Childless See New Hope ‘in Vitro’

During their four years of marriage, Lisa and Bill Holst repeatedly failed in their attempts to have a baby. So last spring, the El Toro couple went to an infertility specialist to discover the cause and cure of a problem that affects one in five American couples of reproductive age.

“We were shocked to find out that I was seven weeks pregnant,” Lisa, 24, recalled recently as Bill, 26, sat on a couch beside her in the living room of their cheerfully decorated condominium.

The Holsts’ delight soon turned to dismay when further tests showed that Lisa had a false, or ectopic pregnancy, in which the egg lodges in one of two slender Fallopian tubes as it travels from the ovaries to the uterus. In order to remove the egg, which had grown into a life-threatening cyst in her blocked right Fallopian tube, Lisa last April underwent emergency surgery; both Fallopian tubes were removed.

However, Lisa’s surgeon was careful not to damage either of her egg-producing ovaries or her uterus--where the egg is deposited and the embryo and fetus develop; he felt that she was an ideal candidate for an in vitro fertilization, or “test-tube” baby program.

Thus, the Holsts became one of 175 couples to sign up for Orange County’s first test-tube baby program. This month-old In Vitro Fertilization and Embryo Transfer (IVF-ET) Program is operated by UC Irvine’s 7-year-old Infertility Institute at the university-affiliated Women’s Hospital of Memorial Medical Center in Long Beach.

In vitro fertilization is a procedure in which a woman is impregnated by removing one or more of her eggs, fertilizing the eggs with her husband’s sperm in glass dishes and then returning these embryos to the womb where it is hoped that at least one of these multiple embryo transplants will survive to develop into a baby.

According to in vitro specialists, the eggs are removed from the ovary by one of two methods: either laparoscopy or ultrasound guided needle aspiration. Laparoscopic egg retrieval is a form of surgery in which an incision is made in the woman’s navel area and a small telescope, or laparoscope, is inserted through the incision to bring the ovaries into view. The physician then directs a needle to find and remove the eggs from their follicles.

In contrast, ultrasound guided egg retrieval is done without surgery. A woman is given local anesthesia and physicians use ultrasound to guide them as they insert specially designed needles through the abdomen to find and remove eggs from the ovary. This procedure is more comfortable for the woman, according to in vitro specialists, and may cost $1,000 less than the $5,000 laparoscopy procedure.

Those most suited for the IVF-ET program are women like Lisa Holst who have no Fallopian tubes or who have both of them blocked, preventing the movement of eggs or sperm, said program director Dr. Paulo Serafini. Other suitable IVF-ET candidates are those 5% of patients with unexplained infertility--cases in which all the standard infertility tests have been performed and show normal results but the couples still are incapable of having children--or cases in which alternative infertility treatments have failed.

Others suitable for the IVF-ET program, Serafini said, are couples in which the husband has some type of sperm abnormality such as low sperm count or poor motility (poor movement of sperm).

“A woman’s participation (in IVF-ET) will be both physically and emotionally demanding,” Serafini explained during a recent tour of the IVF-ET laboratory at Memorial Medical Center in Long Beach. “IVF is quite complex and requires the full understanding and cooperation of both the woman and her husband at all times.

Method Now ‘Fashionable’

“Since (the first IVF-ET birth in 1978 of Louise Brown in England), a lot of programs have used IVF as a way of treating infertility,” continued Serafini. “It has become fashionable, but the fact of the matter is that IVF is psychologically difficult for couples (requiring two psychologists to be on staff), expensive and the pregnancy rate is low. Still, IVF is better than nothing, and there have been tremendous advances in the procedure since 1980.”

Echoing this view is Dr. Sergio Stone, a professor at UCI’s College of Medicine and director of the Infertility Institute. During an informational meeting in June attended by about 180 couples, Stone cautioned: “We’ve got a big crowd here tonight, but some of you might not be interested in our IVF program after you find out that during the first year or two we don’t expect to have a pregnancy rate greater than 20% per impregnation attempt, or ‘cycle.’

“And because half the resulting fetuses are lost because of miscarriages or other complications, we don’t expect a live-birth rate greater than 10%. I wish I could promise you a 35% pregnancy rate per cycle, which some programs are claiming, but I cannot say this in good conscience.”

Serafini and Stone, who have visited or studied the leading IVF-ET clinics throughout the world in preparation for the UCI program--which has been in the active planning stages for two years--both point to the IVF-ET program at the Queen Victoria Medical Center in Melbourne, Australia, as the most successful program anywhere today; it only claims a 35% per cycle pregnancy success rate.

Despite these odds and the financial and psychological costs, Serafini said 175 couples have already been screened and accepted into the program, which has a waiting list of six to nine months. Of these couples, 40% are from Orange County, 30% from Long Beach and Los Alamitos, 10% from greater Los Angeles, 5% from San Diego County, 5% from Riverside and San Bernardino counties, 5% from other states and 5% from abroad.

(Those interested in obtaining further information about the program may call (213) 595-2229.)

High Infertility Rate

“In this country we have a shockingly high infertility rate of 15%,” said Johannah Corselli, IVF-ET’s director of laboratories who holds a doctorate in reproductive biology. “So many couples are coming to us because they see us as their last hope for having a baby.”

About 3.5 million American couples, or one in five couples of reproductive age, are infertile--meaning they’ve failed to conceive a child after trying for one year--and the numbers are increasing, studies show. Speculation on the cause of increased infertility centers on such factors as birth control-related problems, infections, disease and physical disabilities.

Although the the prime fertility age for women is about 20, says Stone, today more women are postponing pregnancy until their 30s. Such is the case with Melinda Dooley, 34, of Chino Hills in San Bernardino County. During an interview with her and her husband, Mark, 28, at their home, Melinda said that they began seeing an infertility specialist last October.

“I was approaching my 34th birthday, and I could hear the biological time clock ticking away,” Melinda said, referring to studies showing that a woman’s fertility declines modestly with age until she reaches 35, when the unfavorable odds mount rapidly. “I realized that if I was going to have kids, it was now or never.

“I’d come to grips with the fact that I really wanted to be a mother. You can have your career, home, travel and other selfish things, but I didn’t want to live the rest of my life just doing selfish things.”

Mark added: “You go through life thinking you can have a kid anytime you want. But when you realize you can’t have a child, it sparks this desire in you; a baby becomes more precious, more dear to you, than almost anything else in the world.”

Ovary Regenerated

Four years before, Melinda’s chances of giving birth greatly diminished when it was discovered that a cystic tumor had destroyed her right ovary and right Fallopian tube and was expanding into her left ovary. In removing that life-threatening tumor, her surgeon had delicately peeled what remained of her left ovary from the cyst in the hope that the ovary would regenerate and make pregnancy possible.

“When I first came out (of the anesthesia), I asked the doctor if I could still have children,” said Melinda, an office administrator for a Placentia chiropractor. “His answer was, ‘I don’t know, but I did what I could.’ Fortunately, my left ovary regenerated--as my doctor had hoped.”

Delayed Trying

The Dooleys delayed trying to conceive not only to give Melinda’s one remaining ovary a chance to regenerate naturally, but also because Mark felt the time wasn’t right before last fall because he was busy establishing an Anaheim motorcycle performance parts company, which he co-owns.

Last fall, Melinda began receiving fertility drug injections. Soon thereafter she became pregnant, but it turned out to be a tubal pregnancy that threatened to rupture Melinda’s uterus and cause her to bleed to death. She underwent emergency surgery last December.

“It was physically painful, but the thing that hurt the most was that I lost the child I wanted so very much,” Melinda recalled. She was doubly depressed when she learned she also had lost her remaining good Fallopian tube during surgery. As she lay in bed recuperating at home, Melinda felt doomed to never being able to give birth.

Enthusiasm Not Universal

But this summer Melinda learned of UC Irvine’s IVF-ET program during a conversation with a patient in the chiropractor’s office where she works. She remembers saying to herself, “Thank you, Lord, for answering my prayers.”

Yet family members, friends and co-workers sometimes do not share the enthusiasm infertile couples show for IVF-ET programs, say the Dooleys and Holsts.

“Most of our friends are supportive, but they don’t understand exactly what we’re doing” in IVF-ET, Lisa Holst said. “Some of them seem to think we’re doing something weird; they think the baby’s going to be created out of a concoction in a test tube rather than it actually being our baby.”

Voicing similar concerns, Mark Dooley said: “The stereotype of the test-tube baby--which I had myself before I learned more about the procedure--is that the doctor is going to pour a bunch of chemicals in a test tube and create a Frankenstein by making the baby’s genetic makeup different from his parents.’ ”

Their friends’ confusion is understandable, IVF-ET experts say. The unfortunate and misleading “test-tube” baby appellation, they say, appeared when the first in vitro baby was born in 1978. The popular press, in an attempt to explain the Latin term in vitro -- literally meaning “in glass”--fell back on the dictionary definition of “isolated from the living organism and artificially maintained, as in a test tube .”

No Genetic Tampering

IVF-ET laboratory director Corselli explained that although it’s true that the fertilization of the mother’s egg by the father’s sperm occurs outside her body, this fertilization takes place in a shallow round petri dish--and not a test tube, which is long and narrow. The fertilized egg, or microscopic embryo, is then returned to the mother’s body, where in the uterus it, the principals hope, will develop into a baby. There is none of the genetic tampering that the term “test-tube” baby connotes, Corselli said.

Since most infertile couples, about 85% of them, can be helped by other methods, Serafini said the IVF-ET program should be considered as a last resort after exhausting other treatment avenues. (Those interested in exploring other infertility treatment options offered by UCI’s Infertility Institute may call (714) 634-5617).

Couples Must Pay

Most insurance companies consider the IVF-ET procedure experimental, or investigative, and thus do not provide reimbursement for the procedure, Serafini said. Couples, therefore, are required to pay the $5,000 IVF-ET fee in advance. Moreover, each couple is required to pay another $5,000 for each cycle, or attempt to have a baby using the IVF-ET procedure, Serafini said.

Serafini said he and his colleagues have not yet decided on the maximum number of cycles they will recommend for couples, but other IVT-ET experts say many couples try the procedure three or four times.

‘What’s $5,000?’

The Holsts have had to borrow the initial $5,000--since neither Bill’s insurance plan through his job at Bolsa Grande High School in Garden Grove nor the insurance coverage Lisa has through her job as a secretary for a Mission Viejo land developer will pay for IVF-ET.

“Most people can’t comprehend why we’re willing to spend $5,000 to have a baby,” Lisa said. “But for them it’s easy to have a baby, so they don’t understand the emptiness you feel in your life when you don’t have a child.”

Added Bill, who’s a physical education teacher and football and baseball coach, “Taking out the $5,000 loan left us broke.” But referring to studies that show that it costs more than $80,000 to raise a child through age 18, Bill asked, “What’s $5,000? We spent twice that much on cars last year.”

Mark Dooley, recalling the trauma he and Melinda went through last December following her tubal pregnancy surgery, said: “We thought back then we wouldn’t be able to have a baby at any price. People who can conceive naturally are bound to say, ‘Gosh, $5,000 is a lot of money.’ But for Melinda and me, $5,000 seems like nothing.”

In the wake of the birth last May of the Frustaci septuplets--conceived after their mother was administered the fertility drug Pergonal, delivered 12 weeks premature and ending in the death of four of them--couples contemplating having babies using fertility techniques are increasingly concerned about multiple births.

Number of Transfers Limited

Serafini, who shares these fears, said, “Early on in IVF, around 1981, it was felt that multiple embryo transfers would result in better fertility rates.

Studies of the Melbourne IVF program, which has the world’s best pregnancy rates, have found that while the pregnancy rate jumps from 7% just using one embryo transfer to 20% using two embryo transfers, any marginal increase in the pregnancy rate using many more than two or three embryo transplants is far outweighed by the danger of multiple pregnancies.

“We’re not going to transfer more than two or three embryos for most couples--and a maximum of four to six embryos in extraordinary circumstances if the couple insists on it--because nobody wants a woman giving birth to seven children at once. Twins are fine, but we want to avoid having one of our patients giving birth to more than two children at once.”

Lisa Holst, who said the possibility of multiple births was the only major misgiving she has about the IVF-ET program, acknowledged: “I can’t imagine having three kids at one swoop. But it’s something that I really have no control over, and if it came down to a choice between three babies or none, I’d take the three babies any day.”