by Monica Hayde
After three ectopic pregnancies, numerous surgeries--including the removal of one fallopian tube--tests for everything from chlamydia to AIDS and years of having doctors tell her "to go home and try again," it had all come down to this one phone call. A Los Altos woman in her mid-30s sat at the kitchen table while her husband waited anxiously for the doctor to pick up the line.
"They put me on hold," he remembers telling his wife, who was too nervous to make this call herself. "They want me to talk to the doctor," he said gravely.
The couple was awaiting the results of a $11,000 gamble that Nova Fertility's Dr. Francis Polansky and his team of embryologists would be able to accomplish what Mother Nature could not.
"We were both thinking, oh boy, if they want the doctor to talk to us it must be bad news. It must mean I'm not pregnant," recalls the woman, who did not want her name to be published.
"Dr. Polansky gets on the phone and he puts the speaker phone on, and I guess he had everyone in the office gather around, and they all yelled 'Congratulations! You're pregnant!' (My husband) looked at me and said, 'It worked! It's positive!' I just started bawling. I couldn't stop. I think I had a mini-breakdown. I was in a state of shock for like a month."
Despite the happy ending--twin boys--this woman's pregnancy after just one cycle of in vitro fertilization is not the norm in this high-cost, high-stakes game of baby-making. Approximately 70 to 85 percent of infertile couples who go through any number of IVF cycles do not come away with a child. And for most infertile couples, IVF is the last stop, the last hope, on an often long and painful quest for a child.
Of the nation's approximately 200 IVF programs, three are based in Palo Alto: Polansky's Nova IVF, Dr. David Adamson's Fertility and Reproductive Health Institute of Northern California and the Stanford Medical Center's program.
The science of IVF has advanced steadily since 1978, when Louise Brown, the world's first "test tube baby" was born in England. Success rates have inched upward over the last 15 years but still hover around 15 to 30 percent, depending on how those all-important, self-reported numbers are calculated. Not great odds for a procedure that costs $8,000 to $10,000 per cycle, not including fertility drugs that can run into the thousands of dollars. Only a few insurance companies cover any portion of the IVF procedure, although Polansky says more and more are recognizing infertility as a "legitimate, treatable disease."
For many couples, there are difficult ethical decisions to confront as well. Because of the tiny odds--just 7 to 9 percent--of a single egg fertilized in a petri dish attaching to the wall of the uterus and developing to full term, the doctor usually places anywhere from four to six embryos in the uterus. (The final decision on the number is usually left up to the couple.)
If one or two continues to develop, the expectant parents are jubilant. But when an ultrasound reveals three, four or even more heartbeats, a "selective reduction" is the only answer for a woman who cannot physically bear multiples, or a couple not desiring more than twins. Doctors will not reduce below two embryos. Almost 50 percent of all IVF pregnancies are twins.
For a couple that might have spent years of anguish and perhaps tens of thousands of dollars trying to have a child, a selective reduction--in which the poison potassium chloride is injected into the most accessible embryo or embryos--seems a cruel and twisted joke.
"It was awful," says the Los Altos woman while cuddling one of her babies. Her husband sits nearby, giving a bottle to their other child. In her case, Polansky implanted five "high-quality" embryos and three took. After much agonizing, they decided that trying to bring triplets to term would be too risky for the mother as well as the babies.
"I still remember the date we had it done," she says, shaking her head. "Part of you thinks, 'OK we wanted this so badly, we'll just take three babies, but part of you says 'You're crazy! I can't carry three babies.'"
"We couldn't believe we were having to think about doing this," adds her husband, whose conservative parents still know only a small portion of the story of how their grandsons were conceived. "Who would have ever thought we would end up having to confront these issues? When you're younger, in college, you only think about not having children; about not getting pregnant."
Selective reduction is not the only dilemma many couples going through IVF must confront. They must consider what will happen to the embryos not implanted. Should they be destroyed? Donated? Frozen for future use? And then there are those couples whose physiological problems force them to consider using donated sperm or eggs. Or both. What are the emotional consequences of carrying and giving birth to a baby who is genetically related to just one of the parents--or to neither?
"It might sound funny, but we were also concerned about getting the right sperm and eggs," the Los Altos woman says. "(My husband) made sure he asked Polansky about his methods for keeping the sperm and eggs straight--whose are whose . . . I still think about the whole process and I'm in awe. They take something out of your body, put it back in . . . Before we did this, I thought there would be no way I would ever do IVF. It's way out of my league, too weird."
But the all-consuming desire to have a child quickly eclipsed many of the couple's reservations.
"Sure, we talked about the fact that maybe it's just not meant to be, and hey, is it so bad not to have children?" she says. "But at the same time, I just knew I could get pregnant if we could bypass the fallopian tubes. We just needed a little help."
Besides, she says, there is always that underlying, nagging feeling of "failure" or "inadequacy."
"It does feel like a failure, not being able to conceive normally. No matter what anyone might say, that is how you feel."
For this and other reasons, the couple went through the IVF procedure pretty much alone, not telling friends or co-workers, and sharing their ordeal only with select family members.
"First of all, IVF for some people is ethically immoral," the woman explains. "And for people who don't understand the trials and tribulations of infertility, they would just have no idea. We just felt that this was something we needed to do alone, together. Yes, it would have been nice to have encouragement, but what if it didn't work? We didn't want the questions, the pity . . . If I meet someone who has done IVF, we're instant friends, but I don't offer it up."
Having friends and acquaintances constantly asking them, "When are you going to have kids?" was a constant source of frustration, even anger.
"Now, if we meet a couple, an older couple, with no kids, we would never bring it up," her husband says. "I would really stress to people to think before they talk."
"And now, with the twins," she adds, "people are always coming up to us and saying, 'Oh twins! Do they run in your family? Did you take fertility drugs?' You wouldn't believe how rude people can be without even thinking about it."
Although basic IVF technology is relatively simple to understand and the outpatient procedure is arguably less complex than many common surgeries, in vitro fertilization treads on that mysterious, hallowed ground of human reproduction and asks us to accept what makes many people uncomfortable: that the "miracle" of life can be manipulated by science. By comparison, though, few people would argue that a heart surgeon is "playing God" if he or she saves someone from dying of a heart attack. Some argue that the lid on that Pandora's box of reproductive possibilities is being opened ever wider. And the world continues to debate the ethical ramifications of some of the more Orwellian offshoots of IVF: the possibility of creating "designer" babies, the harvesting of eggs from aborted fetuses, post-menopausal women having children through donated eggs.
"There are a lot of applications for in vitro fertilization research," says Dr. Linda Juidice, an infertility specialist with Stanford University's 9-year-old IVF program. "Because each cell of an embryo contains all the genetic material of a whole person, genetic analysis of a person can be done before an embryo is transferred into the uterus. Genes for Tay-Sach's (disease), for example, can be identified. But this, of course, creates many moral dilemmas. What gene is not a good gene? A gene for hypertension? A gene for breast cancer? At this point, most countries condemn this sort of genetic selection, but it can be done."
For that couple next door, though, for the woman with blocked fallopian tubes, for the man with a low sperm count, basic IVF--while not an option for every infertile couple--is no longer considered borderline or experimental medicine.
Just ask Palo Alto social worker Linda Miller, who happily and openly recounts her experiences with IVF. Miller and her husband have a nearly textbook-perfect IVF success story to tell.
They had barely begun trying to have a baby about a decade ago when Miller discovered through a routine pelvic exam that her fallopian tubes were almost completely blocked, most likely from some old, undiagnosed infection.
"Because we knew there was basically no chance of conceiving 'normally,' we started exploring other options right away," Miller says. "We were lucky to sort of short-circuit the process."
Too many couples spend years of wasted time trying to conceive before approaching an infertility specialist, Polansky says. Most doctors advise couples to begin investigating possible reasons after about one year of trying.
When Miller first underwent IVF it was still a relatively new procedure. Her eggs were harvested through a laparoscopy, a surgical procedure, instead of through today's 10-minute office procedure called ultrasound-guided trans-vaginal retrieval. And the fertility drugs she took produced about five eggs in one cycle. Today, through different dosages and combinations of drugs, doctors usually harvest an average of a dozen eggs in one cycle, although that number can vary from just a few up to 60.
Of the five eggs Miller's doctor took, four were fertilized and placed back in her uterus. After about two weeks, her doctor in Reno, Nev., found two heartbeats. The news could not have been better. There would be no agonizing over a selective reduction, and they had already beaten the daunting statistics. Once a heartbeat is found, according to Polansky, there is an approximately 90 percent chance that the embryo will develop to full term.
Miller gave birth to twins, a boy and a girl, now 9 years old. "It was just perfect," says Miller, who at the time of her interview with the Weekly was eight months pregnant with a third child, also conceived after just one IVF cycle. Again, Miller, now 39, made mincemeat of the disheartening statistics that say a woman's chances of conceiving through IVF after age 35 nosedive into near oblivion.
"The process is both simple and miraculous at the same time," says Miller, who still has six frozen embryos up in San Francisco. "It is technology, but when it works, it feels almost spiritual. I'm not a very religious person, but I'd have to say that this feels like a gift from God."
Indeed, to have conceived two times after just one IVF cycle is tantamount to a small miracle. Many women have endured three, five, seven or even more cycles and still not gotten pregnant.
Polansky tells most of his patients that if they have not conceived after three or four cycles, "it often makes no sense to continue spending years and money trying to conceive. Each case is different, but generally, the chances are just too slim."
Susan and Steven Hailey of Menlo Park spent six years trying to conceive, initially through fertility drugs alone, later through IVF. After attempting at least six cycles with Polansky, and finishing three with no positive results, the Haileys decided to adopt. Their 19-month-old daughter, whom they adopted at birth, has been an all-consuming joy, they say, but the desire to have their own child is still there. The Haileys, lucky in that their insurance covers IVF, will probably attempt one more cycle this summer.
The Haileys fall into that frustratingly large category of infertile couples whose physiological problems are chalked up simply as "unexplained." One-quarter to one-third of all couples who seek help from an infertility specialist fall into this little-understood gray area.
"The tests were inconclusive," Susan says. "(One doctor) said it just looked like my ovaries just hadn't done a lot of ovulating . . . Never, ever when I was younger did I think this would be a concern. There was nothing in my family history, no indications at all. In fact, when we first started going to Resolve (a support group for infertile couples) meetings, I was thinking, 'Oh, we don't really belong here. I'll probably be the first one to get pregnant.'"
In fact, though, the Haileys ended up enviously watching happy couples trickle away from their support group as, one by one, the women got pregnant through IVF or other infertility treatments, or adopted.
"Absolutely nothing in our life experiences had prepared us for dealing with infertility," says Susan, a marketing manager. "I had always thought that if you work hard enough at something, or spend enough money, if that what it takes, you will be successful at something. That's not how it is with infertility."
While there were many low points along their six-year quest, and their relationship was repeatedly strained--not in small part due to the effect of the fertility drugs on Susan's moods, they now joke--the Haileys have maintained a positive attitude about their ordeal.
"We didn't get pregnant, but at least we know we did everything we could have done," Susan says.
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