Choosing to Skip Sex and Go Straight to I.V.F.

In February, in vitro fertilization, or I.V.F., was thrown into the spotlight when the Alabama Supreme Court ruled that frozen embryos in the state should be considered children. The decision led to a pause on I.V.F. procedures in parts of the state, and even a pause on shipping embryos out of state, to avoid potential criminal liability. In early March, a law was passed to protect I.V.F. providers, prompting some clinics to resume the procedure, though legal challenges could still emerge.

Such rulings could have sweeping consequences for a huge number of would-be parents: In the United States, more than 2 percent of all infants born are conceived using assisted reproductive technology, of which I.V.F. is the most common. At least 12 million babies have been born globally using I.V.F. since 1978, according to the National Committee for Monitoring Assisted Reproductive Technologies.

Couples who choose I.V.F. are still in the minority of those trying to conceive. They tend to be wealthy (the cost of a single cycle of I.V.F. is around $23,474, according to Fertility IQ, an educational website about fertility) and are mostly in their mid- to late 30s or 40s, when the statistics for conceiving naturally are not in their favor: At age 35, there is a 15 percent chance of conceiving naturally per month, according to the American College of Obstetricians and Gynecologists. At 40, that drops to 5 percent.

Dr. Alan Copperman, the chief executive of RMA of New York, a fertility center, is one of many doctors seeing more couples, who are well aware of the challenges of conceiving and carrying a healthy baby to full term, skip sex and go straight to I.V.F.

The challenges that couples cite vary widely. They may not “have the time to try naturally,” said Dr. Copperman, who is also a professor of obstetrics, gynecology and reproductive science at the Icahn School of Medicine at Mount Sinai in New York. “They want to use technology to achieve their reproductive goals,” he said.

The choice may also be an issue of logistics; couples may not be in the same place long enough to have sex during ovulation windows. “I’ve had a lot of patients who are working in consulting or have a business, and they travel a lot for work,” said Dr. Denis Vaughan, a reproductive endocrinologist at Boston I.V.F. “They might tell me they’ve been trying for six months, but they’ve really only been together at the right time for two or three months of that time.”