 | year = 1988 | pmid = 11649236 | doi = 10.1111/j.1467-8519.1988.tb00034.x }}</ref> Bagaimanapun, terdapat berbagai kekhawatiran serius mengenai banyaknya penggunaan IVF. Dr Sami David, seorang spesialis fertilitas dan salah seorang pelopor masa awal pengembangan IVF, menyatakan kekecewaan atas keadaan sekarang industri ini, dan mengatakan bahwa banyak prosedur yang tidak diperlukan; ia mengatakan, "[IVF] telah menjadi pilihan pertama perawatan, bukannya pilihan terakhir. Ketika pertama kali diperkenalkan pada akhir tahun 1970-an, awal tahun 1980-an, [IVF] dimaksudkan sebagai upaya terakhir. Sekarang ini menjadi suatu upaya pertama. Saya pikir itu adalah suatu ketidakadilan bagi kaum wanita. Saya juga berpikir bahwa [IVF] dapat membahayakan para wanita dalam jangka panjang."<ref>{{en}} {{cite news| date = 2009-08-12 | url = http://www.cbsnews.com/stories/2009/08/12/earlyshow/health/main5236035.shtml | work=CBS News | title= Is In Vitro Fertilization Being Overused?}}</ref> Karenanya, IVF menimbulkan isu-isu etika sehubungan dengan penyalahgunaan fakta-fakta biomedis untuk 'menjual' prosedur-prosedur korektif seputar kondisi-kondisi berbeda dari suatu kondisi ideal tubuh 'sehat' atau 'normal' yang tercipta dalam perspektif masyarakat, yaitu pria dan wanita subur dengan sistem-sistem reproduksi yang mampu bekerja sama dalam menghasilkan keturunan.
Allowing women to get pregnant past the natural time can factor into issues of overpopulation. Through the PGD, children born through IVF would credibly have higher life expectancy rates due to eliminated diseases. So increasing the amount of women who are able to bear children increases the population growth rate, while PGD in IVF decreases the death rate, resulting in an increasing population.
 
=== Kehamilan pasca menopause ===
===Same-sex couples, single and unmarried parents===
Meskipun [[menopause]] adalah suatu penghalang alami bagi konsepsi pada usia lanjut, IVF telah memungkinkan kaum wanita untuk hamil pada usia 50-an dan 60-an tahun. Kaum wanita yang rahimnya telah dipersiapkan menerima embrio-embrio yang berasal dari suatu sel telur donor. Oleh karena itu, meski para wanita ini tidak memiliki hubungan genetik dengan sang anak, mereka memiliki hubungan emosional melalui kehamilan dan persalinan. Dalam banyak kasus, ayah genetik sang anak adalah pasangan wanita tersebut. Setelah menopause, memang rahim masih mampu menanggung kehamilan.<ref>{{en}} {{cite journal | author = Parks JA | title = A closer look at reproductive technology and postmenopausal motherhood | journal = CMAJ | volume = 154 | issue = 8 | pages = 1189–91 | year = 1996 | pmid = 8612255 | pmc = 1487687 }}</ref>
{{See also|Donor conceived person}}
A 2009 statement from the [[American Society for Reproductive Medicine|ASRM]] found no persuasive evidence that children are harmed or disadvantaged solely by being raised by single parents, unmarried parents, or homosexual parents. It did not support restricting access to assisted reproductive technologies on the basis of a prospective parent's marital status or sexual orientation.<ref name=asrm2009>{{cite journal | author = The Ethics Committee of the American Society for Reproductive Medicine | title = Access to fertility treatment by gays, lesbians, and unmarried persons | journal = Fertil. Steril. | volume = 92 | issue = 4 | pages = 1190–3 | year = 2009 | pmid = 19732884 | doi = 10.1016/j.fertnstert.2009.07.977 }}</ref>
 
Memperbolehkan kaum wanita untuk hamil setelah masa alamiahnya dapat menjadikan masalah overpopulasi. Melalui [[diagnosis genetik praimplantasi]] (PGD), anak-anak yang terlahir melalui IVF diyakini memiliki tingkat harapan hidup yang lebih tinggi karena eliminasi embrio-embrio dengan penyakit-penyakit tertentu. Sehingga IVF dapat menimbulkan peningkatan jumlah wanita yang mampu melahirkan anak mengakibatkan peningkatan laju pertumbuhan penduduk, sementara PGD dalam IVF mengurangi tingkat kematian, mengakibatkan peningkatan populasi.
Ethical concerns include reproductive rights, the welfare of offspring, nondiscrimination against unmarried individuals, homosexual, and professional autonomy.<ref name=asrm2009/>
 
=== Pasangan sesama jenis, orang tua tunggal dan tidak menikah ===
A recent controversy in California focused on the question of whether physicians opposed to same-sex relationships should be required to perform IVF for a lesbian couple. Guadalupe T. Benitez, a lesbian medical assistant from San Diego, sued doctors Christine Brody and Douglas Fenton of the North Coast Women's Care Medical Group after Brody told her that she had "religious-based objections to treating her and homosexuals in general to help them conceive children by artificial insemination," and Fenton refused to authorise a refill of her prescription for the fertility drug Clomid on the same grounds.<ref>{{cite journal | author = Appel JM | title = May doctors refuse infertility treatments to gay patients? | journal = Hastings Cent Rep | volume = 36 | issue = 4 | pages = 20–1 | year = 2006 | pmid = 16898357 | doi = 10.1353/hcr.2006.0053 }}</ref><ref>Dolan, M. (29 May 2008) [http://www.latimes.com/news/local/la-me-doctor29-2008may29,0,592068.story "State high court may give gays another victory"]. ''Los Angeles Times''.</ref> The California Medical Association had initially sided with Brody and Fenton, but the case, [[North Coast Women's Care Medical Group v. Superior Court]], was decided unanimously by the California State Supreme Court in favour of Benitez on 19 August 2008.<ref>Goldstein, Jacob (19 August 2008) [http://blogs.wsj.com/health/2008/08/19/california-doctors-cant-refuse-care-to-gays-on-religious-grounds/ California Doctors Can’t Refuse Care to Gays on Religious Grounds]. Wall Street Journal.</ref><ref name="Bob Egelko 2008">Egelko, Bob (19 August 2008), "Bob Doctors can't use bias to deny gays treatment", ''San Francisco Chronicle''.</ref>
Pada tahun 2009, [[American Society for Reproductive Medicine|ASRM]] menyatakan kalau mereka tidak menemukan bukti persuasif bahwa anak-anak disakiti atau dirugikan hanya karena dibesarkan oleh orang tua tunggal, orang tua yang tidak menikah, atau orang tua homoseksual. Mereka tidak mendukung pembatasan akses pada teknologi reproduksi berbantuan atas dasar orientasi seksual atau status perkawinan calon orang tua.<ref name=asrm2009>{{en}} {{cite journal | author = The Ethics Committee of the American Society for Reproductive Medicine | title = Access to fertility treatment by gays, lesbians, and unmarried persons | journal = Fertil. Steril. | volume = 92 | issue = 4 | pages = 1190–3 | year = 2009 | pmid = 19732884 | doi = 10.1016/j.fertnstert.2009.07.977 }}</ref>
 
Kekhawatiran dari aspek etika meliputi hak-hak reproduksi, kesejahteraan anak, perlakuan non-diskriminatif terhadap individu-individu yang tidak menikah, homoseksual, dan otonomi profesional.<ref name=asrm2009/>
[[Nadya Suleman]] came to international attention after having twelve embryos implanted, eight of which survived, resulting in eight newborns being added to her existing six-child family. The Medical Board of California sought to have fertility doctor Michael Kamrava, who treated Suleman, stripped of his licence. State officials allege that performing Suleman's procedure is evidence of unreasonable judgment, substandard care, and a lack of concern for the eight children she would conceive and the six she was already struggling to raise. On 1 June 2011 the Medical Board issued a ruling that Kamrava's medical licence be revoked effective 1 July 2011.<ref>{{cite news|url=http://www.boston.com/news/nation/articles/2010/10/25/license_hearing_for_octomom_doctor_resumes_in_la/|author=Mohajer, Shaya Tayefe |title=License hearing for Octomom doctor resumes in LA |agency=Associated Press|date=25 October 2010}}</ref><ref>{{cite web|last=Breuer |first=Howard |url=http://www.people.com/people/article/0,,20436389,00.html |title=Octomom's Doctor Tearfully Apologizes, Admits Mistake |work=People |date=22 October 2010 |accessdate=22 May 2012}}</ref>
<ref>{{cite web |url=http://documents.latimes.com/michael-kamrava-disciplinary-decision/ |title=Michael Kamrava’s medical license revoked|date=1 June 2011 |work=Los Angeles Times }}</ref>
 
Suatu kontroversi baru-baru ini di California berfokus pada pertanyaan apakah para dokter yang menentang hubungan sesama jenis diwajibkan untuk melakukan IVF bagi pasangan lesbian. Guadalupe T. Benitez, seorang asisten medis lesbian dari [[San Diego, California|San Diego]], menggugat dokter Christine Brody dan Douglas Fenton dari North Coast Women's Care Medical Group setelah Brody mengatakan kepadanya bahwa ia memiliki "keberatan-keberatan berlandaskan agama untuk menangani dia dan kaum homoseksual pada umumnya untuk membantu mereka mengandung anak melalui inseminasi buatan," dan Fenton menolak untuk mengesahkan pengulangan resepnya untuk obat kesuburan Clomid dengan alasan yang sama.<ref>{{en}} {{cite journal | author = Appel JM | title = May doctors refuse infertility treatments to gay patients? | journal = Hastings Cent Rep | volume = 36 | issue = 4 | pages = 20–1 | year = 2006 | pmid = 16898357 | doi = 10.1353/hcr.2006.0053 }}</ref><ref>{{en}} Dolan, M. (29 May 2008) [http://www.latimes.com/news/local/la-me-doctor29-2008may29,0,592068.story "State high court may give gays another victory"]. ''Los Angeles Times''.</ref> Asosiasi Medis California awalnya memihak Brody dan Fenton, tetapi, pada tanggal 19 Agustus 2008, kasus tersebut diputuskan dengan suara bulat dalam keberpihakan pada Benitez oleh Mahkamah Agung Negara Bagian California.<ref>{{en}} Goldstein, Jacob (19 August 2008) [http://blogs.wsj.com/health/2008/08/19/california-doctors-cant-refuse-care-to-gays-on-religious-grounds/ California Doctors Can’t Refuse Care to Gays on Religious Grounds]. Wall Street Journal.</ref><ref name="Bob Egelko 2008">{{en}} Egelko, Bob (19 August 2008), "Bob Doctors can't use bias to deny gays treatment", ''San Francisco Chronicle''.</ref>
===Anonymous donors===
{{Further information|Donor conceived person}}
Some children conceived by IVF using anonymous [[Gamete donation (disambiguation)|donors]] report being troubled over not knowing about their donor parent as well any genetic relatives they may have and their family history.<ref name="donor conceived NW">{{cite web|title=Donor-Conceived and Out of the Closet|url=http://www.thedailybeast.com/newsweek/2011/02/25/donor-conceived-and-out-of-the-closet.html#|last=Rafferty|first=Alessandra|work=Newsweek|date=25 February 2012}}</ref><ref name="IVF donor NPR">{{cite web|title=‘My Daddy's Name is Donor’|url=http://www.npr.org/templates/story/story.php?storyId=129233185|date=16 August 2010|work=NPR}}</ref>
 
[[Natalie Suleman|Nadya Suleman]] mengundang perhatian internasional setelah melakukan implantasi dua belas embrio, delapan di antaranya bertahan hidup, menyebabkan ia melahirkan delapan bayi baru sebagai tambahan pada keluarganya saat itu yang beranak enam. Dewan Medis California berusaha untuk mencabut lisensi Michael Kamrava, dokter kesuburan yang menangani Suleman. Para pejabat negara bagian menyatakan bahwa prosedur penanganan Suleman adalah bukti adanya penilaian yang tidak beralasan, penanganan di bawah standar, dan kurangnya kepeluan pada delapan anak yang akan ia kandung serta enam anak yang masih ia perjuangkan untuk dibesarkan. Pada tanggal 1 Juni 2011, Dewan Medis tersebut mengeluarkan putusan bahwa lisensi kedokteran Kamrava akan efektif dicabut pada tanggal 1 Juli 2011.<ref>{{en}} {{cite news|url=http://www.boston.com/news/nation/articles/2010/10/25/license_hearing_for_octomom_doctor_resumes_in_la/|author=Mohajer, Shaya Tayefe |title=License hearing for Octomom doctor resumes in LA |agency=Associated Press|date=25 October 2010}}</ref><ref>{{en}} {{cite web|last=Breuer |first=Howard |url=http://www.people.com/people/article/0,,20436389,00.html |title=Octomom's Doctor Tearfully Apologizes, Admits Mistake |work=People |date=22 October 2010 |accessdate=22 May 2012}}</ref><ref>{{en}} {{cite web |url=http://documents.latimes.com/michael-kamrava-disciplinary-decision/ |title=Michael Kamrava’s medical license revoked|date=1 June 2011 |work=Los Angeles Times }}</ref>
Alana Stewart, who was conceived using donor sperm, began an online forum for donor children called AnonymousUS in 2010. The forum welcomes the viewpoints of anyone involved in the IVF process.<ref name="AnonymousUS CT">{{cite web|last=Scheller|first=Christine A.|title=The Untold Story of Donor-Conceived Children|url=http://blog.christianitytoday.com/women/2011/01/the_untold_story_of_spermdonor.html|work=Christianity Today}}</ref> Olivia Pratten, a donor-conceived Canadian, sued the province of British Columbia for access to records on her donor father's identity in 2008.<ref name="BC Canada ruling"/> "I’m not a treatment, I’m a person, and those records belong to me,” Pratten said.<ref name="donor conceived NW"/> In May 2012, a court ruled in Pratten's favour, agreeing that the laws at the time discriminated against donor children and making anonymous sperm and egg donation in British Columbia illegal.<ref name="BC Canada ruling">{{cite journal|last=Motluk|first=Alison|title=Canadian court bans anonymous sperm and egg donation|doi=10.1038/news.2011.329 |journal=Nature|date=27 May 2011}}</ref>
 
=== Donor anonim ===
In the U.K., Sweden, Norway, Germany, Italy, New Zealand, and some Australian states, donors are not paid and cannot be anonymous.
Sejumlah anak yang dikandung melalui IVF dengan menggunakan donor anonim atau tanpa identitas dilaporkan menderita keresahan karena tidak mengetahui orang tua donor mereka serta kerabat genetik dan sejarah keluarga mereka.<ref name="donor conceived NW">{{en}} {{cite web|title=Donor-Conceived and Out of the Closet|url=http://www.thedailybeast.com/newsweek/2011/02/25/donor-conceived-and-out-of-the-closet.html#|last=Rafferty|first=Alessandra|work=Newsweek|date=25 February 2012}}</ref><ref name="IVF donor NPR">{{en}} {{cite web|title=‘My Daddy's Name is Donor’|url=http://www.npr.org/templates/story/story.php?storyId=129233185|date=16 August 2010|work=NPR}}</ref>
 
Alana Stewart, yang dikandung menggunakan sperma donor, memulai suatu forum daring bagi anak-anak donor dengan nama AnonymousUS pada tahun 2010. Forum tersebut menyambut baik segala sudut pandang yang disampaikan setiap orang yang terlibat dalam proses IVF.<ref name="AnonymousUS CT">{{en}} {{cite web|last=Scheller|first=Christine A.|title=The Untold Story of Donor-Conceived Children|url=http://blog.christianitytoday.com/women/2011/01/the_untold_story_of_spermdonor.html|work=Christianity Today}}</ref> Olivia Pratten, seorang Kanada yang dikandung menggunakan donor, menggugat provinsi [[British Columbia]] pada tahun 2008 agar ia mendapat akses ke catatan identitas ayah donornya.<ref name="BC Canada ruling"/> "Saya bukan sebuah rawatan, saya seorang pribadi, dan catatan-catatan itu milik saya," kata Pratten.<ref name="donor conceived NW"/> Pada bulan Mei 2012, pengadilan memenangkan gugatan Pratten, setuju bahwa undang-undang pada saat itu mendiskriminasi anak-anak donor serta menjadikan donasi sel telur dan sperma anonim di British Columbia ilegal.<ref name="BC Canada ruling">{{en}} {{cite journal|last=Motluk|first=Alison|title=Canadian court bans anonymous sperm and egg donation|doi=10.1038/news.2011.329 |journal=Nature|date=27 May 2011}}</ref>
In 2000, a website called [[Donor Sibling Registry]] was created to help biological children with a common donor connect with each other.<ref name="IVF donor NPR"/><ref name="donor-conceived WP">{{cite news|title=Donor-conceived children use Internet to find relatives and share information|url=http://www.washingtonpost.com/national/health-science/donor-conceived-children-use-internet-to-find-relatives-and-share-information/2011/07/01/gIQA3BiwzK_story.html|newspaper=Washington Post|date=26 September 2011}}</ref>
 
Di Britania Raya, Swedia, Norwegia, Jerman, Italia, Selandia Baru, dan beberapa negara bagian Australia, para donor tidak dibayar dan tidak dapat anonim.
In 2012, a documentary called ''Anonymous Father's Day'' was released that focuses on donor-conceived children.<ref name="anonymous father's day">{{cite news|last=McManus|first=Mike|title=Anonymous Father's Day|url=http://www.thedailyreporter.com/news/x1967199624/Anonymous-Father-s-Day|newspaper=Greenfield Daily Reporter|date=24 June 2012}}</ref>
 
Pada tahun 2000, sebuah situs web bernama Donor Sibling Registry dibuat untuk membantu anak-anak biologis dengan donor umum saling terhubung satu sama lain.<ref name="IVF donor NPR"/><ref name="donor-conceived WP">{{en}} {{cite news|title=Donor-conceived children use Internet to find relatives and share information|url=http://www.washingtonpost.com/national/health-science/donor-conceived-children-use-internet-to-find-relatives-and-share-information/2011/07/01/gIQA3BiwzK_story.html|newspaper=Washington Post|date=26 September 2011}}</ref>
===Unwanted embryos===
 
Pada tahun 2012, sebuah dokumenter berjudul ''Hari Ayah Anonim'' dirilis dengan berfokus pada anak-anak yang dikandung menggunakan sel donor.<ref name="anonymous father's day">{{en}} {{cite news|last=McManus|first=Mike|title=Anonymous Father's Day|url=http://www.thedailyreporter.com/news/x1967199624/Anonymous-Father-s-Day|newspaper=Greenfield Daily Reporter|date=24 June 2012}}</ref>
During the [[Embryo selection|selection]] and [[In vitro fertilisation#Embryo transfer|transfer]] phases many embryos may be discarded in favour of others. This selection may be based on criteria such as genetic disorders or the sex.<ref>[http://www.lifenews.com/2011/09/06/pro-life-concerns-about-ivf-include-abortion-exploitation/ Pro-Life Concerns About IVF Include Abortion, Exploitation]. LifeNews.com (6 September 2011). Retrieved on 2013-08-03.</ref> One of the earliest cases of special gene selection through IVF was the case of the Collins family in the 1990s, who selected the sex of their child.<ref>Lemonick, M. D. (1999). [http://content.time.com/time/magazine/article/0,9171,17696,00.html/ "Designer Babies"] ''Time Magazine''.</ref> The ethic issues remain unresolved as no consensus exists in science, religion, and philosophy on when a human embryo should be recognised as a person. For those who believe that this is at the moment of conception, IVF becomes a moral question when multiple eggs are fertilised, begin development, and only a few are chosen for implantation.
 
=== Embrio-embrio yang tidak diinginkan ===
If IVF were to involve the fertilisation of only a single egg, or at least only an amount that will be implanted, then this would not be an issue. However, this has the chance of increasing costs dramatically as only a few eggs can be attempted at a time. As a result, the couple must decide what to do with these extra embryos. Depending on their view of the embryo’s humanity or the chance the couple will want to try to have another child, the couple has multiple options for dealing with these extra embryos. Couples can choose to keep them frozen, donate them to other infertile couples, thaw them, or donate them to medical research.<ref name="cnn.com"/> Keeping them frozen costs money, donating them does not ensure they will survive, thawing them renders them immediately unviable, and medical research results in their termination. In the realm of medical research, the couple is not necessarily told what the embryos will be used for, and as a result, some can be used in [[stem cell]] research, a field perceived to have ethical issues.
Selama tahap pemilihan dan pemindahan, banyak embrio yang mungkin dibuang demi yang lainnya. Pemilihan tersebut mungkin didasarkan pada kriteria seperti kelainan genetik atau jenis kelamin.<ref>{{en}} [http://www.lifenews.com/2011/09/06/pro-life-concerns-about-ivf-include-abortion-exploitation/ Pro-Life Concerns About IVF Include Abortion, Exploitation]. LifeNews.com (6 September 2011). Retrieved on 2013-08-03.</ref> Salah satu kasus paling awal seputar pemilihan gen khusus melalui IVF adalah kasus keluarga Collins pada tahun 1990-an, yang memilih jenis kelamin anak mereka.<ref>{{en}} Lemonick, M. D. (1999). [http://content.time.com/time/magazine/article/0,9171,17696,00.html/ "Designer Babies"] ''Time Magazine''.</ref> Isu-isu etika masih belum terselesaikan karena dianggap belum ada konsensus dalam ilmu pengetahuan, agama, dan filsafat mengenai kapan embrio manusia harus diakui sebagai seorang pribadi. Bagi yang meyakini bahwa hal ini bermula sejak saat konsepsi (pembuahan), IVF menjadi suatu masalah moral ketika ada beberapa sel telur yang dibuahi, sehingga memulai perkembangan mereka, dan hanya sedikit atau satu saja yang dipilih untuk implantasi.
 
Apabila IVF melibatkan pembuahan satu sel telur saja, atau setidaknya hanya sejumlah yang akan diimplantasikan, maka hal ini dianggap bukan suatu isu. Bagaimanapun, hal ini mungkin mengakibatkan peningkatan biaya secara drastis karena hanya satu atau sedikit sel telur yang diupayakan pada satu waktu. Akibatnya, pasangan tersebut perlu memutuskan apa yang harus dilakukan dengan embrio-embrio tambahan yang dihasilkan. Tergantung pada pandangan mereka tentang aspek kemanusiaan sang embrio atau apakah mereka kelak menginginkan anak lagi, pasangan tersebut memiliki beberapa pilihan dalam memperlakukan embrio-embrio ekstranya. Pasangan memiliki pilihan untuk membekukan mereka, menyumbangkan mereka kepada pasangan infertil lainnya, melelehkan mereka, atau menyumbangkan mereka untuk penelitian medis.<ref name="cnn.com"/> Membekukan mereka membutuhkan biaya, menyumbangkan mereka tidak menjamin kalau mereka akan bertahan hidup, mencairkan atau melelehkan mereka dengan segera membuat mereka tidak dapat bertahan hidup, dan penelitian medis mengakibatkan pengakhiran kehidupan mereka. Dalam ranah penelitian medis, pasangan belum tentu diberitahu untuk apa embrio-embrio tersebut digunakan, dan sebagai hasilnya, beberapa dapat saja digunakan dalam penelitian [[sel punca embrionik]], suatu bidang yang juga dipandang memiliki isu-isu etika.
===Religious response===
{{main article|Religious response to assisted reproductive technology}}
 
=== Tanggapan keagamaan ===
The [[Roman Catholic Church]] opposes all kinds of [[assisted reproductive technology]] and artificial [[contraception]], asserting they separate the procreative goal of [[Sacraments of the Catholic Church#Matrimony|marital]] sex from the goal of uniting married couples.
{{main article|Tanggapan keagamaan terhadap teknologi reproduksi berbantuan}}
The Roman Catholic Church permits the use of a small number of reproductive technologies and contraceptive methods like [[natural family planning]], which involves charting [[ovulation]] times. The church allows other forms of reproductive technologies that allow conception to take place from normative [[sexual intercourse]], such as a fertility lubricant. [[Pope Benedict XVI]] had publicly re-emphasised the Catholic Church's opposition to ''in vitro'' fertilisation, claiming it replaces love between a husband and wife.<ref>{{Citation | newspaper = Medical news today | url = http://www.medicalnewstoday.com/articles/38686.php | title = Pope Benedict XVI Declares Embryos Developed For In Vitro Fertilization Have Right To Life}}</ref>
The Catechism of the Catholic Church claims that [[Natural law#Contemporary Christian understanding|Natural law]] teaches that reproduction has an "inseparable connection" to sexual union of married couples.<ref>{{cite web | location = Rome | url = http://www.vatican.va/holy_father/paul_vi/encyclicals/documents/hf_p-vi_enc_25071968_humanae-vitae_en.html | title = Humanae Vitae: Encyclical of Pope Paul VI on the Regulation of Birth, sec 12| author = Pope Paul VI | authorlink = Pope Paul VI|date= 25 July 1968|accessdate= 25 November 2008|publisher = Vatican}}</ref> In addition, the church opposes IVF because it might cause disposal of embryos; in Catholicism, an embryo is viewed as an individual with a [[soul]] that must be treated as a person.<ref name=medill>[http://news.medill.northwestern.edu/chicago/news.aspx?id=136743 Reconciling religion and infertility] By Alina Dain. July 30, 2009</ref> The Catholic Church maintains that it is not objectively evil to be infertile, and advocates adoption as an option for such couples who still wish to have children.<ref name = "catechism">{{cite web| title = Catechism of the Catholic Church. Section 2377 | url = http://www.vatican.va/archive/ENG0015/__P86.HTM |accessdate=25 November 2008|publisher = Vatican |year= 1993 | location = Rome}}</ref>
 
[[Gereja Katolik]] menentang semua jenis [[teknologi reproduksi berbantuan]] dan [[Pandangan Kristen tentang kontrasepsi|kontrasepsi buatan]], menegaskan bahwa Gereja memisahkan tujuan prokreatif hubungan seksual dalam [[Sakramen (Katolik)#Pernikahan|perkawinan]] dengan tujuan penyatuan pasangan dalam perkawinan. Gereja Katolik mengizinkan penggunaan sejumlah kecil teknologi reproduksi dan metode kontrasepsi seperti [[keluarga berencana alami]], yang mencakup pencatatan waktu [[ovulasi]]. Gereja memperbolehkan bentuk-bentuk lain teknologi reproduksi yang memungkinkan pembuahan terjadi melalui [[persetubuhan]] normatif, misalnya pelumas fertilitas. [[Paus Benediktus XVI]] secara terbuka menekankan kembali penentangan Gereja Katolik terhadap fertilisasi ''in vitro'' atau "bayi tabung", memandangnya menggantikan cinta antara pasangan suami-istri.<ref>{{en}} {{Citation | newspaper = Medical news today | url = http://www.medicalnewstoday.com/articles/38686.php | title = Pope Benedict XVI Declares Embryos Developed For In Vitro Fertilization Have Right To Life}}</ref> [[Katekismus Gereja Katolik]] menyatakan kalau [[Hukum alam#Yurisprudensi hukum alam Katolik|hukum alam]] mengajarkan bahwa reproduksi memiliki suatu "hubungan yang tak terpisahkan" dengan hubungan seksual di antara kedua pribadi pasangan menikah.<ref>{{en}} {{cite web | location = Rome | url = http://www.vatican.va/holy_father/paul_vi/encyclicals/documents/hf_p-vi_enc_25071968_humanae-vitae_en.html | title = Humanae Vitae: Encyclical of Pope Paul VI on the Regulation of Birth, sec 12| author = Pope Paul VI | authorlink = Pope Paul VI|date= 25 July 1968|accessdate= 25 November 2008|publisher = Vatican}}</ref> Selain itu, Gereja menentang IVF karena dapat menyebabkan pembuangan embrio-embrio, mengeliminasi [[hak untuk hidup|hak hidup]] mereka; dalam Katolisisme, embrio dipandang sebagai seorang individu dengan [[jiwa]] yang harus diperlakukan layaknya seorang pribadi manusia.<ref name=medill>{{en}} [http://news.medill.northwestern.edu/chicago/news.aspx?id=136743 Reconciling religion and infertility] By Alina Dain. July 30, 2009</ref> Gereja Katolik berpendapat bahwa infertilitas bukanlah suatu kemalangan secara objektif, dan mendukung adopsi sebagai pilihan bagi pasangan-pasangan yang masih ingin memiliki anak.<ref name = "catechism">{{KGK|pp=2379|long=yes}}</ref>
[[Hindu]]s welcomed the IVF as gift for those who can't bear child and termed doctors related to IVF doing [[Punya (Hinduism)|punya]] as there are several characters who were claimed to be born without intercourse, mainly [[Karna]] and five [[Pandava]]s.<ref>{{cite web| title = Science in hinduism-Test tube babies | url = http://www.mallstuffs.com/Blogs/BlogDetails.aspx?BlogId=333&BlogType=Spiritual&Topic=Science%20in%20hinduism-Test%20tube%20babies |accessdate=30 May 2016|publisher = |year= Oct 20, 2013 | location = }}</ref>
 
Dikatakan bahwa [[umat Hindu]] menerima IVF sebagai anugerah bagi mereka yang tidak dapat memiliki anak dan menyebut dokter-dokter terkait IVF melakukan ''[[Punya (Hinduisme)|punya]]'' karena terdapat beberapa karakter yang mengaku dilahirkan tanpa hubungan seksual, terutama [[Karna]] dan kelima [[Pandawa]].<ref>{{en}} {{cite web| title = Science in hinduism-Test tube babies | url = http://www.mallstuffs.com/Blogs/BlogDetails.aspx?BlogId=333&BlogType=Spiritual&Topic=Science%20in%20hinduism-Test%20tube%20babies |accessdate=30 May 2016|publisher = |year= Oct 20, 2013 | location = }}</ref>
Regarding the response to IVF of [[Islam]], the conclusions of Gad El-Hak Ali Gad El-Hak's ART fatwa include that:<ref>{{cite web | url = http://vlex.com/vid/fatwas-ivf-gamete-sunni-shia-islam-418643 | last = Inhorn | first = MC | title= Making Muslim babies: IVF and gamete donation in Sunni versus Shi'a Islam | journal= Cult Med Psychiatry | volume= 30 |issue= 4 |pages = 427–50 |date=December 2006 | pmid= 17051430 | pmc = 1705533 | doi = 10.1007/s11013-006-9027-x}}</ref>
*IVF of an egg from the wife with the sperm of her husband and the transfer of the fertilised egg back to the uterus of the wife is allowed, provided that the procedure is indicated for a medical reason and is carried out by an expert physician.
*Since marriage is a contract between the wife and husband during the span of their marriage, no third party should intrude into the marital functions of sex and procreation. This means that a third party donor is not acceptable, whether he or she is providing sperm, eggs, embryos, or a uterus. The use of a third party is tantamount to ''zina'', or [[adultery]].
 
Mengenai tanggapan atas IVF dari [[Islam]], kesimpulan dari fatwa Gad El-Hak Ali Gad El-Hak mengenai teknologi reproduksi berbantuan meliputi:<ref>{{en}} {{cite web | url = http://vlex.com/vid/fatwas-ivf-gamete-sunni-shia-islam-418643 | last = Inhorn | first = MC | title= Making Muslim babies: IVF and gamete donation in Sunni versus Shi'a Islam | journal= Cult Med Psychiatry | volume= 30 |issue= 4 |pages = 427–50 |date=December 2006 | pmid= 17051430 | pmc = 1705533 | doi = 10.1007/s11013-006-9027-x}}</ref>
Within the [[Orthodox Judaism|Orthodox Jewish]] community the concept is debated as there is little precedent in traditional Jewish legal textual sources. Regarding [[Judaism and sexuality|laws of sexuality]], religious challenges include [[masturbation]] (which may be regarded as “seed wasting”<ref name=medill/>), laws related to sexual activity and menstruation ([[niddah]]) and the specific laws regarding intercourse. An additional major issue is that of establishing paternity and lineage. For a baby conceived naturally, the father’s identity is determined by a legal presumption ([[chazakah]]) of legitimacy: ''rov bi'ot achar ha'baal'' - a woman's [[Human sexual behavior|sexual relations]] are assumed to be with her husband. Regarding an IVF child, this assumption does not exist and as such Rabbi [[Eliezer Waldenberg]] (among others) requires an outside supervisor to positively identify the father.<ref>Tzitz Eliezer 9 p. 247</ref> [[Reform Judaism]] has generally approved ''in vitro'' fertilisation.<ref name="medill"/>
* IVF satu sel telur sang istri dengan sel sperma dari suaminya dan pemindahan kembali sel telur yang telah dibuahi ke rahim sang istri diperbolehkan, dengan syarat prosedur itu diindikasikan untuk suatu alasan medis dan dilaksanakan oleh seorang dokter ahli.
* Karena pernikahan adalah suatu kontrak antara sang istri dan suami selama kurun waktu pernikahan mereka, seharusnya tidak ada pihak ketiga yang mengganggu fungsi-fungsi perkawinan dalam hubungan seksual dan penghasilan keturunan. Hal ini berarti bahwa donor pihak ketiga tidak dapat diterima, apakah ia menyediakan sel sperma, sel telur, embrio, atau rahim. Penggunaan pihak ketiga sama artinya dengan ''zina'', atau [[perselingkuhan]].
 
Dalam komunitas [[Yahudi Ortodoks]], konsep ini diperdebatkan karena hanya ada sedikit preseden pada sumber-sumber tekstual hukum tradisional Yahudi. Mengenai [[Yudaisme dan seksualitas|hukum seksualitas]], yang menjadi keberatan misalnya [[Pandangan agama tentang masturbasi|masturbasi]] (yang dapat dipandang sebagai "penyia-nyiaan benih"<ref name=medill/>), hukum-hukum terkait aktivitas seksual dan menstruasi ([[niddah]]) serta hukum khusus mengenai persetubuhan. Satu masalah tambahan yang penting adalah penetapan garis keturunan dan keayahan. Bagi seorang bayi yang dikandung secara alami, identitas ayahnya ditentukan melalui suatu presumsi legitimasi hukum ([[khazakah]]): ''rov bi'ot achar ha'baal'' - hubungan seksual seorang wanita diasumsikan dengan suaminya. Mengenai seorang anak IVF, asumsi ini tidak ada dan karenanya Rabi [[Eliezer Waldenberg]] (antara lain) mensyaratkan adanya seorang pengawas dari luar untuk secara positif mengidentikasi sang ayah.<ref>Tzitz Eliezer 9 p. 247</ref> [[Yudaisme Reformasi]] umumnya menyetujui fertilisasi ''in vitro''.<ref name="medill"/>
===Society and culture===
 
=== Masyarakat dan budaya ===
Many people of sub-Saharan Africa choose to foster their children to infertile women. IVF enables these infertile women to have their own children, which imposes new ideals to a culture in which fostering children is seen as both natural and culturally important. Many infertile women are able to earn more respect in their society by taking care of the children of other mothers, and this may be lost if they choose to use IVF instead. As IVF is seen as unnatural, it may even hinder their societal position as opposed to making them equal with fertile women. It is also economically advantageous for infertile women to raise foster children as it gives these children greater ability to access resources that are important for their development and also aids the development of their society at large. If IVF becomes more popular without the birth rate decreasing, there could be more large family homes with fewer options to send their newborn children. This could result in an increase of orphaned children and/or a decrease in resources for the children of large families. This would ultimately stifle the children's and the community's growth.<ref>{{cite journal | author = Drah B | title = Orphans in Sub-Saharan Africa: The Crisis, the Interventions, and the Anthropologist | journal = Africa Today | volume = 59 | issue = 2 (Winter2012 2012) | pages = 3–21 | doi=10.2979/africatoday.59.2.3}}</ref>-->
Banyak orang [[Afrika Sub-Sahara]] memilih untuk memercayakan pengasuhan anak-anak mereka pada kaum wanita infertil. IVF memungkinkan para wanita infertil itu untuk memiliki anak-anak mereka sendiri, sehingga memaksakan standar ideal baru pada suatu budaya di mana membesarkan anak-anak dianggap alami dan penting secara kultural. Banyak wanita infertil yang mampu mendapatkan lebih banyak rasa hormat dalam masyarakat mereka dengan cara merawat anak-anak yang bukan anak kandungnya, dan mereka mungkin akan kehilangan rasa hormat tersebut jika memilih untuk menggunakan IVF. Karena IVF dipandang tidak alamiah, IVF dapat mengganggu posisi sosial mereka serta tidak menjadikan mereka setara dengan para wanita fertil. Juga dipandang lebih menguntungkan secara ekonomis bagi kaum wanita infertil untuk membesarkan anak-anak asuh karena memberikan anak-anak ini kemampuan lebih besar untuk mengakses sumber daya yang penting bagi perkembangan mereka dan juga membantu perkembangan masyarakat pada umumnya. Jika IVF menjadi lebih populer tanpa penurunan angka kelahiran, akan ada lebih banyak rumah dengan keluarga besar yang memiliki sedikit pilihan untuk mengirim anak-anak mereka yang lahir. Hal ini dapat mengakibatkan peningkatan jumlah anak yatim dan/atau penurunan sumber daya bagi anak-anak dari keluarga besar. Pada akhirnya hal ini akan menahan pertumbuhan masyarakat dan anak-anak tersebut.<ref>{{en}} {{cite journal | author = Drah B | title = Orphans in Sub-Saharan Africa: The Crisis, the Interventions, and the Anthropologist | journal = Africa Today | volume = 59 | issue = 2 (Winter2012 2012) | pages = 3–21 | doi=10.2979/africatoday.59.2.3}}</ref>
 
== Kaum pria dan IVF ==
Baris 144 ⟶ 208:
Semua pembatasan utama di Australia pada wanita lajang namun [[mandul|infertil]] untuk menggunakan IVF dicabut pada tahun 2002 setelah pengajuan banding terakhir ke Pengadilan Tinggi Australia ditolak dengan alasan prosedural dalam kasus Leesa Meldrum. Suatu pengadilan federal [[Victoria, Australia|Victoria]] telah memutuskan pada tahun 2000 bahwa larangan yang ada atas semua wanita lajang dan lesbian untuk menggunakan IVF merupakan diskriminasi gender.<ref>{{en}} [http://wwrn.org/articles/11389/?&place=australia&section=health-medical Australian court OKs fertility treatment for single women, lesbians] by Peter O'Connor (AP, 18 April 2002)</ref> Pemerintah Victoria mengumumkan perubahan dalam hukum IVF pada tahun 2007 dengan menghilangkan pembatasan pada lesbian dan wanita lajang, sehingga menjadikan [[Australia Selatan]] satu-satunya negara bagian yang masih mempertahankan batasan tersebut.<ref>{{en}} Hoare, Daniel (15 December 2007) [http://www.abc.net.au/news/stories/2007/12/15/2119738.htm Lesbian community welcomes Vic IVF changes]. abc.net.au</ref>
 
Undang-undang federal di Amerika Serikat mencakup skrining kebutuhan dan pembatasan dalam hal donasi, tetapi umumnya tidak berpengaruh pada pasangan intim secara seksual.<ref>{{en}} {{cite web|url=http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=1271.90|title=21 CFR 1271.90(a)(2)|publisher=[[US Food and Drug Administration]]}}</ref> Namun, dokter mungkin diperlukan untuk ''menyediakan'' perawatan karena undang-undang non-diskriminasi, seperti misalnya di California.<ref name="Bob Egelko 2008"/> Negara bagian [[Tennessee]] mengusulkan suatu rancangan undang-undang pada tahun 2009 yang akan menetapkan donor IVF sebagai 'adopsi'.<ref>{{en}} {{cite web|url=http://www.capitol.tn.gov/Bills/106/Fiscal/HB2159.pdf |title=Fiscal Note, HB 2159 – SB 2136, from Tennessee General Assembly Fiscal Review Committee |format=PDF |accessdate=22 May 2012}}</ref> Pada sesi yang sama diusulkan rancangan undang-undang lainnya yang membatasi adopsi dari pasangan yang belumtidak menikah dan hidup bersama; kelompok-kelompok aktivis menyatakan bahwa meloloskan rancangan undang-undang yang pertama akan secara efektif menghentikan orang-orang yang belumtidak menikah untuk menggunakan IVF.<ref>{{en}} {{cite web|url=http://wapp.capitol.tn.gov/apps/billinfo/BillSummaryArchive.aspx?BillNumber=SB0078&ga=106 |title=SB 0078 by Stanley, Bunch. (HB 0605 by DeBerry J, Hensley.) |publisher=Wapp.capitol.tn.gov |accessdate=22 May 2012}}</ref><ref>{{en}} {{cite web|url=http://www.eggdonor.com/blog/2009/03/31/tennessee-seeking-to-ban-ivf-for-unmarried-individuals/ |title=Tennessee Seeking To Ban IVF For Unmarried Individuals |publisher=Eggdonor.com |date=31 March 2009 |accessdate=22 May 2012}}</ref> Tak satu pun dari kedua rancangan undang-undang itu lolos.<ref>{{en}} {{cite web|url=http://www.outandaboutnewspaper.com/article/2992 |title=Study shows barriers to same-sex adoption hurt children |publisher=Outandaboutnewspaper.com |date=1 November 2008 |author=Jones, Sam}}</ref><ref>{{en}} {{cite web|url=http://www.tnep.org/html/LegislativeUpdates/ |archiveurl=https://web.archive.org/web/20080207084218/http://www.tnep.org/html/LegislativeUpdates/ |archivedate=2008-02-07 |title=Legislative Update |publisher=Tnep.org |accessdate=22 May 2012}}</ref>
 
== Lihat pula ==
Diperoleh dari "https://id.wikipedia.org/wiki/Fertilisasi_in_vitro"