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days, and is primarily used by fertile couples who are worried about a particular disease that runs in the family. The second is a less targeted technique, known as pre-implantation genetic screening, or PGS, which has a turnaround time of twenty-four hours. PGS looks for mistakes across all of an embryo’s chromosomes, using tests that can detect any abnormalities in an embryo’s chromosomes – for instance, if it gained extra chromosomes, or lost some of them. This technology is still new and evolving, but it is likely to improve in the next few years. As it does, the genetic weaknesses involved when IVF or ICSI is necessary will almost certainly become less of a problem. With better PGS, fertility doctors will gain the ability to pick the most normal embryos.

Of course, while genetic problems may be soon within the reach of science to resolve, IVF and ICSI also give birth to complex moral conundrums that would never arise in a world where every pregnancy happens through sex. When fertilization occurs outside of the womb, and the embryo is then placed there, a woman becomes able to carry a child to term who is not genetically her own. For a woman who does not have good quality eggs, this is a great advantage, because she can choose to use an egg donated from another woman.

The technology has also become a very efficient way for older women to have successful pregnancies – by freezing a number of eggs or early-stage embryos from which they can select, and then trying each one out. Some women choose to freeze their eggs at a young age, and use these healthier eggs later in life, when they are ready to have children. But mistakes do happen.

In 2009, Caroline Savage, a forty-year-old American mother of three, returned to the fertility clinic where she had previously received IVF – and got pregnant. The clinic had kept frozen five of her early-stage embryos, left over from her last cycle of treatments. Unfortunately, there was a mix-up, and the embryo implanted into her womb was not one of her own; it belonged to a completely different couple, who also had ‘leftover’ embryos stored at the clinic.

Ten days after the procedure, Savage received a call from her doctor, notifying her of the error – news she later described as the worst of her life. The clinic’s directors offered her a choice: an abortion (free of charge, one presumes) or a surrogate pregnancy (after which she would give the child to its rightful genetic parents). Savage opted for the latter, on religious grounds, and because she realized that if one of her embryos had been mistakenly inserted into another woman’s body, she would go to the ends of the earth to get back her child. And if that hypothetical surrogate had chosen the abortion, she would have been helpless to stop it. In the state of Ohio, where Savage lived, surrogacy agreements are open to interpretation, though genetic parents are considered natural and legal parents of a child that another woman has carried. This was no surrogacy case, however; there was no intention, let alone an agreement, to have someone else’s baby end up in Savage’s womb. Yet, in this case, Ohio law recognizes the woman whose womb the foetus is in to be the mother of the child, rather than the woman who is genetically related to it. As mere donors of genetic material used to create that embryo, the other couple have no parental rights or responsibilities with respect to the child being carried to term.

Wracked with this knowledge, Savage and her husband asked a lawyer to reach out to the genetic parents, and three months later the couples met. The pregnancy was a difficult one for Savage, and she was scheduled for a Caesarean section. She cannot now risk another pregnancy herself, but still wants to grant a chance of life to her remaining embryos. To do so, she will have to hire another woman to carry the embryos to term. Savage would never have given birth to someone else’s genetic child in a world without IVF, but nor would another woman have been able to give birth to hers.

Infertility is a complex problem with many causes, and its solutions present just as many ethical conundrums. A century ago, European doctors tried to allay the public’s fears by claiming that there was nothing truly ‘artificial’ about this new method of insemination. After all, the babies produced would be very real, the equal of any who had been naturally conceived. The field of reproductive medicine was simply a way of assisting nature.

Today, around one out of every fifty babies born in the UK, and one in a hundred babies in the US, starts life in a lab. What is more, starting life in vitro is no longer seen to be unnatural. In Europe, around one in four young men now have a sperm count that would render them subfertile or infertile; they will likely need to use ICSI if and when they decide to reproduce. An estimated sixty thousand women in Britain seek IVF every year. By the current medical definition of infertility – the failure to achieve a pregnancy within one year of regular, unprotected intercourse – some nine million people in the UK fall into this category.

There are many women with abnormally shaped wombs, unhealthy eggs, or no eggs; many men whose sperm are just not up to scratch; and men and women who have had, for example, treatments for cancer that have killed off their reproductive material before they have had a chance to become a parent. Some couples can’t have children because one of them is infertile, but if a couple cannot have a child because they are two men or two women, then technically, they are infertile