The Baby Gamble : Infertile Couples Are Not Being Told the Real Odds Against ‘Test-Tube’ Conception

NOT BEING ABLE to conceive children--a feat that most people do without much effort--is one of the biggest stress factors a marriage can endure,” says JoBeth Williams, a Los Angeles actress who tried unsuccessfully for six years to have a child before finally deciding to adopt. For infertile couples such as Williams and her husband, sex can become a clinical task, dictated by the woman’s menstrual cycle and by doctor’s orders. This loss of privacy, together with the physical pain of the tests, injections and operations that compose current infertility treatments, add up to “an intense emotional drain on the infertile couple,” Williams says.

Last spring, Williams described the emotional turmoil that she and her husband experienced during their years of trying to conceive. That agitation was compounded by struggles to get facts about the cost and effectiveness of infertility treatments, she told a Congressional panel chaired by Rep. Ron Wyden (D-Ore.) that was investigating abuses in the in vitro fertilization (“test-tube baby”) industry. “The doctors I dealt with were all honest and kind men,” she told the legislators, “but I felt they should have been more open about their limitations. . . . I believe it is cruel to put people who are already emotionally battered in the desperate position of not knowing how to find the right care.”

Last year, 2.4 million infertile American couples spent more than $1 billion in their attempts to have children. But clinics treating infertility have sometimes been reluctant to admit that there is still no successful medical treatment for about 50% of infertile couples. And some who testified at the hearings charged that certain clinics in their advertising were presenting statistics in a misleading way, claiming a much higher than average success rate for in vitro fertilization, even though no infants had yet been born to couples treated at those clinics.

Infertility, defined medically as the inability to conceive after one year of unprotected sex, results from a variety of different problems in either the man or the woman. The starting point for treatment, then, is finding out what is preventing pregnancy for a particular couple. In some cases, there is no clear diagnosis--the infertility is “unexplained” in medical terms. Explained or unexplained, however, Dr. Joseph Gambone, director of the In Vitro Fertilization Program at UCLA, notes that infertility is without question a medical disorder. “It is normal for people to procreate,” he says, “and it should be considered a disease when they cannot.” And treating that disease may involve years of diagnostic evaluations and therapies.

Couples who have had no success after trials of medications or minor surgical procedures may be advised to consider one of the newer techniques--in vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT). In the decade since the first test-tube baby was born, in vitro fertilization has helped about 5,500 American couples to have babies. But many more couples underwent the procedure unsuccessfully. In fact, IVF, though it was one of the most exciting advances in infertility therapy, has also been among the most disappointing in terms of success rates.

According to Gary Ellis of the Office of Technology Assessment, a couple trying IVF in 1986 had a 6% chance of taking home a baby after one IVF stimulation cycle. To increase their chances, couples are encouraged to go through several IVF cycles, at a cost of $4,000 to $7,000 per cycle. Even after three or four tries, the chances of a successful pregnancy resulting from IVF are only about 1 in 10, or 1 in 7 to 1 in 8 at the very best programs in the country.

JoBeth Williams and her husband had gone through several years of infertility workups and treatments by the time they underwent their first in vitro cycle. She had undergone a surgical examination of her ovaries known as a laparoscopy. Her husband had given numerous sperm samples for testing. By the fifth year, the couple attempted vaginal insemination. When that failed, Williams underwent a second surgical procedure, after which she finally became pregnant. However, she miscarried 12 weeks later. It was at that point that the couple considered an in vitro program.

In the in vitro fertilization procedure, which takes several weeks, doctors first use hormones to stimulate a woman to produce a mature egg. The egg is then removed from the woman and mixed with her partner’s sperm in a laboratory dish. The combined egg and sperm become a fertilized and dividing egg that is then transferred into the woman’s uterus.

In Williams’ case, in vitro fertilization failed to result in pregnancy, and Williams, like many of those who testified before Wyden’s panel, argued that doctors should have explained the odds.

The Wyden panel concluded that the in vitro industry was in need of monitoring and guidelines. The panel also published a clinic-by-clinic survey listing clinic success rates in clear terms. Until an effective monitoring system is firmly in place, Wyden, Williams and others say, infertile couples will need to do their own investigations. Infertile couples should be wary of:

(1) Doctors who claim to be infertility specialists but are not. Many gynecologists who claim to be experts in infertility have not undergone the years of advanced training necessary to be board-certified in reproductive endocrinology. Ask about training and credentials.

(2) Misleading clinic statistics. Different clinics compile statistics in very different ways. For example, some programs define success as a pregnancy, while others define it as the birth of a baby. Also, when comparing statistics, make sure that they are for women of the same age group, since younger women have higher success rates with IVF than do older women.

Couples should also ask various questions, such as:

--When was the first procedure performed at the clinic?

--How many babies have actually been born from IVF at the clinic?

--How many pregnancies have resulted from IVF at the clinic?

--Does my insurance cover in vitro fertilization? A bill passed in California last fall requires health insurers to cover most infertility treatments, but it specifically excludes IVF. Furthermore, mandated coverage does not necessarily mean complete coverage for all procedures.

--Are there hidden costs, such as expensive medications?

The local Harbor City chapter of Resolve, a national organization providing education, referrals and support groups for infertile couples, and the American Infertility Society, 2140 11th Ave. South, Suite 200, Birmingham, Ala. 35205, can be of enormous help. One particularly useful pamphlet published by the American Infertility Society is called “IVF and GIFT--A Patient’s Guide.”