New Hope for Childless : Huntington Memorial Hospital to Offer Ovum Transfers to Infertile Women

In the next few weeks, an advertisement will appear in San Gabriel Valley newspapers showing a woman and child and asking a simple question: “Remember your baby’s first touch?”

Beneath the question, the ad says, “Help the women who never will.”

The plea is part of an areawide search by Huntington Memorial Hospital for healthy women willing to participate in an infertility treatment program that will start at the Pasadena hospital in March.

The program involves a recently developed technique called ovum transfer, which allows women with no eggs of their own to carry and give birth to a child using eggs donated by another woman.

The non-surgical treatment involves fertilizing an egg in the donor through artificial insemination and, after a short growth period, transfering the fertilized egg into the uterus of the infertile woman, who carries the child through a normal pregnancy and delivers the baby.

Related Only to Father

The child will be genetically related only to its father, who provides the sperm to inseminate the donor’s egg. However, for many couples whose only alternative had been adoption, the advantages of ovum transfer outweigh the fact the egg is another woman’s.

“The child may not have my genes, but it is still going to be my husband’s sperm,” said one woman enrolled in a similar program at Memorial Medical Center of Long Beach. “And I’m going to carry it. To carry the child is really important to me.”

The treatment, which was developed by a team of doctors at Harbor/UCLA Medical Center in Torrance and Dr. Leonardo Formigli, an Italian physician, has resulted in nine births since clinical experimentation began in 1982.

The treatment has been available on an experimental basis in this country since 1982 and became available to patients last October, when the first ovum transfer clinic was opened at Memorial Medical Center of Long Beach.

Huntington Memorial will be the second hospital in the country to open a clinic.

The clinics in Long Beach, Pasadena and Milan are joint ventures with a private company, Fertility and Genetics Research Inc., which plans to operate up to 50 ovum transfer clinics nationwide over the next five to seven years.

The clinics could treat an estimated 12,500 infertile women a year, according to Dr. John R. Marshall, former chairman of Harbor/UCLA Medical Center’s department of obstetrics and gynecology and now medical director for Fertility and Genetics Research.

Marshall said he expects the clinic at Huntington Memorial to treat up to 150 women during its first year and up to 250 women a year in the next two years as the number of women willing to donate eggs increases.

The treatment has produced pregnancies in about 10% of the inseminations so far, Marshall said. That compares to a success rate of 3% to 30% reported for in vitro, or “test-tube,” fertilization, according to figures provided by the American Fertility Society.

However, Marshall said that as doctors gain experience with ovum transfer, the success rate will rise as high as 25%, which is the probability of healthy couples conceiving a child during any given month.

Fertility and Genetics Research also plans to begin experimenting soon with so-called superovulatory drugs that increase the number of eggs a donor ovulates, significantly increasing the chances of pregnancy for the infertile woman.

It now costs $2,500 for the health and psychological screening required to enter the ovum transfer program and $2,000 each time a donor is inseminated.

Donors, who also go through a screening process, are paid $35 for each visit to the clinic in connection with the procedure. Donors usually visit the clinic from five to eight times a month.

Some Costs Covered by Insurance

Marshall said some insurance companies cover certain portions of the treatment, reimbursing about one-third of the total cost.

Marshall described the treatment as a “last stop” for couples whose infertility problems had appeared insoluble.

Although modern science has learned to treat a number of infertility problems through drug therapy, microsurgery and test-tube fertilization, there has been little help available for a woman who has no eggs or damaged eggs.

One such woman is Lori, who like many others has gone through the gauntlet of tests and consultations, only to find out nothing could be done.

She was married three years ago and had no idea that she would have a problem conceiving a child.

‘Wanted a Family’

“We just wanted to have a family,” said Lori, who asked that her family’s real names not be used. “It’s something you always thought would be so easy.”

After discovering her infertility, Lori and her husband, Jim, began researching the topic and searching for a clinic that could help them.

“I just about became a medical student,” Jim said. “You spend so much of your life trying not to have a baby and then when you want one, you can’t.”

The couple saw several specialists, who began the necessary screening and testing to treat Lori’s infertility with drug therapy or in vitro fertilization.

After months of testing and spending about $2,000, her hopes began to fade when she was told that she probably would not be able to have children because of her ovaries failed to produce eggs.

She abandoned the treatments but later entered the ovum transfer program in Long Beach and is waiting for a donor.

Lori is one of an estimated 4.5 million women between the ages of 15 and 44 who cannot conceive or have some problem bearing and delivering children, according to a 1982 study by the National Center for Health Statistics. These women represent about 8.4% of the nation’s 54.1 million women in the same age group.

But many of these infertile women can bear children with the help of modern infertility treatments, Marshall said.

Help for Infertility

For example, drugs like clomiphene citrate and human gonadotropins are used to improve or induce ovulation and are successful on less severe infertility disorders.

Women with damaged Fallopian tubes also can be helped with in vitro fertilization, a process that bypasses the Fallopian tubes by surgically removing the egg from a woman’s ovaries, fertilizing it in a laboratory dish and placing it in the woman’s uterus.

But none of these techniques can help women who have no eggs, who are now the most common candidates for the ovum transfer treatment, Marshall said.

Other likely candidates include those who fail to respond to conventional treatment and those who do not want to pass on serious diseases to their children. All candidates for the Fertility and Genetics Research program must be between the ages of 18 and 44.

The idea of transfering a fertilized egg from a healthy woman to an infertile one originated with cattle breeders, who have used the technique since the mid-1960s.

‘Why Not People?’

Marshall said he heard of the idea in 1980 from Richard G. Seed, an inventor and physicist who first proposed using ovum transfer on humans.

“My first reaction was that the guy was nuts,” Marshall said. “But the more I thought about it, the more reasonable it became. I mean, if it worked with cows, why not people?”

Marshall and others at Harbor/UCLA began researching the procedure, along with Formigli, who was working independently in Italy but later collaborated with the Harbor/UCLA group.

The first step is to match the ovulatory cycles and hormonal levels of the donor and the recipient so the egg can be implanted in the patient when the uterus is most receptive to nurturing a fertilized egg.

The synchronization is achieved by using birth control pills, which regulate a woman’s cycle.

Checking Hormonal Levels

The next step is to determine when the donor is ovulating by monitoring her hormonal levels.

Once the donor ovulates, she is artificially inseminated, using sperm from the patient’s husband.

The fertilized egg is captured and recovered from the donor after five days. The recovered egg is microscopically examined and within hours is transfered into the patient’s uterus, where it implants and the pregnancy proceeds.

Marshall said the process is simple, painless and can be completed in a doctor’s office in a few brief visits. Because the process involves no surgery, women can attempt the transfer as many times as they please.

There are several potential risks in the ovum-transfer process, including the chance that a donor could become pregnant if the fertilized egg is not removed, Marshall said.

Forced Abortions

Of the 130 inseminations at Harbor/UCLA and Formigli’s clinic in Milan, there have been three donor pregnancies, all of which were aborted, he said.

There is also a chance, as in normal pregnancies, that the donor could experience ectopic pregnancy, one that occurs outside the uterus. This type of pregnancy usually takes place in the Fallopian tubes and if it does not abort naturally, it must be surgically terminated, which could damage the woman’s reproductive organs, said Dr. Roger Freeman, chairman of the American College of Obstetrics and Gynecology’s committee on obstetrical practices.

Freeman stressed that the chances of a woman being injured in an abortion or an ectopic pregnancy are “extremely small.” Marshall said no ectopic pregnancies have occurred so far.

Freeman said another potential problem is that donors could become infected with a sexually transmitted disease from semen used during artificial insemination.

Fertility and Genetics Research has developed a testing program that monitors all semen donors for a battery of sexually transmitted diseases, such as gonorrhea, acquired immune deficiency syndrome (AIDS), herpes and syphilis, Marshall said.

‘Washing’ Sperm

The sperm is also “washed” in the laboratory to remove bacteria. He said there have been no infection problems so far.

The American Fertility Society has issued a report recommending that general treatment be delayed until more information is collected, said Joyce Zeitz, a spokeswoman for the group.

Marshall said the report was based on the first 53 cases his firm reported in 1985. The number of inseminations has risen to 130, and details on 109 of them will be reported this month in the society’s Fertility and Sterility magazine.

“Some will say that is not as many as 10,000. Well, that’s true. But the thing we feel is impressive is that with 130 cycles, the data is virtually identical to the data with 53 cases,” he said.

Several legal and ethical concerns also have been raised about the process.

Paternity Questions

According to Freeman, ovum transfer could raise legal questions concerning paternity, as have other modern fertility techniques.

B. J. Anderson, associate general counsel of the Chicago-based American Medical Assn., said the AMA is concerned about Fertility and Genetics Research’s attempt to patent the ovum-transfer process.

The catheter used to retrieve the donated egg in ovum transfers has been patented by Fertility and Genetics Research. The AMA, however, is opposed in general to patents on medical procedures because they limit the number of people who can benefit from treatment and restrict the work of other researchers.

“If you have developed a procedure or technique with a medical use, you should have as widespread a use as possible for the public benefit,” Anderson said.

Marshall said the patent is necessary to protect Fertility and Genetics Research’s position in the growing infertility treatment market and added that other medical companies share his firm’s patent philosophy.

Limited Access

Marshall said his company has no plans to limit access to the technique.

“The only way FGR can make any money is to have as many people as possible use the clinics,” he said.

Anderson added that the relatively high cost of ovum transfer excludes many people from the procedure.

Marshall agreed that not everyone can afford the minimum $4,500 cost, but added that test-tube fertilization is also expensive. The American Fertility Society has estimated that each attempt at in vitro fertilization costs from $4,000 to $6,000.

Marshall said infertility treatment will become more affordable only when insurance companies agree to pay a larger portion of patients’ expenses, he said.

Volunteer Donors

Despite the risks and ethical problems, about a dozen women have agreed to act as donors to help infertile women. Marshall expects that number to grow when the clinic opens at the Huntington in March.

Donors, who must be between 18 and 33 years old and preferably have borne a child, are required to go through psychological, genetic and health testing to ensure that the child will be healthy and that the donors will feel no undue attachment to the baby after it is born, Marshall said.

Donors are also informed of the risks and inconveniences connected with the process. For example, donors must either abstain from sex or use condoms just before ovulation so they will not be impregnated by their own partners. They also cannot use birth control pills, which prevent ovulation.

“The program is not for everyone. It’s not for people looking for a job or some kind of ideology to create more of themselves in the world,” said donor JoAnn Lund of Long Beach. “It’s for people who have an empathy with infertile people.”

Lund, 30, has been donating an egg once a month for the last two years.

‘Better Than Any High’

“The good feelings you get are just indescribable,” she said. “It’s better than any high or what any monetary compensation could accomplish.”

Lund said she also donates her eggs because it is so easy for her.

“What hit me was that it wasn’t something major to give to somebody,” she said. “It was easy, non-surgical and something I got rid of every month anyway. I don’t need another egg.”

A few days before she ovulates, Lund goes to the Fertility and Genetics Research clinic in Long Beach and has her blood and urine tested to determine exactly when she will ovulate. The test takes 5 or 10 minutes.

The day she ovulates, she visits the hospital to be artificially inseminated. Five days later, she returns and the fertilized egg is removed. Those steps take 15 to 20 minutes, and she is finished until the next month.

‘Hasn’t Lost the Magic’

“Every time, even now, you’re still excited and want everything to work,” she said. “It still hasn’t lost the magic.”

Donors are told if a fertilized egg is recovered, Marshall said, but not if their eggs resulted in a birth because the number of births is so low that a donor might be able to determine the identity of the patient who got her egg. He said that as the number of births increase, donors might be informed of births resulting from their eggs.

Lund said she plans to donate her eggs until she reaches the maximum age of 33, and even then she would like to remain involved with the program, either as a recruiter or counselor for new donors.

“I will probably look back on this as one of the better reasons why I existed,” she said.

Marshall said he hopes to find 40 to 50 donors who live near Huntington Memorial, enough to provide easy synchronization of ovulation cycles and matching of physical characteristics, such as race, height, hair color, eye color and major blood groups.

Easy Match Ups

“Matching is not as difficult as you think,” he said. “You only run into a problem when you have two Swedes with blond hair and blue eyes,” and must find a donor who has the same characteristics.

In the future, Marshall said Fertility and Genetics Research plans to experiment with superovulatory drugs and the implantation of more than one fertilized egg at a time.

The drugs can make a donor ovulate two to three eggs each month, he said. Marshall said the transfer of two eggs instead of one greatly increases the chances that a pregnancy will occur.

Marshall said there will always be an element of uncertainty in the process because of the complexity of creating and nurturing life. Even with natural conception, he said, “it’s a lot like Russian roulette.”

OVUM TRANSFER PROCESS: INSEMINATION PROCEDURE 1. Donor is artificially inseminated.

2. Fertilization takes place in the donor’s Fallopian tubes.

3. Fertilized egg descends through the Fallopian tubes into the uterus, where it floats until it is captured and removed from the donor’s uterus.

4. Within hours, the egg is transferred to the patient’s uterus.

5. Egg attaches to patient’s uterus and she experiences a natural pregnancy.

Source: Dr. John R. Marshall, former chairman of the Harbor/UCLA Medical Center”s Department of Obstetrics and Gynecology and now medical director for Fertility and Genetics Research Inc.

POTENTIAL CANDIDATES FOR OVUM TRANSFER 1. Women who have had their ovaries surgically removed; women who have congenital absense of ovaries; women who have had their eggs damaged or destroyed because of radiation therapy.

2. Women who have eggs that do not mature and who do not ovulate with stimulation by drugs.

3. Women who do not desire to pass on an inherited disease to their children.

4. Women who have severely damaged or blocked Fallopian tubes who have had a lack of success with other infertility treatments.

5. Women with unexplained infertility.

* Ovaries alternate as egg sources from month to month with the unused one lying dormant until needed for the next ovulation.

* Mature eggs are usually produced by only one ovary at a time. In this diagram, the ovary on the left side is producing the mature egg.