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  Infertile couples face a maze of hope, strain and science (Pt. 2) Whether or not you're infertile, chances are you have a friend, relative or co-worker grappling with the issue. They may not have advertised it, but they give off signals; watch how quickly they change the subject when someone else's childbirth is mentioned. About 2.1 million married couples in 1995 were infertile, meaning unable to conceive after trying a year of unprotected intercourse, according to the government's National Survey of Family Growth. Men and women are considered equally responsible for the difficulties. The survey of women of child-bearing age estimated that 6.1 million -- or one in 10 -- believed they or their partners had physical problems that could prevent childbirth. Both demographers and infertility specialists report that more and more well-educated, middle-class women pursuing careers have delayed their efforts at pregnancy until well into their 30s, unintentionally reducing their chances to conceive. The quality of their eggs diminishes with age while other reproductive obstacles increase. There's less evidence of any significant increase in infertility for others, but that hasn't kept public discussion of the problem and efforts to fix it from multiplying. "The percentage of couples having trouble getting pregnant has been a fairly stable number," said Dr. Benjamin Younger, executive director of the American Society for Reproductive Medicine. "What's different is that we have more to offer, and so we're treating more couples." The national survey estimated that, within the prior year, 1.2 million women had made a visit for infertility diagnosis or treatment. Fertility drugs such as Clomid, Fertinex and Humegon represent the most common form of treatment. In 1997, a record 1,271,000 such prescriptions were written in the United States, according to IMS America, a pharmaceutical research group. The number of in vitro fertilizations and similar assisted reproductive procedures carried out in the country has been surging, though it's still a small fraction of overall infertility treatment. In 1995, women underwent nearly 60,000 attempts at such advanced treatment, more than double the number from five years earlier. In vitro succeeded in producing babies for couples in about one of every five tries, which is similar to the success rate a healthy couple would have in a month without any help. "Most people who come to see you don't need that high-tech treatment," notes Dr. Miguel Marrero, director of the infertility program at St. Clair Memorial Hospital. "To me, in vitro is a last resort." Infertility specialists recommend that most couples become concerned only after trying on their own for a year, by which time about 85 percent of them should become pregnant. It's the 15 percent who fail the year-long test who become the focus of the growing infertility industry. If they're determined to become biological parents, the couples typically undergo evaluation by an obstetrician-gynecologist and a urologist. That's when a confusing array of options begins to unfold, none of them likely to produce a pregnancy on the first try despite the physical discomfort, emotional distress and financial cost accompanying most of them. If repeated attempts at conception through well-timed intercourse fail, even with the assistance of drugs or surgery to repair reproductive organs, the couple may forgo becoming parents, may pursue adoption or seek advanced laboratory treatments through infertility specialists known as reproductive endocrinologists. Every couple has a different limit to what it will endure or expend for the sake of a child. "The problem with infertility is there's always a new procedure out there. There's always a carrot dangling, so when do you stop?" wondered Naomi Howard, 41, a geriatric social worker from West Deer. She's had six unsuccessful intrauterine inseminations, also known as artificial insemination, a middle ground between intercourse and in vitro in which the male's sperm is injected into the uterus to shorten that arduous journey to find and fertilize an egg. Howard also failed to conceive in two procedures known as gamete intrafallopian transfer, or GIFT. GIFT is a surgical procedure in which a couple's eggs and sperm are injected jointly into a woman's fallopian tubes in hopes they fertilize there, while in vitro entails trying to fertilize the egg and sperm in a laboratory dish before placing them in the woman's uterus. Howard and her husband, a bank executive, are now mulling whether to pursue adoption. Howard still clings to the idea of somehow experiencing pregnancy, as doctors haven't been able to pinpoint the cause of her and her husband's infertility. "It's gotten to the point where if someone told me to hang upside down for two hours every day and run around the neighborhood naked, and that would get me a baby, I'd do it," she said. Infertile couples may spend years taking precautions to avoid pregnancy because they're unaware of their condition. Then they decide they're ready to join the ranks of minivanned friends happily preoccupied with their children's drooling and schooling. For months, they try unprotected intercourse midway through the female's menstrual cycle, when women ovulate. They wait a few weeks each time, only to be disappointed by the return of her period and the realization that no baby is on the way. One of the most common causes of infertility in women is a hormonal imbalance that affects their ability to ovulate, meaning there's no egg for sperm to fertilize. Would-be mothers also may have blocked fallopian tubes requiring surgery, or abnormal growths in their uterus that pose obstacles to sperm. Or they may lack healthy uterine lining for a fertilized egg to implant. Such problems were the focus of most efforts to address infertility before the 1990s. Oral ovulatory drugs were introduced in the 1960s, followed by new ultrasound techniques to monitor the drugs, noninvasive surgical repairs called laparoscopies, and common use of in vitro and intrauterine insemination by the 1980s. New techniques in the 1990s have taken more note of the male's problems, trying to assist those whose sperm lack sufficient numbers and strength to effectively navigate the female reproductive system. Specialists say men have also shed some of their traditional hesitancy to confront their role in infertility. By identifying and injecting a single viable sperm into the female's egg in the laboratory, doctors help men whose sperm count and activity was once considered too low to be useful. If men have blockages that prevent them from ejaculating sperm, doctors now use minor surgery to collect it from the testicles. Ten to 20 percent of the time, as with the Howards, an evaluation of the pair will turn up no cause of infertility. "It's not a female problem or a male problem -- it's a couples problem," Marrero says of infertility. "Most of them don't understand their situation that well -- nobody ever really sat down and explained it to them." Once they recognize their unexpected difficulty, the biggest jolt to many couples is how much time infertility treatment takes from their lives. If oral pills supposed to assist and enhance a woman's ovulation don't work, more potent hormone-related drugs must be injected by needle into a woman at the same time every day for nearly two weeks. Plenty of females, queasy at doing the injections themselves, rely on their mates to give the shots in thighs, arms or buttocks. That presents its own trials -- both in arranging daily schedules and exploring new dimensions of husband-wife dynamics. Other complications involve making three or more office visits for blood tests and another group of sessions for ultrasounds to monitor the drugs' effectiveness during a two-week cycle, wreaking havoc with any working woman's schedule. And all the while, the impact of the hormones can trigger depression, irritation, bloatedness, hot flashes and other side effects. Some women feel minor changes, others get real ornery. "This flipped me in a way I'd never been flipped," said Wanda Sowell, 36, who always considered herself tough until fertility drugs made her feel helpless. "I thought this is what it's like when people are losing their mind."
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