Assisted Reproduction Puts Lives Under the Microscope : Science: For couples who conceive, the tests and costs are worth it. But sometimes marriages are strained.
The dream blooms or dies here in this last way station for the childless. Couples exasperated by their failure to conceive entrust fertility doctors to give them what no one else can: their own child.
To these doctors they must confide the most intimate details of their lives, the things no one else in the world knows about them. Months of tests, daily shots and pills, weekly doctor visits will follow. And constant emotional swings from hormones and chemicals and the uncertainty that come with riding the roller coaster that is assisted reproduction.
This for a $10,000-or-more gamble--often unsuccessful--on parenthood.
It is into this ambivalent and costly world that patients of the now-besieged Center for Reproductive Health affiliated with UC Irvine and other fertility clinics enter. The University of California has charged three of its most prominent doctors working at the center with transplanting patients’ eggs without permission, conducting human-subject research without consent and prescribing a fertility drug not approved by the government.
Aspiring parents say assisted pregnancy is often traumatic even without such disturbing allegations and the wondering: Are your children, in fact, really your children?
“It’s horrible being infertile,” said Julie Thornton of San Juan Capistrano. “You have to give so many samples and do so many tests that it almost became callous.”
“You don’t want to see pregnant people. You don’t want to go to baby showers. You get so hopeful only to be let down again . . . and again. It’s heartbreaking. But you’re so driven, you want this child so bad, you just want to keep going,” she said.
Thornton went through five attempts at artificial insemination with her husband’s sperm. A sixth try, working with Ricardo Asch, one of three doctors under investigation at UC Irvine, and using in-vitro fertilization, was successful.
On Thanksgiving morning in 1987, Thornton and her husband, Loren, received the news that their dream had become a reality. A child was growing inside her. “It’s indescribable the feelings you get when you find out you’re pregnant. For months, I couldn’t even say the word, ‘pregnant.’ ”
Despite the pain of six years of failed assisted pregnancy attempts, despite the approximate $20,000 the couple spent (their insurance policy took care of 80% of the procedures), despite the frustration, the long process was worth it all, the Thortons say.
The result was Shane, now 6.
“He is worth every second of the pain, every penny,” the mother gushed. “He’s brought us a lot of happiness.”
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No one starts out wanting to do it this way. The stories of the thousands, who ultimately submit themselves to the stress and indignities that assisted reproduction requires, start out simply.
And they often end fruitlessly.
Like the Long Beach couple, married in 1983 and in no hurry to have children. A few years later, in their 30s with successful professional careers, they decided to start their family. But after a year or so, the would-be mom began to suspect something was wrong.
Doctors told her that her Fallopian tubes were blocked. So she underwent surgery to unblock them. Instead, the doctors removed them; they could not be repaired.
A few years went by before the couple decided to pursue Plan B: the fertility experts. It was this process that led them to specialists in both Orange and Los Angeles counties.
“At that point I knew I had to do the in vitro if I was gonna get pregnant at all,” the woman, now 47, said.
In vitro, literally, means in glass. More specifically, it means that a woman’s eggs are removed from her and placed with a man’s sperm for possible fertilization in a petri dish, then later surgically implanted in the mother’s uterus.
In preparation, the Long Beach couple went through numerous tests and evaluations; her menstrual cycle was carefully timed and daily, for weeks, he gave her shots to alter her reproductive system.
“They want you to the point where they’ve got your system where they want it through manipulation by the drug,” the woman said. “It can take a couple of months. This is to boost your egg production and to regulate your period. They are constantly monitoring you, giving you ultrasound.
“It’s really emotionally draining because you go through these incredible highs and incredible lows, hormone levels, you’re really up and really down,” said the woman. “I’m a really mellow, even person, and for me to be down like that was very hard for me.”
Plus, she added, “you’re uncomfortable and you gain weight, have a needle stuck in you every day.”
When the time is right, the ripened eggs are extracted through the vagina or abdomen via laparoscopy or by ultrasound-guided needle aspiration.
Then comes the petri dish fertilization, and waiting. The Long Beach couple’s fertilized eggs were surgically implanted in the woman’s uterus. For 24 hours, doctors had her stay off her feet so that the embryos would have a better chance of attaching to the uterine wall. Then more waiting, and finally a blood test to determine whether the gamble had paid off.
For this couple, who went through the process three times, it never did.
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Couples who have been through the process say it often feels like living under a microscope even outside the doctors’ offices. Friends and loved ones ask about matters as personal as the husband’s sperm count or the wife’s menstrual cycle.
“Because you’re taking so much time off work, everybody knows what you are doing, so everyone is tied up with your reproductive life,” one veteran of the process said, “and whether you want it or not, someone is always asking about it, [when] ordinarily you wouldn’t tell people about this.”
“It’s just the opposite of normal, when you would conceive a child privately. It’s much more public. Your friends know, your family knows, your doctor knows. Your co-workers know.”
Other factors conspire to fray nerves and test the strength of relationships, couples say.
A 40ish father with a professional career in Orange County said the whole episode was “punishing” for him and his wife. They now have two children, the second one conceived without assistance, the first through a technique in which his sperm was fertilized in his wife’s Fallopian tube. The technique, known as GIFT for gamete intra-Fallopian transfer, was pioneered by the UCI doctors now under siege.
Things, the father said, got testy in the beginning because he was more interested in adoption when the couple’s efforts to conceive a child failed. “But I also didn’t want to end up divorced, and she really, really wanted it.”
So on came the tests on both prospective parents, sperm counts, questions about sexually transmitted diseases, history of abortion and “all the stuff you wouldn’t talk to most anyone in the world about,” he said. “You get over it. The initial humiliation passes.” He laughs. “Eventually.”
One such embarrassment, several couples said, is the obtaining of the sperm.
“I went into the doctor’s office waiting room, which has mostly women in it,” said a 43-year-old man and veteran of assisted pregnancy drills. “And they all know what I’m there for. And I go into this private room, and then I come out with a plastic cup. And all the people in the waiting room know what you’ve done. Masturbating so that everyone knows about it, that was . . . “ he sighs, “not great.”
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While most couples start out with the hope that a child conceived will be biologically theirs, it is sometimes ruled out as a possibility. It is at that point that the use of donor sperm or eggs--sometimes both--is considered.
Fertility doctors often solicit donors from among the college populace. They are seeking young adults in good health and, if a bright college student, all the better.
Jennifer King, 22, a former UC Irvine student, is among those who responded to an ad in a college paper seeking a blonde, blue-eyed woman to donate her eggs to a couple. “I thought it sounded interesting,” she said.
King ended up working with a private doctor in Newport Beach who was working with an infertile couple. After being screened for health problems, King underwent a series of shots to adjust her reproductive cycle so that it would synchronize with that of the intended mother. That process alone took two to three months, she said.
“The hormones they make you take, make you crazy,” King said, adding they put her in a temperamental mood.
When it was determined that their cycles were in sync and her eggs were ready to be harvested, King went to a hospital in Los Angeles where her donor eggs were removed and placed with the father’s sperm in an attempt to fertilize them.
King said she insisted on assurances from the doctor that any unused eggs were to be frozen and used only with this mother.
The last King heard, the fertilized eggs were successfully implanted. She does not know whether a baby was ever born. “I didn’t want to know. I don’t consider it my child. . . . I was actually kind of apathetic about it.”
She says it simply seemed a worthwhile thing to do, to help an infertile couple. For her participation, she was paid $1,500.
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Entering the realm of assisted reproduction often takes an emotional as well as physical toll on a couple--especially given that the process usually spans several years. There is a reason some psychiatrists specialize in treating couples with fertility issues.
“It brings you apart first before it brings you together,” said the Long Beach woman of its effect on her marriage. “You realize there is something you can’t do together that is, quote unquote normal, that makes you look suspiciously at each other a bit: you’re not doing this right, you’re not taking the shots right.
“When it didn’t work, we said to each other, we have to get on with our lives now. We could continue to do this for years and years and have it be a terrible all-consuming part of our life, or go on. And just being together is fine. We are lucky because we are logical. But we went through the blaming yourself for awhile, why is this happening to me. You hear stories of people whose kids are abandoned and think, why?
“But we came back together and realized we love each other and if we don’t have a child that’s just a part of our lives we’re not going to have. You move on. If you can. I mean, I’ve read stories where couples go on and on for years and it breaks up their marriage. But it was never the one consuming thing in our lives.”
She has never regretted going to the additional effort to conceive, she added.
“Never. And every time I read about a scientific discovery about it, I’m happy, because someone else won’t have to go through what I did.”
Times staff writer Lily Dizon contributed to this report.
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Creating Fertility
In-vitro fertilization is a highly specialized treatment for some types of infertility, including low sperm count and blocked Fallopian tubes. The procedure----about $5,000 per implantation----is successful in about 10% of couples the first try, and multiple births may occur. How the procedure works through the menstrual cycle:
Days 1-8: Patient given fertility drugs to help ripen eggs
Days 9-13: Ultrasound scans monitor egg-ripening
Days 14-15: Before ovulation, ripe eggs removed through vagina or stomach. Eggs mixed with sperm in Petri dish and incubated
Days 16-17: In about 40 hours, eggs checked for embryo development; if developed, several embryos placed in uterus through vagina
Glossary
Artificial insemination: Using an instrument to inject semen; about 10,000 babies are born in the U.S. annually as a result of this procedure
Embryo: The stage of egg development during the first eight weeks after conception
Fallopian tubes: Tubes extending from the uterus to the ovaries that transport eggs and sperm, where fertilization occurs
Fertility drugs: A diverse group of hormonal or hormone-related drugs used to treat male and female infertility
Fetus: The stage of development for the duration of pregnancy after the embryonic stage
In vitro: Literally, “in glass.” Refers to a glass Petri dish used for in-vitro fertilization
Laparoscopy: The method of examining the abdominal cavity with laparoscope, a viewing tube; commonly used to examine Fallopian tubes when investigating infertility
Ovary: One of a pair of almond-shaped glands on either side of the uterus; contains numerous cavities where egg cells develop
Ultrasound scan: A diagnostic technique in which very high-frequency sound waves are passed into the body and reflected echoes are analyzed to build a picture.
Uterus: The hollow, muscular organ of the female reproductive system where a fertilized egg normally becomes embedded and the developing embryo and fetus grow.
Source: American Medical Assn. Encyclopedia of Medicine
