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  • 6/21/2025
In-depth look at the scientific breakthroughs in reproductive science, their impact on human lives, and the doctors and biologists on the leading edge.

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00:00Frozen at minus 380 degrees Fahrenheit, a human embryo is selected to be thawed, resulting in the birth of Melina, now four years old.
00:24Her brother Luke was created in the same way.
00:27Their parents are Will, a lawyer in Los Angeles, and Marceline, who's a surgeon.
00:36They've been able to have children because of a discovery made in 1978, that by bringing together a man's sperm and a woman's egg in a laboratory, a baby could start its life outside the human body.
00:50It's called in vitro fertilization.
00:53Marceline was a sperm donor for one, and I was a sperm donor for the other.
00:59But we don't tell the public, or even our close friends or family, who that is.
01:03But our children will know.
01:05Marceline's from a very large family. He's the youngest of 20.
01:08He's the youngest of 20. And I'm an only child, so I sort of always idealized family life and a big family.
01:14To me, it was just a basic human desire to want to have children.
01:17Since neither Will nor Marceline could carry their baby, they searched for a woman willing to serve as a surrogate mother.
01:26Many of the women we knew who wanted to help us didn't really want to carry a child that they were biologically related to.
01:35And with IVF, our friends said, okay, if the egg's not for me, I would feel comfortable carrying the child.
01:42In vitro fertilization has enabled thousands of couples to create the family they desperately want.
01:52It has also opened a gateway to a brave new world, where a child can have five parents, or be born to a mother in her 60s.
02:02Where a baby can have its sex determined before conception, or be created with borrowed DNA.
02:11Where an embryo, no larger than a speck of dust, can have its genes scanned for diseases, or one day be designed with new strengths and talents.
02:23What IVF does is it takes the process of reproduction out of the darkness of the womb into the light of the laboratory.
02:32And all of a sudden, you can do anything you want with these human embryos and eggs, which couldn't be done before.
02:42A new revolution in making babies is underway.
02:45One that could allow us to influence, and even shape, the genetic fate of our children.
02:53Major funding for NOVA is provided by The Park Foundation, dedicated to education and quality television.
03:23This program is funded in part by the Northwestern Mutual Foundation.
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03:35Northwestern Mutual Financial Network.
03:42Scientific achievement is fueled by the simple desire to make things clear.
03:48Clear.
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04:02ELLEMENT
04:13I think it's very difficult for anybody to explain why we are able to learn the same thing.
04:16I think it's very difficult for anybody to explain why they want a child.
04:33And the thing that I always felt so strongly about, why as an infertile person do I have
04:39to explain why I want a child, where somebody who's not infertile doesn't.
04:47And it's something that I think nobody is prepared for.
04:49Nobody is prepared for somebody to sit across a desk from them and say, I'm sorry, but you
04:54can't have a child.
04:56One out of every six couples struggles with infertility.
05:02You come to realize how lucky so many other people are, that they don't have a situation
05:07like this.
05:07And there are worse things, I definitely agree, but to us, we were devastated.
05:15For many, in vitro fertilization is their last hope for a child, despite the stark reality
05:21that it fails 70% of the time.
05:26These patients have often gone through years of trying to get pregnant.
05:30They're really stressed just from that alone.
05:32And often, by the time they reach the office of a specialist, are depressed because of this
05:36illness.
05:37And not many people view this as an illness, but infertility is a rotten, horrible disease.
05:43And you know, it's not a disease that will kill you, but it wreaks havoc in these patients'
05:47lives.
05:48It's not a cosmetic illness.
05:49This is a girl, as was expected.
05:50The disease of infertility once seemed incurable until the miraculous birth of Louise Brown in
06:021978.
06:03Her arrival marked an historic moment, for Louise was the first human baby ever conceived outside
06:13a mother's womb.
06:16British doctors Robert Edwards and Patrick Steptoe had labored for years trying to help women
06:22with blocked fallopian tubes.
06:26They could surgically remove their eggs and fertilize them in the lab.
06:31Yet they couldn't figure out why the embryos failed to develop into pregnancies once they
06:36were returned to the mother.
06:37We had got all the techniques ready right up the stage of implantation, beautiful embryos,
06:44and checked out the chromosomes and everything about them.
06:48And it was clear this method had to work.
06:51There was too much knowledge already in mice and rabbits and goats mind that the techniques
06:58we were doing were in advance of those.
07:00So we felt that the human was not so different that the method could not work.
07:09The breakthrough came when Steptoe and Edwards decided to transfer the embryo earlier, allowing
07:15it to divide only three times before placing it in the womb.
07:19I can see the embryo beautifully.
07:23We were trying to come earlier and earlier, really to avoid long-term cultures.
07:29That was my primary aim, and so suddenly the system started to work, and we were there.
07:39Three years later, Nova filmed the birth of America's first test tube baby, Elizabeth Jordan
07:45Carr.
07:48Although Louise Brown was healthy at birth, many feared that IVF babies could well be abnormal.
07:54Ultrasound had shown that Elizabeth was small, and the doctors that created her, Georgiana
08:03and Howard Jones, were extremely worried.
08:06I had written out a press release that said that we had been disappointed at birth, that
08:15the child was abnormal, but that we did have a couple of other pregnancies come along behind
08:20that.
08:21And we would hope that the others were perfectly okay.
08:25And fortunately, I didn't have to use that.
08:27All right ladies, here she is, Elizabeth.
08:29All right.
08:30There you go.
08:31I'd like you to be a girl.
08:33I think the major moral concern was, were you going to have a child born who had birth
08:39defects?
08:40Were you going to have developmental abnormalities?
08:42Would something go wrong later in the life of that person?
08:45And I think the terror was that somehow doing something in a dish was going to create a person
08:51that was less than healthy.
08:52That's you, Louise.
08:53Do you see that before?
08:55But the terror faded quickly.
08:58As the press followed Louise Brown and Elizabeth Carr, it was clear that the girls who had made
09:04medical history were growing up to be perfectly normal.
09:09Every year, people pop up and say, oh, we'd like to do an update on Elizabeth.
09:14And every year I say, well, I'm the same as I was last year, just a year older.
09:19That's it.
09:20It's kind of like they expect a wonderful answer.
09:23Like, oh yes, I feel so different.
09:25I feel so special.
09:26And I don't.
09:30Initially, IVF could only help a small percentage of infertile couples.
09:36Today, it has become the starting point for treating almost every cause of infertility.
09:41As defective eggs, weak sperm, or abnormal chromosomes, once insurmountable obstacles, are overcome.
09:52Radical new techniques have proven that life on the cellular level is easier to manipulate
09:58than ever imagined.
10:03But for those who embark on this high-tech process, IVF remains a grueling ordeal.
10:12The first hurdle is to endure daily injections of powerful drugs to force the ovary to produce more than one egg.
10:23Lisa had gone through three weeks of taking shots.
10:26You know, all of her body bruises every morning at six in the morning to go to give blood.
10:30And you have a lot of guilt seeing your spouse go through all this stuff knowing that if I didn't have this problem,
10:37she wouldn't have to do this.
10:38You know, she's very fertile.
10:40I mean, that's the best part.
10:42Infertility was often seen as a woman's curse.
10:48But in fact, 40% of cases can be attributed to male problems, like Darren's.
10:55The sperm count is very, very low.
10:59And when you have such low sperm count, the challenge is to select a normal sperm,
11:05or what looks like a normal sperm, and to get fertilization.
11:08However, as long as we have some sperm, and they're alive, we can allow the sperm to get to the egg.
11:15Because Darren's sperm are too weak to reach Alyssa's eggs, her eggs must be surgically retrieved.
11:25Using a long, thin needle, Rosenwax probes her ovary.
11:32One by one, the tiny eggs are sucked out into test tubes and taken to the lab.
11:40It is the quality and number of the eggs and sperm that will determine the outcome.
11:45We had 15 mature eggs, and there are several motile sperm, but very, very few.
11:54So they're looking, they have to search out quite a bit.
11:57And the hope is, of course, to get at least an equal number of sperm to the number of eggs we have.
12:02And this is the kind of situation we're dealing with here.
12:05A fertile man will produce millions of sperm.
12:09Today, the doctors have found only 12 of Darren's to work with.
12:16Using a thin glass needle, one sperm is grabbed by its tail.
12:24Then, Alyssa's egg is placed into position.
12:30It was only by accident that scientist John Palermo discovered he could inject a sperm into an egg without damaging it.
12:43While I was placing sperm around the egg, underneath the shell, then, accidentally, I perforated the membrane of the egg.
12:53And then, one sperm went inside.
12:56Ironically, I didn't pay much attention.
12:58I thought that the egg would not survive the procedure.
13:01And I put a question mark to it because I thought it was going to die.
13:04But that was the only egg that fertilized.
13:06That finally was transferred to the patient.
13:08And this became the first ICSI baby.
13:11Palermo called his discovery ICSI for intracytoplasmic sperm injection.
13:19Amazingly, creating a human being through the manual injection of sperm proved to be just as effective as natural fertilization.
13:30The only known safety risk seemed to be the possibility of passing on the gene for male infertility.
13:46ICSI's success would push forward a new frontier of reproductive biology.
13:53If a fragile human egg could be penetrated without harm, perhaps a human embryo might be manipulated in any number of ways.
14:06These new techniques would open up uncharted territory for another couple, Anne and Michael, as conventional treatments failed them.
14:18People who are faced with infertility don't have the same decisions as people that aren't.
14:23And these decisions, they're not what we would want.
14:26These are the choices we're left with.
14:29If I could make a choice, I would like it if my husband and I could get pregnant on our own.
14:34And it's easy to sit there and say what you would or wouldn't do when you're not in those shoes.
14:39Well, she'd been trying for over four years.
14:42And she had done several treatments.
14:44She had done some of the more kind of low-key treatments.
14:47You know, medication by itself, medication with insemination using her husband's sperm.
14:52She had had the full battery of diagnostic tests, none of which really revealed a smoking gun cause as to why she's having difficulty.
15:01And she was climbing the ladder from least aggressive to most aggressive treatment.
15:06During Anne's first IVF cycle, her doctors retrieved 35 eggs, an astounding number.
15:18Yet once the eggs were fertilized in the lab and began dividing,
15:22embryologist Jacques Cohen noticed fragments, little pieces of cells that are left behind when embryos divide inefficiently.
15:30And normally they're not really a hindrance to further development and pregnancy because they occur in about 85% of all embryos.
15:40But when you have a lot of them, it interferes with normal development.
15:44The cells then cannot interact.
15:46And that's what happened in their case.
15:48There were so many of them that you couldn't even count the number of cells.
15:51Let's say you had a four-cell embryo or an eight-cell embryo.
15:54You couldn't make a count, which you normally can.
15:56So on the one hand, I have an answer, which is finally after like three years,
16:02I finally have an answer of why I'm not getting pregnant.
16:05Then on the other hand, I have this news that I don't know if this is going to be fixable.
16:11This may be a permanent problem that we could never fix.
16:19For decades, no one dared to invade the inner sanctum of an embryo for fear of harming it.
16:25But in 1990, Cohen began piercing the shells of fertilized eggs that appeared brittle to help them hatch.
16:38Today, he uses this technique to enter Ann's embryos and remove their fragments.
16:43This plastic surgery is now routine in many IVF clinics in order to boost a poor-quality embryo's chance of implanting.
16:58To be honest, in the beginning, I don't think we were sure whether we were just making the embryos look better
17:03or whether we were actually helping them to develop.
17:05And then when we put the data together, it turned out that, yes, indeed, there's a window of accumulation of fragments
17:13from about 15 to about 30 percent of the embryo.
17:16Previously, that embryo didn't have much of a chance of implanting and turning into a pregnancy.
17:20But if you remove those fragments, they had a very good chance of turning into a pregnancy.
17:29Five of the best-quality embryos were transferred back to Ann.
17:35Although she became pregnant, six weeks later, she lost the baby.
17:39During all this time, we were surrounded by people that were getting pregnant.
17:46And here we were putting our financial savings into this.
17:50A typical IVF cycle in this area costs $12,000 to $15,000.
17:54And you would invest your time, emotions, and your money.
17:59And to have a result like this, you just feel like you've been beaten.
18:03Ann endured one more IVF cycle.
18:09Once again, she conceived and then miscarried.
18:14Although she was only 29 years old,
18:17it seemed unlikely that she would get pregnant using her own eggs.
18:21Failure is not the only risk of IVF.
18:37For those patients lucky enough to become pregnant,
18:40one-third will deliver more than one baby.
18:42Do you want to have ears outside?
18:44Right.
18:45Laura and David May became the parents of triplets
18:48after three of their four embryos implanted.
18:54Although they were desperate to have children,
18:56they were not prepared for the high risk of a multiple pregnancy.
19:02I had to go into the hospital,
19:03and I had like a little pump that they installed
19:05to help control the contractions.
19:08I just ballooned.
19:10And the most painful part was I no longer had ankles.
19:13We gave her six meals a day
19:16to make sure that all the nutrients
19:18and everything that she needed
19:20and the children needed were there.
19:24We had the option to abort some
19:26to increase the odds of the other ones being healthy.
19:30But we've tried five years,
19:31and there was no question in our minds
19:33that we were going for the multiple.
19:38Fortunately, Laura May delivered three healthy children.
19:41But not every family is as lucky.
19:46Most triplets and higher order multiples
19:50are born prematurely.
19:52Thirty percent will weigh less than two pounds.
19:57And the data that we have on that shows
20:02that about one in four of those babies
20:05is going to have serious disability.
20:07Not mild disability,
20:08but real developmental handicaps in life.
20:15Given the enormous risks,
20:16why not limit the number of embryos
20:18transferred back to the mother?
20:23When a patient goes through an IVF cycle
20:24and goes through all of what's involved,
20:26they want the best possible chance.
20:29Now how do you give them the best possible chance?
20:31By putting back more embryos.
20:32And how are clinics compared?
20:35People look at success rates.
20:36Even though they don't understand the nuances
20:38and differences between patient populations,
20:41they want the one with the best percentage.
20:43So there is this incredible pressure on us
20:45to have high pregnancy rates.
20:50Because seventy percent of all embryos
20:52fail to develop,
20:54doctors transfer back several
20:56in the hope that at least one
20:58will turn into a baby.
21:01You know, when you look at an embryo
21:03under the microscope,
21:04as beautiful as it is,
21:06on the first day after fertilization
21:08and when they're single cells,
21:10they just almost all look the same.
21:13You can't pick out the highest quality embryo
21:17on that first egg.
21:20Since the early days of IVF,
21:23doctors have transferred fertilized eggs
21:25back to the mother
21:26when they reach the eight-cell stage.
21:30But recently,
21:31labs have been getting better
21:33at keeping embryos alive.
21:36The hope has been to let nature
21:39take its course
21:40and keep them in culture
21:42for a few more days,
21:43up to the stage we call the blastocyst,
21:45when really the embryo proper
21:47starts developing.
21:48And the thought is,
21:49at that stage,
21:50nature will have selected,
21:52in our incubators,
21:53the best embryos.
21:57By transferring back only two embryos
21:59at the blastocyst stage,
22:01doctors avoid the risks of multiples
22:03without diminishing the chance
22:05of a pregnancy.
22:08But not every embryo can make it
22:10to the fifth day.
22:14At Cornell University,
22:16Elissa and Darren anxiously await news
22:18about their 13 fertilized eggs.
22:24Fortunately,
22:25eight have become viable blastocysts.
22:27Now the challenge is to pick the two
22:30that are most likely to survive.
22:32Yes, there is a possibility of having twins,
22:34and I'd be ecstatic.
22:35I'd be, like, so happy.
22:36You know, I even joked, you know,
22:38can I request them?
22:39And they're like, no.
22:40But you just want something to stick,
22:41and hopefully it will work.
22:42But if it doesn't,
22:43we would do it again.
22:44Although more than half the couples
22:45going through IVF
22:46walk away childless,
22:47Darren and Elissa hope
22:48that they will be the lucky ones,
22:49who defy the odds.
22:53Back in the lab,
22:54their two embryos are located
22:55beneath the microscope
22:56and carefully sucked up
22:57in a catheter.
22:58And they're like,
22:59you know,
23:00you know,
23:01you know,
23:02you know,
23:03you know,
23:04you know,
23:05you know,
23:06you know,
23:07you know,
23:08you know,
23:09you know,
23:10you know,
23:11you know,
23:12you know,
23:13you know,
23:14you know,
23:15have a lot of women
23:16up in a catheter.
23:18Having live embryos
23:19transferred to her womb
23:20will be the closest
23:22Elissa has ever come
23:23to being pregnant.
23:25But to become babies,
23:29they must implant.
23:30You're not going to feel much,
23:32but what it does
23:33is it just go
23:34into the cervix, right?
23:35With blastocyst transfer,
23:36we have a very high
23:37success rate.
23:38Nevertheless,
23:39it's age-dependent.
23:40And in the early 30s,
23:42it's 50%.
23:43It's still 50-50.
23:4450-50. At the end of the day, it's the biology and the competence of that embryo. And that depends
23:50on both the egg and the sperm and the combination. This was the smoothest. The most difficult part
23:57of IVF is every day you're waiting for results in something. Waiting to find out how much sperm
24:04and how many eggs there were. Then a day later, waiting to see, hey, when are they going to
24:08inject them back into you? And that, you know, that was very stressful. That was four days of
24:13just waiting. And now you don't hear anything until you find out if you have a child or not.
24:19So now will be the greatest of all results. But you won't know for two weeks.
24:24One final question. Were they above average, the two that you put in?
24:27They look very, very... I mean, she has a picture. I can see it. Very nice embryos.
24:30All right. We'll put that on the refrigerator. Thank you very much.
24:33Very much. Appreciate it.
24:34It's a good luck.
24:35Thanks.
24:36Okay, very good.
24:37As technology advances, the treatment of infertility has been transformed from a small medical specialty
24:49into a $4 billion a year industry. At this trade fair, sales teams from all over the world
24:58pitch their services to doctors, hospitals, and couples desperate for a baby.
25:03The center for surrogate parenting is in business to find surrogates and egg donors for infertile
25:11couples.
25:12Mother, they're still alive. What diseases they have.
25:15Now, this field started with everybody thinking that it was ungodly, satanistic. I couldn't
25:20get a doctor to even talk to me when I first started. I was considered such a maverick.
25:25Doctors were afraid of being put in jail. I cannot think of any other field of medicine
25:30that in 20 years has gone from being a pariah to being considered a mainstream this quickly.
25:37CSP professional fee due upon confirmation.
25:39Many clinics insist that egg donors remain anonymous, but Bill Handel has launched a thriving
25:44business, finding applicants willing to reveal their backgrounds and matching them with infertile
25:49couples.
25:50What's going to come up for you, and we're going to click on...
25:53Our internet site, eggdonor.com, offers the profiles of 300 of our egg donors.
26:00What are you looking for?
26:02Do you have Jewish donors?
26:03Absolutely.
26:04In our area?
26:05In your area is?
26:06In California?
26:07Yes, we do.
26:08Okay. Just click Jewish here?
26:10Yes.
26:11You can go on blonde, blue-eyed, Caucasian, Christian woman.
26:14And it will then select everybody in our database that has those characteristics.
26:19Bringing a third person into the reproductive process raises many troubling questions.
26:30For an infertility patient like Ann, turning to egg donation or even adoption meant forsaking
26:36a biological tie to her child.
26:42As she grappled with this dilemma, the research team at St. Barnabas Hospital was pushing forward
26:48a new frontier of reproductive biology, involving the exchanging of parts from one egg cell to
26:55another.
26:57They offered Ann an experimental procedure called cytoplasmic transfer, designed to help
27:03women whose eggs divide inefficiently.
27:07The reason that an egg might not be able to do its job very well is that it may have abnormal
27:13chromosomes inside.
27:14On the same hand, there's a possibility that there's a defect in the ability of the egg
27:20to distribute its normal chromosomes.
27:25And we most suspect that that's true in younger women, who we believe still have genetically normal
27:30eggs, and in whom the usual in vitro fertilization techniques uniformly result in very poorly developing
27:38embryos.
27:39The procedure would preserve the nucleus of Ann's eggs that contain over 99% of her chromosomes,
27:48the DNA or genetic material that makes her unique.
27:53She would borrow from a donor egg a portion of its cytoplasm containing tiny cellular structures.
28:03Among them are thousands of mitochondria that provide energy for the cell to divide, and incidentally
28:10carry DNA for a small number of genes.
28:14In theory, a deficiency in the cytoplasm might prevent an egg from developing normally.
28:20The idea behind it was that if there were situations where it appeared that the cytoplasm was damaged or
28:30insufficient in one way or another, even if one was unable to say precisely what it was that was wrong with it,
28:35one might be able to replace it with a presumed normal cytoplasm.
28:43Cohen and Willardson experimented with animal models, mixing the cytoplasm from different mothers of the same species.
28:49As they had hoped, the babies appeared healthy and normal.
28:56Although the doctors felt confident enough to proceed, Ann struggled with the risks.
29:04When you're left with these choices, egg donation or adoption, or doing this new procedure,
29:10egg donation, you don't know who is donating this egg.
29:14It's all anonymous egg donation.
29:16You don't know any dispositions towards illnesses, whether it be mental or physical illnesses.
29:22And you don't know how your children are going to react to the news when they grow up that they are not genetically your child.
29:28With adoption, you have the same risks, except the adoptive mother can want this child back in their life.
29:34So you're looking at three options that are risky, and you have to decide emotionally, medically, and financially which have the fewer risks.
29:44Deciding to proceed with cytoplasmic transfer, Ann and a donor had their eggs harvested.
29:56Then, Cohen removed the cytoplasm from the donor's egg, carefully avoiding its nucleus.
30:03One could argue, as indeed some people are arguing, that all this is unnatural and shouldn't be done and just leave it alone.
30:13But on the other hand, if we want to gain more insight that can be a benefit in the area of human reproduction,
30:21well, then every now and then the boundaries have to be moved a little bit.
30:26You simply cannot gain experience without experimenting, and it's as simple as that.
30:31By using the fertilization technique of ICSI, donor cytoplasm can be safely injected into Ann's eggs, along with her husband's sperm.
30:43Three days later, when the developing embryos were examined, they appeared less fragmented.
30:54Four were selected for transfer.
30:59I think looking at the pictures of the four embryos that were transferred in a final cytoplasmic attempt,
31:04and compare them to the photographic material we have available from the previous attempt,
31:08there were more cells, and the cells looked healthier.
31:11And therefore, my impression is that at least in one or two of the embryos,
31:15there seemed to be a higher chance of development.
31:18I said I'm going to do the three tries. If I don't get pregnant, then we'll start the adoption.
31:22Unlike Ann, the majority of patients who turn to IVF are in their late 30s or early 40s.
31:32Many find it difficult to get pregnant simply because of the age of their eggs.
31:36Melanie and Laura.
31:38Our peak fertility is in the mid-20s, early 20s, and yet most of us are delaying childbearing until the late 30s.
31:47Now, it is clear that one of the reasons the older patients don't get pregnant with the same efficiency as the younger patients
31:53is that the embryos are chromosomally abnormal at a higher rate, and it all correlates with the egg and what happens to the egg.
31:59During a woman's childbearing years, one egg is ovulated each month.
32:08If it is fertilized, it will replicate its chromosomes and then divide, splitting them in half.
32:14Now, when that process happens in a young woman's egg, it goes along just fine.
32:20When it happens in an older woman's egg, it doesn't.
32:23The chromosomes get lost or are missing, and you make an unhealthy embryo from that.
32:27So the theory is that there's something in the machinery or the cytoplasm, not the nuclear portion of the egg,
32:35but the surrounding portion of the egg, that moves those chromosomes around that causes these defects in the older woman.
32:42To avoid the possibility of chromosomal damage, Griffo went one step further than cytoplasmic transfer.
32:54He carefully took the nucleus from an older woman's egg and injected it into a younger donor egg that had had its nucleus removed.
33:05The reconstructed egg was then fertilized and allowed to divide using the machinery in the cytoplasm of the younger donor.
33:15And we were able to reconstruct an egg in that fashion, get it to fertilize and make embryos.
33:20And we did it in a couple of patients, and we transferred embryos, and nobody got pregnant.
33:24We only transferred three or four embryos total in the experiment.
33:27But then we got into trouble.
33:30Criticized for unacceptable human experimentation, Griffo returned to the lab.
33:37Nuclear transfer techniques had recently been used to clone animals.
33:43And although Griffo was not trying to clone a human being,
33:47some feared his work might take us one step closer.
33:51There's a lot of criticism of human reproductive biologists
33:58who are using all these new technologies to allow people to have babies.
34:02Because as a scientist, you do all of this background research,
34:05and you don't try anything until you're absolutely 100% confident.
34:10But in these cases, we have women and men who are desperate to have children.
34:15And what the reproductive biologists are working on is the basic premise that
34:19if you do a manipulation and you've manipulated it too far, you don't get a birth defect.
34:25You get no fetus or baby.
34:31On December 20, 1998, Ann delivered a healthy baby girl named Katie.
34:39She was the third child born using cytoplasmic transfer.
34:46This was my closure. This birth was closure to five years of infertility.
34:51And I really think this whole experience, when I look back on it,
34:55it made me and it makes me appreciate my daughter and my family so much.
35:01And every day I look at her in amazement that she's here and that she's my child.
35:08She knows her background. She knows her roots.
35:10And to me, that's important.
35:14Katie has a mix of her parents' genes, as well as traces of mitochondrial DNA from the egg donor.
35:23But was cytoplasmic transfer responsible for her birth?
35:29My problem with cytoplasmic transfer is I can't conceptualize very well what, in fact, is the significant component
35:36that's being transferred from the cytoplasm of a donor egg to the cytoplasm of the infertile woman's egg
35:43that's conferring upon that egg some kind of improvement in quality if, in fact, that's happening.
35:48I mean, the numbers at this point don't allow us to say anything in terms of efficacy.
35:52And clearly they don't allow us to say much in terms of safety.
35:58There's no scientific proof that the genetic change brought about the development of this child.
36:04But there is scientific proof that this child has DNA from a source other than her parents.
36:11And so this is the first instance of genetic engineering,
36:14whether or not the genes themselves really had an impact on allowing this child to be born.
36:19The threshold has been crossed. We have already engineered embryos.
36:24And so people can't say, well, we have to wait until a certain point. It's already been done.
36:33With each new breakthrough in making babies, the limitations and randomness of nature are slowly being overcome.
36:40One of the most intractable barriers egg donation has pushed back is the limit of age.
36:47Back in 1980, when Arcelia Kay got married, she was entering menopause and had no chance of becoming pregnant or even adopting a child.
36:59For years, she followed the development of IVF, hoping that new techniques might help her become a mother.
37:09She saw her chance with egg donation and, at age 60, decided to bend the rules.
37:21I really lied about my age because they have this age limit at 55.
37:26So I think I will not qualify if I will not lie, you know, about my age.
37:32And I really want to have a baby.
37:35She presented herself as someone who was 50 years old, well within our age guideline of 55.
37:41Underwent the usual kinds of medical testing, including a treadmill test and a variety of other blood tests that we do on all the patients.
37:49And as far as we were concerned, we thought that she was just another routine patient.
37:54Mrs. Kay took hormones to force the tissues lining the walls of her uterus to thicken.
38:02Within months, her womb returned to its premenopausal state, capable of sustaining a pregnancy.
38:10Then, donated eggs, fertilized with her husband's sperm, were transferred back.
38:21After spending $40,000 and enduring five IVF cycles, she gave birth to Cindy.
38:30At age 63, she was the oldest woman to ever have a baby.
38:37The deception had been obvious. She knew that she had deceived us.
38:41She did it consciously and successfully because she had attained the goal that she had wanted to.
38:47What should I tell her? Scold her for being not forthright? I congratulated her.
38:56I feel very happy, actually. She changed her life for a better one.
39:02I just hope God will give me a much longer life, you know, to be around her.
39:11When an older woman has a baby, it's very likely that her partner or mate may be old as well.
39:18And I think it's risky to create orphans.
39:21So you might want to set an age limit, if not on the age of the woman, then at least on the couple,
39:27so that you do what we do in adoption, which is to say at some age we're nervous that you can't be around
39:32to make sure that the child's interests are protected.
39:35The creation of families with borrowed eggs, sperm or wounds has raised a myriad of complex issues.
39:47One of the most difficult is explaining to children how they came to be.
39:52Oh, help. There's a mouth about the house.
39:55That's okay.
39:56And it gave Mrs. B a fright.
39:58That's okay.
39:59That's okay, huh?
40:00When we turn to IVF from traditional methods such as artificial insemination,
40:06one of the things we did think about was what story we tell our children.
40:11Because when you start separating the functions of carrying the child
40:17versus donating the genetic material, then it becomes more complex.
40:21Will and Marceline created a birth book to explain to Melina why she doesn't have a mother in the traditional sense.
40:30Mr. B jumped up and down.
40:32It's a very simple story about how her daddy and papa met, fell in love, wanted a family,
40:38and how men don't have eggs and women have eggs, and men can't carry children or deliver children, but women can.
40:46And Pop and Daddy searched the world to find two women who would help them.
40:51There's like 18 different ways to make a baby now because of the technologies.
40:56And you know, that makes us have to rethink, what is a family?
41:00Well, the fact is, what it means to be a family is to have a parent or two parents raise a child and care for the child
41:07and have an attachment to that child that nobody else has and a responsibility to that child that no one else has.
41:12And that's really what matters.
41:14Assisted reproduction began with the idealistic goal of helping infertile couples have babies.
41:24But increasingly, it has given parents greater control over their unborn offspring.
41:30At a leading infertility clinic in Virginia, a technology called microsort is enhancing the ability of science to determine one of a child's most important traits, its sex.
41:45The commonest types of individuals that we help are families who are at risk for having children with X-linked disorders.
41:54These are disorders that affect males, and therefore microsort can be very helpful in producing disease-free female offspring in these families.
42:03And the other largest group come to us for family balancing, where they already have a preponderance of children of one gender in the family,
42:10and they wish to weight the odds in favor of the opposite gender.
42:15Of the 23 chromosomes carried by the sperm, only one determines gender.
42:24Sperm carrying an X chromosome will produce a girl.
42:28Sperm carrying a Y chromosome will produce a boy.
42:31For $3,200, sophisticated machines can detect the minute differences in size between male and female sperm, and sort them.
42:46The chance of having a girl when that is sought exceeds 90%, and the chance of having a son exceeds 70%.
42:54I think what's involved here is not the choice of boy or girl, it's the fear of sexism.
43:02If we knew that the percentage of boys and girls would be about the same, I don't think anybody would care.
43:07So I think the issue isn't choice of sex, it's actually is it going to distort the makeup of the population,
43:13or reinforce stereotypes about men and women.
43:16Sex selection has already led to an imbalance in India, where there are an estimated 40 million fewer women,
43:26primarily because of the routine abortion of female fetuses.
43:32In China, the desire for boys at one point changed the sex ratio to 153 Chinese males, for every 100 females.
43:41In contrast to the rest of the world, American parents are using microsort to have baby girls.
43:52I think if patients want to use it and want to spend the amount of money that's required, that's their choice.
43:57To me, it's the wrong message. To me, gender is not a disease, and I'm not going to select against it.
44:02I want people to have healthy babies, and whether it's a healthy boy or a healthy girl, I don't care.
44:11Choosing a baby's sex is a far cry from designing our children.
44:18But eventually, parents will have even more choices, using a powerful technique called pre-implantation genetic diagnosis, or PGD.
44:30From a single cell plucked from an embryo, doctors can analyze individual chromosomes and genes.
44:36This microsurgery rarely harms embryos, and helps doctors figure out which ones are disease-free.
44:45One of the earliest pioneers to use PGD was Barbara Nastro.
44:51I had many chemical, what they refer to as chemical pregnancies, so that means that I would become pregnant, and then within a couple of weeks of holding the pregnancy, it would fizzle out.
45:06When we see that, it's very suggestive that many of the fertilized eggs have abnormal chromosomes, and that nature is just doing its best to stop these abnormal pregnancies from developing.
45:19At age 41, Barbara underwent IVF in order to use PGD to test her embryos.
45:30A single cell was plucked from each one, and analyzed with fluorescent dyes targeted to bond with five specific chromosomes, most prone to have either an extra copy or a missing one.
45:41Embryos with the correct number of chromosomes, like this one, with matching pairs of color signals, could be transferred back.
45:53In contrast, this embryo is missing one of its red signals, and would not develop normally.
46:02Barbara had nine fertilized eggs to test.
46:05And it turned out that four of them were chromosomally abnormal, including some of the embryos that looked very, very good, that typically we would have transferred, and would have resulted in another miscarriage.
46:19And we subsequently transferred the normal embryos, and a successful pregnancy occurred.
46:26Barbara gave birth to healthy fraternal twins, Gabriel and Luke.
46:31Although PGD spared her repeated miscarriages, its cost, in conjunction with IVF, was almost prohibitive.
46:42The pre-genetic determination test alone, as I recall, is about $20,000.
46:49Plus, then, when our babies were born early, premature, six weeks, they then had to spend the three weeks in the NIC unit.
46:55That alone, I believe, was somewhere in the several hundred thousand dollars for them to be there for that length of time.
47:02It's an enormous amount of money. Money that, you know, is inconceivable to most couples.
47:09No, you're not sleepy. Okay. That's fine.
47:12But for parents who risk passing on inherited diseases, like cystic fibrosis, PGD offers the hope of having a healthy baby.
47:20At the moment, scientists can look for genes related to several dozen diseases.
47:28But our ability to screen embryos will improve exponentially, as a result of the decoding of the human genome.
47:37And what's going to happen over the next decade is we're going to understand how those genes cause all sorts of diseases, like asthma, or juvenile diabetes, or severe depression, or predisposition to heart disease, or Alzheimer's diseases.
47:56All these diseases are going to be understood in terms of their genetic influence.
48:04To exploit this knowledge, technology is emerging that allows DNA fragments containing thousands of genes to be analyzed with automated gene scanners.
48:16In the future, DNA computer chips may be able to tell you every single form of the approximate 30,000 genes that you've got.
48:26They used to say that a child conceived in love has a greater chance of happiness.
48:31Hollywood has already imagined the implications of this powerful technology.
48:36I'll never understand what possessed my mother to put her faith in God's hands rather than those of her local geneticist.
48:43Ten fingers, ten toes, that's all that used to matter. Not now.
48:52Now, only seconds old, the exact time and cause of my death was already known.
48:57Neurological condition, 60% probability.
49:07Manic depression, 42% probability.
49:10Attention deficit disorder, 89% probability.
49:13Heart disorder.
49:14The amazing thing about Gattaca is that it's scientifically right on the mark.
49:20Because it will be possible in the future to take a drop of blood from a child and know the predispositions to every kind of disease that this child is going to face in his or her life.
49:31DNA chips revolutionize our ability to look at human genes.
49:37And it will be possible in the future to use a DNA chip on embryos.
49:41What I envision in 20 years is that someone will be able to go to the in vitro clinic who's very fertile, who has no infertility problems at all, but simply says,
49:53if you can tell me a lot about the kind of child that I'm likely to have, then I'm going to spend the money and use an artificial way to create a baby to kind of get a better baby.
50:02And then what a couple would be able to do is to look at their computer screen and look at what the child's height would be, certainly what the hair color would be, whether the child's going to go bald, whether the child's going to get asthma, whether the child's going to be a bit aggressive or shy.
50:17All of these things are going to come out of looking at a DNA chip profile from each of these embryos.
50:24The limitation to pre-implantation genetic diagnosis is that parents can only select for genes that embryos already have.
50:32But scientists have begun inserting new genes into embryos, endowing thousands of animals with unusual traits.
50:42A specific gene from a jellyfish can make mammals glow in the dark.
50:49Molecules involved in learning and memory can be genetically augmented to create smarter mice.
50:56As reproductive biology and genetics merge, will parents of the future have the tools to design their children with new strengths and talents?
51:08Yes, these things could happen. Right now, they don't. We don't know the genes for hair color, eye color, intelligence. We don't know how to select for them. We don't know how to analyze for them.
51:19So these fears, while based in the potential reality that they could occur, are really unfounded.
51:27I think we'll see this happen. I think it's going to be very difficult to say to people, you can't do this, because in a sense today we're already down that road.
51:34Some people do everything they can to environmentally advantage their kids. Do we say they're morally wrong? In fact, we say they're doing a morally good thing.
51:43It's good to give your child, in a competitive market society, the best shot at success.
51:49And I think that's the ethos that's going to carry us right straight into using pre-implantation, genetic testing and new genetic knowledge to design our descendants.
52:04In many ways, the brave new world of assisted reproduction promises far more benefits than perils.
52:13In the 21st century, newborn children will be spared lethal diseases that plagued past generations.
52:23As the mysteries of reproduction give way to knowledge, even infertility might be overcome.
52:32For Elissa and Darren, ICSI has paid off.
52:35They are now the elated parents of a healthy baby girl named Sarah, born January 29th, 2001.
52:45Anne's daughter, Katie, appears to be healthy and developing normal.
52:50What did he say?
52:52Although cytoplasmic transfer is still highly experimental,
52:56for the small group of patients that have turned to it, 36% have become pregnant.
53:02Hi, Baxter.
53:04People are afraid of the unknown.
53:07And most people, therefore, reject new technology.
53:10It takes the mavericks, the maverick scientists,
53:13and the people who have some guts to work with the maverick scientists and clinicians
53:18to bring the technology into the public domain.
53:21There are risks to these things, but there's also risks to not treating disease.
53:26And people forget that.
53:27People forget how hard it is to live with infertility.
53:31People forget how devastating that is.
53:33And people don't understand why patients are willing to take these unknown kinds of risks
53:38to have that child, because they forget about the disease.
53:41Doctors today have a surprising number of ways to help make a baby.
53:57On NOVA's website, explore the more than 18 high-tech procedures now in use.
54:02On PBS.org, or America Online keyword, PBS.
54:11Educators can order this or any other NOVA program for $19.95 plus shipping and handling.
54:34Call WGBH Boston Video at 1-800-255-9424.
54:41NOVA is a production of WGBH Boston.
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