Pittsburgh Post-Gazette - Baby Boom Baby Bust - Conception technologies give rise to ethical concerns

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Conception technologies give rise to ethical concerns (Pt. 2)

In vitro fertilization and other high-tech methods of conceiving are hardly the norm for infertile couples.

Nearly 60,000 such procedures were attempted in the United States in 1995. About 100 times that many women consider themselves or their sexual partner to have a fertility problem, according to a national survey done the same year.

But the in vitro world of dealing with infertility snares all the publicity, and the couples desperate and wealthy enough to enter it can find it daunting. Even well-educated consumers are befuddled by the new terminology, procedures and decisions critical to their ability to have a family.

"I found it intimidating and overwhelming, and I wonder how people with no background in the medical system can do it," said Dr. David Baker, a Shadyside opthalmologist who has been through two unsuccessful in vitro cycles with his wife.

He was referring to unfamiliar medications that had to be mixed for his wife and injected; complicated consent forms they had to fill out; difficulty in getting clear, prompt answers from doctors and their staffs; and confusion about chances of success using the sperm he had frozen 12 years ago, before receiving chemotherapy for Hodgkins lymphoma.


	Dr. Anthony Wakim, director of the advanced reproductive program at Allegheny General Hospital, sees too much "hyperbole" in his field that could victimize vulnerable patients.

Dr. Anthony Wakim, director of the advanced reproductive program at Allegheny General Hospital and a former infertility patient himself, said the specialists running the largely unregulated field can easily mislead vulnerable couples.

"The hyperbole is shameful," he volunteered, asserting that some doctors quote misleading statistics about their facilities and encourage young patients to attempt one procedure after another.

Wakim and other local specialists said most successful cycles of either intrauterine insemination or in vitro come on the first three tries, and they don't encourage patients to try much more than that.

Couples researching their options received some help in December, when the Centers for Disease Control and Prevention published its first annual report on all of the advanced reproductive procedures attempted in the United States.

Of 59,142 cycles of in vitro and other high-tech procedures at 281 sites in 1995, the most recent year that could be tabulated, 24.4 percent resulted in pregnancies and 19.6 percent in live births.

The numbers suggested continuation of gradual improvement in success of in vitro during the 1990s. The biggest boost comes from new laboratory fertilization techniques requiring just a single sperm from infertile men instead of 50,000 or more.

Nationally, in vitro now matches the success probability of what healthy couples can do on their own in one month of unprotected intercourse. There's wide variation, however, among clinics.


Dr. Carolyn Kubik, center, conducts a daily meeting at University Womens Health Care Associates for the staff to review progress of patients' treatment. She's joined here in going through a stack of patients' charts by nurse coordinator Mary Jo Meyer, left, and embryologist Eve McPartland.

For instance, the University Womens Health Care Associates program at Magee-Womens Hospital and the Allegheny General Hospital in vitro program both had live birth rates of less than 14 percent. St. Barnabas Medical Center in Livingston, N.J., which the Huntes from Jeannette used twice, with success the second time, was above 41 percent.

Specialists, even those who do in vitro well, have trouble explaining why one clinic can show results three times better than another.

"I don't think there's anything magic about what we do," said Dr. Paul Bergh, director of the Institute for Reproductive Medicine and Science at St. Barnabas.

Success rates can reflect the particular problems and ages of the patients being seen, not just the clinic's quality. Laboratory personnel, policies and procedures in handling of embryos -- and deciding how many are transferred into patients -- also can have as much bearing on in vitro success as the doctor's skills.

Combining fertility drugs with in vitro is intended to cheat nature, providing a woman with more eggs that can be fertilized as potential embryos than just the one her body would normally release each month. When more embryos are transferred, the chance of pregnancy increases. So does the risk of multiple births.

The CDC report for 1995 found that 37 percent of the births from advanced reproductive techniques were multiple births, as opposed to 2 percent for the general population. Many of those who practice infertility medicine believe reducing the number of multiple births -- with the risks they entail -- is the biggest challenge they face.