Whatever anybody has to give up, they should just keep trying and not quit because it's the most wonderful thing that could ever happen to finally get a baby! --Janice and Darwin Base
Although Janice Base was told she could never bear children, she and her husband, Darwin, married in 1983, gave up "almost everything" when they decided to try to have a high-tech baby.
Due to the cost of the procedures, the Ventura couple took no vacations, bought no furniture, carpets or cars, and when their $15,000 in savings was gone and they still had not conceived a child, they stopped trying only until they could save enough money to start again.
"I still drive the 1971 Chevy Malibu I got for my 16th birthday and we've had to refinance the house," Janice says. "But we'd do it all again."
Six months ago, Janice, a part-time grocery checker at Albertson's, and Darwin, a Ventura city fireman, became parents of twins, Ashley and Aaron. Both are named in honor of the doctor, who, after seven years of attempts, finally helped them conceive via one of the fastest-growing, most controversial medical specialties in the country: assisted reproductive technology.
Because Janice had no Fallopian tubes, her eggs, produced after a course of fertility drug treatments, were aspirated from her ovaries by a new, nonsurgical ultrasound technique. Each egg was prepared, mixed with 25,000 of her husband's washed and treated sperm, and fertilized in vitro--meaning in a petri dish containing fluid to simulate that which is normally found in Fallopian tubes. The embryo was placed in her uterus and she carried her twins through a normal nine-month pregnancy.
If Darwin's sperm had been weak or nonexistent, if Janice had blocked tubes, no eggs, no ovaries or an unexplained inability to sustain pregnancy, the couple possibly still could have achieved the birth of a child. In fact, there is almost no reproductive problem or combination of problems that doctors won't tackle nowadays as long as the female has a uterus in which she can carry a baby.
With new developments in reproductive technology occurring regularly, and an increasing number of infertile couples opting to attempt such engineered pregnancies, the number of assisted-reproductive clinics is mushrooming.
Five years ago there were 10. Now there are about 200 nationwide, 13 in the Los Angeles area alone--more than in all the Southeastern states, making Los Angeles a key center in the reproductive revolution.
Freezing and storage of human embryos has become routine; there are probably more frozen embryos stockpiled in Los Angeles than anywhere else in the nation. In fact, America's first live birth from a frozen embryo took place in Los Angeles in 1986 at the Institute for Human Reproduction headed by Dr. Richard Marrs at Good Samaritan Hospital.
And there's no shortage of clients at centers like his. It is estimated that one in every six couples of child-bearing age has a fertility problem; 60% caused by female factors, 40% by male factors. That figure is increasing, experts say, as more and more couples defer having children until both have worked for a number of years. Some who might have had little trouble conceiving when they were younger can experience difficulties made worse by their age.
Success with frozen embryos has helped make assisted reproduction easier and more affordable for these would-be parents.
When a woman undergoes drug stimulation and produces more eggs than can be used for a single pregnancy attempt, the doctor retrieves all her eggs and fertilizes them with sperm from her husband or a donor. Three or four of the resulting embryos are transferred to the patient and the rest are frozen in large cryogenic tanks of liquid nitrogen.
If the first implanted embryos don't produce pregnancy (as is often the case), the doctor can simply thaw another batch and try again.
This second try, using thawed embryos, costs about $500. The first try, which includes a full cycle of treatment--drug therapy to produce eggs, egg retrieval, fertilization of eggs and sperm and implantation of the resulting embryo--costs anywhere from $6,000 to $10,000 per pregnancy attempt.
That does not include the cost of travel, hotel and meals for couples who choose a clinic not near their home.
A Santa Barbara woman now has 31 frozen embryos stored at Marrs' laboratory at Good Samaritan. He says the woman produced multiple eggs after the drug stimulation phase. He implanted some and froze the rest. She became pregnant on the first try, and so all the embryos remain in his laboratory. She has signed a document that if she dies, they are to be donated to another infertile couple.
That does not totally answer the question of what will happen to the frozen embryos if she lives but elects not to use them.
Or if she divorces and the wants to use them to become pregnant against her ex-husband's wishes. (That was the issue in the recent Junior Davis case in Tennessee.)
Or if she or her husband elect to do something bizarre with them, against her doctor's wishes.
Whether embryos are legally considered property or potential human beings is a point not yet totally decided in the courts. (In the Tennessee case, the judge ruled that life begins at conception.)
And what about a child carried for nine months in its mother's womb, but conceived with another woman's egg? Should the child be told that there is a genetic mother? Should the parents meet the egg donor? Should records be kept so that the child can seek its genetic parent when he or she grows up?
(Increasing numbers of women who cannot produce eggs are choosing to be impregnated with embryos created from a donor's egg and their husband's sperm. The infertile woman, thus, gets to experience pregnancy and birth. The baby is biologically hers, but genetically that of another woman.)
Whether embryos should be used for medical research is another emerging problem with ethical, moral and religious overtones.
And there are many more issues--to be hotly debated in San Francisco later this month--when the American Fertility Society and the Society for Assisted Reproductive Technology (SART) hold their annual meetings. Already on the agenda are at least two issues of critical interest to those considering new reproductive techniques:
* Medical credentials: Any obstetrician-gynecologist now may claim to be a fertility expert or reproductive specialist, although his or her training and experience in techniques that have emerged in the last few years may be limited. At recent congressional hearings on consumer-protection issues relating to reproductive clinics, evidence was offered that couples can be injured and financially exploited by inexperienced practitioners; injuries can range from near-blindness to raging infection that necessitates hysterectomy. The Society for Assisted Reproductive Technology suggests that patients seek centers with doctors who are board-certified reproductive endocrinologists, meaning they have undergone two additional years of training in the obstetrics-gynecology sub-specialty.
* Definition and reporting of success rates: Neither the government nor the medical community oversees reproductive clinics. There is no requirement for them to report their pregnancy success rates anywhere and there is no uniform definition of pregnancy. Some clinics attract patients by claiming high rates of pregnancy, which they define as a temporary elevation of hormones, a missed period or a successfully fertilized egg. Experts say the only legitimate measure of success is the number of live babies produced for parents to take home and that all reproductive clinics should be required to report how many healthy, live babies are born each year out of how many attempts. It is estimated that half the reproductive clinics nationwide have never produced a live baby.
Risa and Stephen York, now of Sherman Oaks, found that even reputable clinics can mislead. While living in New York, they elected to travel to a Virginia clinic because their research showed it to have "the highest number of pregnancies. It took us years and thousands of dollars to realize that they didn't necessarily mean live babies when they cited pregnancies," they said.
The Yorks subsequently moved to Los Angeles, signed on with Marrs and tried to transfer a frozen embryo from Virginia to Los Angeles. But the Virginia clinic refused, citing potential "abuses" that might befall the embryo. The Yorks filed a lawsuit and the clinic released the embryo to them.
"We bought an airline ticket for the embryo, strapped it in to a seat, and flew it home to L.A.," Risa York recalls.
After all that, she did not become pregnant after the embryo was implanted.
Such disappointments are typical in the lives of infertile couples trying to have babies by the new methods. Most reputable doctors admit that success rates hover between 10% and 20%. They say the field still is in its infancy, is still partly experimental and that couples ought to be told the truth about its limits as soon as they walk in a doctor's door.
Couples like the Yorks (she's a doctoral candidate, he's a physician) keep trying in the face of adversity, however, because their doctors believe they can conceive--eventually.
The question is, for how long can they keep going, emotionally and financially?
If the toll grows overwhelming, the Yorks say, they will consider adoption.
Carole Lieber Wilkins and her husband already had adopted a baby when they decided to have a child using her husband's sperm and an anonymous donor's egg. Lieber Wilkins had tried for years to have a baby. Her gynecologist, however, did not notice that she was going into menopause while still in her 20s. Because she was infertile by the time she switched doctors, there was no possibility that Lieber Wilkins could produce eggs and have a baby genetically her own.
A donor's egg and her husband's sperm were fertilized; the resulting embryo was implanted in Lieber Wilkins, who carried it for nine months until birth.
"It was not easy to use the egg of a woman about whose genetic background we know very little, about whom I can give my son very little information," Lieber Wilkins says. "I worry that my son will want to know." She asked to meet the donor but was not permitted to do so. "The doctor said he didn't want to get into matchmaking."
'A Little Eerie'
"The whole procedure was a little eerie," she recalls. "It's high-tech stuff. Cold and austere, emotionally traumatic and artificial. . . . "
But in retrospect, she adds, "it was a miracle and a blessing. I used to walk through the mall and see all these young couples, with one in the carriage and one in the belly. And I hated them because they were so normal and I was not. Suddenly, I, an infertile woman, was also walking through the mall with one in the carriage and one inside of me."
Dr. Mark Sauer, a reproductive endocrinologist with the USC program at California Medical Center in Los Angeles, began an egg donation program there in 1988. He says that only in the last year, when a nonsurgical method of retrieving eggs was perfected, has such a program become viable.
"Now that women don't need surgery in order to donate eggs, they are more likely to be willing to do it. We have women who function regularly as donors," he says. Some do it for money ($1,500 a cycle); others do it for sisters or friends.
Sauer's donors are not anonymous, he says: "Donors and couples always meet and get to know each other face to face.
"But in my experience, most couples have no intention of ever telling the child about the donor. The baby is raised, from time of implantation to birth, by the egg recipient. The recipient is the child's biological mother. All the donor does is give an unfertilized egg. The biological mother carries it and nourishes it for nine months. Without her it could not be born. No, she is not the genetic mother. But it's a rare patient who gets hung up on the genetic aspect."
And there's no way for outsiders to know. "It's all so easy to conceal," Sauer says. "There's no record. These women become pregnant with me, and I send them to their own obstetrician-gynecologist, who takes care of them like any other pregnant patient. The baby comes out normally at the hospital and no one even knows. There are no records."
But, "ethically, it is all very complex," he says. "At this point, there's no case law on the books about embryo donations. It will have to go through trial in terms of disclosure."
In this, as in most aspects of assisted reproduction, Sauer says, "the medical sciences are way ahead of social and legal codes. We're setting our own rules."
Dr. Arthur L. Caplan, who directs the Center for Biomedical Ethics at the University of Minnesota in Minneapolis, agrees that there are few rules and thinks there ought to be strict ones. "It would be atrocious policy for (the government or insurance companies) to fund these techniques until some minimal standards of success are set."
Of children conceived with donor eggs, he says, "scientists are learning more about genetics, trying to map out information on chromosomes so they can diagnose and treat genetic illnesses. It will become very important to know who your genetic parents are. We cannot compare you to your mother if your mother didn't make the egg that made you."
His list of the top ethics questions in the field:
* Who should have access to new techniques? Does society want to impose any restrictions? Should it be only for the infertile or should it be acceptable for people to create children this way as a means of convenience? Or for eugenic purposes? Or because the would-be parent is homosexual, elderly or single?
* What to do with unused embryos? Should experts let them disintegrate or throw them away?
* Who should get paid for this work, who should do it and how many of them should do it?
* What happens when genetic engineering is perfected? That's not an issue now but it will be in five to 10 years, when experts say they may be able to manipulate chromosomes of egg and sperm, outside the body, to repair or change a child's traits. That will present ethical problems society should start pondering now.
* Who has what rights to what medical records? What are the rights of parents, sperm- and egg-donors and children created by these techniques?. What if sperm and egg donors want to meet their offspring or vice verse? Should record-keeping be mandatory? Should there be a central record storage spot?
Although Caplan heard two years ago from a West Virginia man in his 80s who had a fortune and no heirs and wanted directions to a clinic where he could create one, today's typical reproductive center patients are more like the couples Lieber Wilkins counsels in her West Los Angeles practice. She is a marriage and family therapist specializing in infertility and alternative family building issues.
Most of the couples, Lieber Wilkins says, have deferred children until husband and wife have established careers, their marriage is solid and they are financially stable. Then they plan the time, day and even the ambience when they will begin their family. They awaken the next day, sure they have created the perfect child and life together. But they're not pregnant that month or the next, maybe not for five years.
These couples, who have been able to control every other aspect of their lives until now, when they find they cannot conceive, "experience the same feeling of loss as if a death had occurred." It's then that they start to investigate the high-tech alternative.