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The Long Road From Infertility to Fatherhood

AMERICAN HEALTH MAGAZINE

“Some guys won’t admit they’ve got a problem. It’s a macho thing,” says Los Angeles Raider Bob Golic, who was diagnosed as infertile.

“I felt guilty,” admits the 6-foot-3-inch, 275-pound defensive lineman. “My wife could have had a baby if she were married to someone else.”

Male infertility is now receiving increased attention from reproductive specialists and was a major topic of last year’s annual meeting of the American Fertility Society. The struggle for parenthood waged by Golic, 32, and his 33-year-old wife, Jackie, illustrates the obstacles that can hinder fertility as well as the newest treatment options for overcoming them.

Infertility, defined as the inability to conceive after one year of trying, affects one of every six married American couples. Until recently, doctors usually assumed that childlessness was the woman’s “fault.” Research now shows that infertility affects men and women almost equally: Each sex is responsible about 40% of the time, with both partners sharing responsibility in 20% of the cases.

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“We found that a lot of our friends had the same problem,” says Golic, who served as chairman for National Infertility Awareness Week. He considers infertility a private matter but has gone public to show other men that fertility has nothing to do with virility. Impotence and other sexual problems account for only about 5% of all male infertility problems.

When male infertility is suspected, the first step is a medical history and physical exam. Golic’s diagnosis--a low sperm count--accounts for most cases of male infertility. Other reasons include underactive sperm (they don’t swim well enough to penetrate the ovum) and deformed sperm.

Doctors believe Golic’s problem resulted from an injury or excessive heat exposure caused by long soaks in the hot tub after games. But many other factors have also been implicated in male infertility, and some of them are readily correctable.

One of the most common causes of male infertility--accounting for about 35% of all cases--is varicocele, a varicose vein in the scrotum. Blood coursing through the vein overheats the testicles and reduces the number and quality of sperm. More than a third of men who’ve undergone surgery to tie off the vein have impregnated their partners within two years. Other correctable causes of infertility include inguinal (groin) hernias, prostate infections and abnormal hormone levels.

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After consulting fertility experts, Golic and his wife first tried using traditional treatments. He avoided hot showers and hot tubs, and the couple tried to time intercourse with ovulation. When those efforts failed, treatment moved out of the bedroom and into the laboratory. The next step was intrauterine insemination, in which Bob’s sperm were treated in a test tube so that the healthiest ones would rise to the top. These “super sperm” were introduced into Jackie’s uterus via a catheter--but still no luck.

The Golics then resorted to in vitro fertilization, the technique first heralded in 1978 with the birth of Louise Brown, the world’s first test-tube baby. In in vitro fertilization, sperm and eggs are combined in a test tube, and the fertilized eggs are then transferred to a woman’s uterus. In vitro fertilization is used in treating both male and female infertility--when women have blocked or damaged Fallopian tubes, for example.

According to the American Fertility Society, about 12% of in vitro fertilization attempts are successful. But for couples with patience--and money--to keep trying, the success rate can climb to about 50% after three tries.

The Golics tried an in vitro fertilization variant known as zygote intrafallopian transfer. One or more zygotes (fertilized eggs before they divide) are transferred to the Fallopian tubes (where fertilization normally takes place) rather than the uterus. After several failed zygote intrafallopian transfer attempts, the Golics tried an experimental form of in vitro fertilization, called micromanipulation.

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In one micromanipulation technique, called partial zona cracking, a tiny needle is used to prick the zona pellucida (the egg’s protective covering). With another method, microinjection, doctors select a single sperm and then inject it through the membrane and into the egg. The Golics were treated with a third technique, zona drilling, in which a chemical is used to “burn” small holes in the egg’s membrane.

Doctor’s harvested 10 of Jackie’s eggs, drilled half of them and then combined all 10 with Bob’s sperm. Two drilled and one undrilled egg became fertilized. (“Bob was really proud of that one,” Jackie laughs.”) Doctors transferred the three embryos into Jackie’s Fallopian tubes, and one was implanted in her uterus. After seven attempts using the latest techniques that reproductive science can offer, the Golics had finally conceived a baby.

Bob was almost afraid to react at first. “After four years of constant disappointment, I really didn’t believe it until she started getting big,” he says. On Dec. 11, Jackie Golic gave birth to the couple’s first child--a girl.


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