In Vitro Fertilization Advances
Jessica and Bennett Brookstein were in their mid-30s, devastated at not yet conceiving their family. Jessica recalls when an 11th grade boy in their neighborhood — arm around his girlfriend , boasting that they were pregnant — asked her, “When are you gonna have a baby?”
“It’s hard,” she says. “You see high schoolers having babies. People don’trealize how much it hurts.”
After multiple rounds of medications and three in vitro fertilization (IVF)procedures, the Brooksteins finally conceived, carried and successfully delivered a healthy daughter.
IVF is a form of assisted reproductive technology in which the sperm and egg are fertilized outside the body and the embryo is then transferred into the woman’s uterus. This method to achieve pregnancy may be recommended when disease or damage has disrupted the fallopian tubes or when sperm havedifficulty reaching or penetrating egg cells. Approximately 59,000 U.S. babies were born in 2010 using IVF.
IVF can also be a treatment for “secondary infertility” — when a couple has difficulty conceiving despite a previous birth. Age is a major factor contributing to “reproductive inefficiency,” according to William Schlaff, MD, OB/GYN Chair at Thomas Jefferson University Hospital in Philadelphia.
Fortunately, IVF technology has advanced greatly since the first “test tube baby” was born in England in 1978.
Single Births. Among the most important advances in IVF has been a reduction in the likelihood of multiple births. Increasingly, IVF achieves the goal of a healthy, singleton embryo. Improvements that account for this progress include more sophisticated screening and later transfer of the fertilized egg, allowing the embryo to further develop.
Freezing Techniques. One of the most exciting advances is in the freezing of eggs, says Sharon Anderson, PhD, scientific and laboratory director of Main Line Fertility & Reproductive Medicine in Bryn Mawr, PA. New techniques “enable young women to preserve their reproductive potential” before facing radiation or chemotherapy for cancer, says Dr. Anderson. This development also enables the establishment of egg banks and encourages egg donation programs, potentially benefiting women older than 35 or with premature menopause.
Genetic Screening. Some fertility centers now offer “pre-implantation genetic screening” (PGS) on biopsied embryo cells to try to help identify healthy embryos and to increase pregnancy rates from IVF. Several centers report significant progress in the past two years.
However, American Society for Reproductive Medicine committees have found contradictory and inconclusive research results for PGS. Current clinical guidelines do not recommend PGS as a way to increase pregnancy rates.
Finances & Other Stresses
IVF costs on average around $10,000 for the procedure and another $5,000 for the medicines. Embryo freezing and other optional procedures add additional costs. Insurance plans differ widely in the range of services covered.
As a state employee in New Jersey, Bennett Brookstein received strong family benefits under his government insurance plan. That level of support is not typical of most policies.
Some fertility clinics offer discounts, or even free IVF procedures and medications, to patients who agree to participate in clinical research trials. Some practices offer a package of services and a partial rebate if the process — for example, after six cycles of attempts — does not result in a birth.
Financial obligations are just part of the stress that couples face when trying to overcome fertility problems with IVF.
Many couples experience isolation and social pressure. The IVF method itself involves careful timing, daily injections, an interdisciplinary team of specialists, frequent trips to the clinic and invasive procedures. Many cycles are sometimes required to achieve a pregnancy.
“It takes a lot out of you,” says Jessica Brookstein. She emphasizes the importance of partners being on the same page and of having someone to talk to. Once they had their baby, the Brooksteins were surprised to find out how common fertility problems are and how many couples go through IVF. Despite all the stress, they’d do it again, she said.
Ann L. Rappoport, PhD is a contributing writer to MetroKids.