Prenatal Assessment

A number of assessments are suggested to women as part of their routine prenatal care to find conditions that may increase the risk of complications for the mother and fetus (Eisenberg, Murkoff, & Hathaway, 1996). These can include blood and urine analyses and screening and diagnostic tests for birth defects.

Ultrasound is one of the main screening tests done in combination with blood tests. The ultrasound is a test in which sound waves are used to examine the fetus. There are two general types. Transvaginal ultrasounds are used early pregnancy, while transabdominal ultrasounds are more common and used after 10 weeks of pregnancy (typically, 16 to 20 weeks). Ultrasounds are used to check the fetus for defects or problems. It can also find out the age of the fetus, location of the placenta, fetal position, movement, breathing and heart rate, amount of amniotic fluid in the uterus, and number of fetuses. Most women have at least one ultra sound during pregnancy, but if problems are noted, additional ultrasounds may be recommended.

When diagnosis of a birth defect is necessary, ultrasounds help guide the more invasive diagnostic tests of amniocentesis and chorionic villus sampling. Amniocentesis is a procedure in which a needle is used to withdraw a small amount of amniotic fluid and cells from the sac surrounding the fetus and later tested. Chorionic Villus Sampling is a procedure in which a small sample of cells is taken from the placenta and tested. Both amniocentesis and chorionic villus sampling have a risk of miscarriage, and consequently they are not done routinely.

Box 2.4 Infertility and Reproductive Technology

Infertility: Infertility affects about 10 to 15 percent of couples in the United States (Mayo Clinic, 2015). Male factors create infertility in about a third of the cases. For men, the most common cause is a lack of sperm production or low sperm production. Female factors cause infertility in another third of cases. For women, one of the most common causes of infertility is the failure to ovulate. Another cause of infertility in women is Pelvic Inflammatory Disease (PID), which is an infection of a woman’s reproductive organs (Carroll, 2007). It is a complication often caused by some STDs, such as chlamydia and gonorrhea. Other infections that are not sexually transmitted can also cause PID. Based on a nationally representative sample from 2006-2010, 5.0% of U.S. women have reported being treated for PID in their lifetime, and 1 out of 8 women with a history of PID experience difficulties getting pregnant (CDC, 2014). Both male and female factors contribute to the remainder of cases of infertility.

Fertility treatment: The majority of infertility cases are treated using fertility drugs to increase ovulation or with surgical procedures to repair the reproductive organs or remove scar tissue from the reproductive tract. In vitro fertilization (IVF) is used when a woman has blocked or deformed fallopian tubes or sometimes when a man has a very low sperm count. This procedure involves removing eggs from the female and fertilizing the eggs outside the woman’s body. The fertilized egg is then reinserted in the woman’s uterus. The average costs of IVF are between $12,000-$17,000 (U. S. National Library of Medicine, 2014). The success rate varies depending on the age of the mother and type of egg implanted, such as whether the egg was recently removed from the woman, used after being frozen, or donated from another woman. According to a 2006 CDC report on assisted reproductive technologies that led to a healthy baby, the percentages were as follows:

  • 40.9% in women aged 25
  • 39.5% in women aged 30
  • 33.4% in women aged 35
  • 15.4% in women aged 40

Higher success rates, but less common procedures include gamete intra-fallopian tube transfer (GIFT) which involves implanting both sperm and ova into the fallopian tube and fertilization is allowed to occur naturally (Carroll, 2007). Zygote intra-fallopian tube transfer (ZIFT) is another procedure in which sperm and ova are fertilized outside of the woman’s body and the fertilized egg or zygote is then implanted in the fallopian tube. This allows the zygote to travel down the fallopian tube and embed in the lining of the uterus naturally. This procedure also has a higher success rate than IVF.

Insurance coverage for infertility is required in fifteen states, but the amount and type of coverage available varies greatly (American Society of Reproductive Medicine, 2015). The majority of couples seeking treatment for infertility pay much of the cost. Consequently, infertility treatment is much more accessible to couples with higher incomes. However, grants and funding sources are available for lower income couples seeking infertility treatment as well.