Groggy but conscious, Toni Marlow is wheeled into a tiny room at the California Medical Center in Downtown Los Angeles.
Inside, Dr. Mark V. Sauer, dressed in burgundy scrubs and with a surgeon's cap over his graying hair, waits by the ultrasound machine that will help him retrieve Marlow's eggs. He hopes they will be healthy enough to eventually impregnate their intended recipient, a childless woman in her early 40s.
Sauer's pioneering work in egg donation has made him a hero to would-be moms, some of whom are long past their reproductive primes. As such, his face--an earnest one, with kind blue eyes--has appeared regularly in millions of living rooms via such shows as "Today," "Nightline" and "48 Hours," as well as in a 1994 People magazine spread.
In the last three years, the procedure Sauer helped develop and refine has become common in the nation's 300 in-vitro fertilization (IVF) centers, and he is among its leading advocates, particularly for women past 40. His research at USC has been published extensively in medical journals. His protocols for the technique, created with his colleagues at the USC-IVF Program, are in practice worldwide. More than any other U.S. infertility expert, perhaps, Sauer pushes the envelope, accepting women up to age 55 while doctors elsewhere routinely draw the line a decade earlier.
"He's not afraid of controversy and he can be a risk-taker," says Dr. Lawrence Platt, chairman of obstetrics and gynecology at Cedars-Sinai Medical Center, who has tried to recruit Sauer for his staff.
That willingness to crash boundaries may endear Sauer to infertile women, but it also inspires scorn from critics who believe he's tinkering too much with Mother Nature. Some bioethicists accuse him of promoting a society of "Medicare orphans." And a Los Angeles woman is awaiting trial for faxing death threats to the USC-IVF Program offices, across the street from California Medical Center. "We know where you live," she allegedly wrote. "We know what your loved ones look like."
If the criticism and threats have been getting to Sauer, a 40-year-old father of three, it doesn't show.
Prepped on a recent morning to extract Marlow's eggs, he carefully picks up a transvaginal probe equipped with a hollow needle. As he guides it toward the ovaries, an assisting physician squints at the ultrasound monitor. "She's got 10 or more (eggs) on each side," estimates Dr. Tina Koopersmith, who is completing a fellowship at the USC-IVF Program.
Taking turns, the two doctors draw off fluid from the egg-filled sacs, collecting it in test tubes that are passed to an adjacent lab. The eggs will later be mixed with sperm--one egg to 200,000 sperm--to produce fertilized embryos. Meanwhile, the hopeful future mother has been injecting herself with hormones to support a pregnancy.
"Toni, you OK?" Sauer asks the donor.
She moans and asks for more painkiller. Soon, she is talking in a "conscious sedation" babble. She mumbles something about going skiing.
"Water-skiing or snow?" Sauer plays along.
"Water," she says.
"You could probably ski right down Santa Monica Boulevard," he jokes, referring to the recent heavy rains.
After the retrieval is complete, the doctors learn from embryologist Thelma Macaso that the yield is 30 eggs. They are delighted. Sauer always worries that he will overlook an egg and, he jokes, that "oversight could have become President."
Egg donation tends to make the news, particularly the tabloids, when a woman in her 50s or 60s gives birth. (During medical talks, Sauer amuses audiences by displaying one such headline about one woman "having another gal's baby.") But the technique was developed more than a decade ago to help women of traditional childbearing age whose ovaries had failed. Physicians initially didn't consider the procedure for older women, assuming that as the ovaries aged, prompting the onset of menopause, so did the uterus.
Then Sauer and others began to ask: What if the uterus ages more gracefully than the ovaries? Could egg donation, used in conjunction with hormone treatments to create a hospitable uterus, make motherhood possible for menopausal women?
It generally does, and it can.
In 1984, Sauer had just signed on as a fellow in reproductive endocrinology at Harbor/UCLA Medical Center when its physicians performed this country's first embryo-transfer procedure, in which the donor egg is fertilized in the donor's body, then removed and implanted in the recipient. These days, fertilization occurs in an IVF lab.
Three years later, Sauer joined USC-IVF and was charged with developing its egg-donor program. In an unusual arrangement, Sauer and his partners, Drs. Roger Lobo and Richard Paulson, divide their time among research, teaching duties at Women's Hospital of County-USC Medical Center and a private practice. Paulson oversees the IVF lab and directs the program; Lobo is chief of the reproductive endocrinology division at USC.
On Oct. 25, 1990, the New England Journal of Medicine published a paper by the three partners detailing their success in using egg donations for women over 40. The study was small--only seven patients. Of the six who became pregnant, one miscarried and another gave birth to a stillborn infant. But the other four delivered healthy babies, including one set of twins.
With that news, so many calls flooded USC-IVF offices, Sauer recalls, that the lines went berserk; it is now known among staffers as "The Day the Phones Broke." "Suddenly all these patients all over the country and all over the world were seeking the service," Sauer says.
The research also impressed the medical community. The USC team was and is hotly recruited by other IVF centers hoping to duplicate its success. Lobo recently accepted a job as head of obstetrics and gynecology at Columbia University Medical School in New York, and Sauer fielded offers this month from Columbia and the University of Chicago. Both Sauer and Paulson are also candidates to replace Lobo at USC.
The Journal report snowballed into a blizzard of media attention. It was an about-face from the early days when Sauer tried but failed to persuade magazines to write about egg donation. When traveling to medical meetings, he would rip editors' names out of in-flight magazines and send off letters suggesting articles. "Somebody should pay attention to this," he thought. "There's gotta be a story here."
These days, Sauer is more media savvy. He is generous about giving interviews to print and broadcast media, but declines to appear with his patients on television talk shows. He's turned down Oprah, Donahue and the others.
"I don't want to make this a circus--and that's out of respect for my patients, not out of fear," Sauer says. "I love my patients. I consider these women pioneers. This is not a freak show."
Still, he concedes, the attention sometimes goes to his head. The first time one of his 50-year-old patients became pregnant via egg donation, he recalls gloating to himself: "I can make anyone pregnant." Then he came down to Earth, Sauer says.
Jonie Mosby Mitchell, a 55-year-old country singer from Ventura and mother of a 2-year-old USC-IVF son, can't say enough good things about Sauer, calling him warm, funny and a nice guy. She keeps in touch by phone and mails him photos of her toddler.
"(He) was my easiest delivery," says Mitchell, who also has four grown children and a 7-year-old adopted daughter. She and her second husband, Donnie, had been thinking of adopting again when she read a blurb in a newspaper about Sauer's work. Now she appears on talk shows, urging other women to follow their hearts and find a competent doctor. "I don't think all doctors do this as well as (Sauer)," she says.
But Sauer can't guarantee pregnancy. And when things don't go well, or as quickly as had been hoped, he finds himself in the middle of warring couples, each half blaming the other. The pressure to conceive is intense.
"There's a lot of obsession, pathological obsession," Sauer says. "Having a baby becomes more than just having a baby. It becomes a mark of their life's work."
Sauer's role as a spokesman for "the baby-making industry," as he calls it, also makes him a target for critics and cranks.
The complaint that egg donation is accessible only to well-off patients is often heard. Each USC-IVF cycle, including retrieval, fertilization and implantation, costs $12,000. Reimbursement from insurance companies is extremely rare.
Sauer hates to turn away patients who cannot afford the procedure, especially those whom he believes would be good parents. ("He can be a jellyfish without a spine," confirms Nanette Bahl, office manager at USC-IVF.) But budget constraints allow only an occasional discount.
Some critics also question the investment of time and money in IVF research. "I think in a time of increasingly restricted resources in health care, it's hard to argue that extending the frontiers of fertility should be a top priority," says Arthur Caplan, director of the Center of Bioethics at the University of Pennsylvania.
He also worries about the age factor, particularly if both parents are older, say 55. They may be "literally creating an orphan," Caplan says, if they don't live long enough to see their child reach 18.
Statistically, a 40-year-old woman can expect to live 41 more years; a 40-year-old man, 36 more years.
Sauer steadfastly believes that almost any woman who desperately wants to be a mother should have the chance, whether she is young or old, married or single, heterosexual or gay. "To me, there is no one way to raise a child," he says. He doubts, however, that he will extend his age limit of 55. It's his personal comfort zone. "It's a reproductive rights issue," he says.
Sauer mostly laughs off or ignores criticism. He even tells stories on himself, recalling the physician at a recent medical conference who introduced him as "the guy who makes grandmas pregnant." But he turns serious when recounting the death threats.
In early 1993, the USC-IVF office fax began spewing the missives, addressed to Sauer and Paulson as well as other local fertility specialists. The letters condemned the doctors' "discriminatory policies." In part, one read: "The police will not take this terrorist campaign/vindictive stalking seriously until you are lying in a pool of blood."
Then came telephoned bomb threats.
"I took it seriously after talking to the LAPD," Sauer says. When the police decided it was time to show Sauer how to inspect his car for bombs, he obtained a restraining order against the woman. A trial is pending.
Despite the scary experience, Sauer's commitment to helping infertile women is unshaken.
"My work is my life," he says. "I love my work. It's a seven-day-a-week job." A 60-hour workweek, he says, is light; logging 100 hours is not unusual. He travels more than 50,000 miles a year to speak at medical meetings and other conferences.
His younger sister, Debby Mathison of Orange, remembers her brother as being "always goal-oriented."
Their father, Victor, an insurance executive, kept the family on the move. They lived first in Iowa, then Illinois, Ohio, Maryland and St. Louis, where Mark graduated from high school. At each new home, Joyce Sauer recalls, her son would have his room organized within an hour of the moving van's departure.
Summers were often spent with his maternal grandparents in the tiny farm town of Martinsburg, Iowa. Each Christmas, Sauer sends a huge floral arrangement to his 83-year-old widowed grandmother, just to make her friends crazy with envy. "I love to knock the socks off those old birds," he says with a grin. This year's display, Grandma Mary Sanchez says proudly, was so large it had to be set on the floor. "There was a three-foot pine tree, a poinsettia, chrysanthemums. . . ."
Sauer thought about becoming a veterinarian, but Francis Perkins, the old town doctor in Martinsburg, unwittingly changed his mind. "I got real sick when I was about 15 from drinking bad water," Sauer recalls. "He gave me some shots and saw me daily for a couple days. (He was) a self-sacrificing, always available man who would come to your home in the middle of the night to save you, to deliver a baby."
That experience, along with a teen-age infatuation with a movie, hooked him on medicine. "It sounds corny to say, but I was always so obsessed with 'Doctor Zhivago,' " Sauer says, "with the idea of this romantic, idealized young physician and his attempt to do the right thing and help people and yet live in touch with life and not miss life."
After Washington University in St. Louis and medical school at the University of Illinois, he decided to specialize in obstetrics and gynecology. Lured by the offer from Harbor/UCLA Medical Center, he moved west and settled in the South Bay. His fellowship training quickly thrust him into the brave new world of egg donation.
"I loved working with him," says Sauer's former supervisor, Dr. John Buster, who now oversees the reproductive endocrinology division at Baylor College of Medicine in Houston. "He was intense, focused and devoted."
But Sauer's dedication also has a downside. He and wife Lynda, an attorney, separated recently after 15 years of marriage. "I don't think it's easy to be married to a professional person," Sauer says in a sad voice. "And if a professional person is married to another professional person. . . ." What happens when both partners want high-powered careers, he adds, is that "you begin to live separate existences."
The couple have three children: Julie, 11; Christopher, 8, and Jeffery, nearly 4. During football season, Sauer takes one of the kids each week to a Raiders or a Rams game. And he tries to make it to the older kids' soccer, gymnastics, cheerleading, softball and other events.
The football season tickets, Sauer says, are one indication "that I've arrived." The frequent offers to join a private practice--jobs that could quadruple his current salary--are another. So far, though, he prefers the mix of research, academics and private practice.
Anyway, Sauer says, it's hard for him to spend money on himself, with a few exceptions. When he recently traded in his Mercedes for a new Mustang GT, "the guys at the Ford dealer thought I was nuts." On a more modest level, he has been known to splurge on a feast of live crickets for the office lizard, Ben (now deceased), stowing the critters in his briefcase.
He also donates heavily to his church. After some shopping around for a denomination in his teens, he settled on becoming a "convenient" Catholic. "If I was a practicing Catholic, I couldn't do what I do (in infertility)," he says. "When I need to go to church, I go to church. When I need to talk to a priest, I talk to a priest."
Separating church and work, he says, is no problem: "I have absolutely no ethical dilemmas about what I do."
Now that he's proved that menopause and motherhood can mix, Sauer is working on the next advance in IVF--egg banking. "You can't at this point successfully freeze human eggs," he says. "We're dabbling in it."
He believes the practice will initially be offered to women facing ovarian failure, such as those scheduled to undergo chemotherapy. He predicts that oncologists, who understandably tend to focus on eradicating cancer rather than on preserving fertility, will be hearing from patients as soon as freezing is feasible.
As Sauer has learned, nothing matches the mettle of a woman intent on having a child. Twenty years from now, he dreams of conducting and publishing a follow-up study on the offspring of menopausal moms.
His prediction for its conclusion?
"Look at these children. They did great."
(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)
Dr. Mark V. Sauer Age: 40.
Native?: No; born in Cedar Falls, Iowa; raised "all over the Midwest"; lives in the South Bay.
Family: Separated. Three children--Julie, 11; Christopher, 8, and Jeffery, almost 4.
Passions: Work, Rams and Raiders games, the kids' sporting events, animals.
Weak spots: Chocolate chip cookies, on-again/off-again exercise. ("I'd like to think that I still have a six-minute mile in me.")
On his increasing notoriety: "You can say to a taxicab driver, 'Have you ever heard of a 50-year-old having a baby?' And he probably has. The idea of grandmas having babies is so interesting to everyone."
On the backlash against egg donation: "I transplant human embryos. People don't say to heart surgeons, 'You're evil for performing heart transplants.' "
On his long hours on the job: "I don't think of it as work."