TIME: Almanac 1993/TIME Almanac 1993.iso/time/110590/1105351.000

Text File | 1992-08-28 | 6.6 KB | 136 lines

                                                                                MEDICINE, Page 76

A Revolution in Making Babies


New techniques help childless couples -- even after menopause

By PHILIP ELMER-DEWITT


    For hundreds of thousands of years, there was only one way
to make a baby, at least for humans. Either it worked or it
didn't, and if it didn't, there was little anyone could do
about it. All that has changed dramatically. The growing
problem of infertility -- exacerbated by a generation of
would-be parents who put off having babies until their 30s and
40s -- and the early successes of in-vitro ("test tube")
fertilization have laid the groundwork for a revolution in
reproductive technology. Hardly a week goes by without news of
a breakthrough to help nature take its course. Last week
produced two such announcements: one offers new hope to women
with blocked Fallopian tubes; the other promises to extend
women's fertility beyond their prime childbearing years -- even
past menopause.

    Of all the barriers to pregnancy, menopause, which shuts
down the release of eggs from the ovaries, was long considered
the most insurmountable. But though the ovaries may shrivel
like raisins, the other reproductive organs of postmenopausal
women are still viable. These women can now become pregnant
using someone else's eggs, according to a remarkable report in
last week's New England Journal of Medicine. A team led by Dr.
Mark Sauer of the University of Southern California impregnated
six of seven postmenopausal women, ages 40 to 44, using eggs
that were taken from younger women and fertilized with sperm
from the older women's husbands. Four of these prematurely
menopausal women gave birth to healthy offspring, one
miscarried, and one had a stillborn baby -- an outcome that
Sauer said would have been considered normal with six younger
women.

    "The limits on the childbearing years are now anyone's
guess," wrote Dr. Marcia Angell in an accompanying editorial.
Theoretically, donor eggs could allow women whose ovaries have
stopped functioning to bear children into their late 40s and
50s. Researchers believe that the new technique will have the
biggest impact on women in their 40s who have not yet reached
menopause but have failed to conceive. The new findings suggest
that these women may be infertile not because their uteruses
are too old but because their ovaries are, and that with eggs
donated by younger women their chances of getting pregnant may
be as good as those of the young women themselves. The hitch
is, of course, that the children developing from such eggs have
the genes of the female donor and are genetically unrelated to
the mother who bears them -- a fact that presents both legal
and ethical problems as yet unresolved.

    The other report issued last week focuses attention on the
Fallopian tubes, the narrow passages that carry eggs from the
ovaries to the uterus. Women whose tubes are clogged with scar
tissue or other obstructions cannot conceive by natural means
because their eggs have no way of getting to the womb. In the
past, such women had to undergo surgery to have their tubes
cleared. Now the problem can be overcome in a doctor's office,
according to an article in the Journal of the American Medical
Association. With a tiny balloon similar to those used to clear
blocked arteries, scientists were able to unclog the Fallopian
tubes in 64 of 77 women, 22 became pregnant within a year. Dr.
Edmond Confino, who pioneered the technique at Mount Sinai
Hospital Medical Center in Chicago, estimates that it could
help nearly one-third of the 1 million American women who
suffer from blocked tubes.

    The new methods join an array of novel techniques that seem
to multiply faster than test-tube babies. Most are variations
on the pioneering procedure known as in-vitro fertilization.
In IVF, eggs are removed from the ovaries, mixed with sperm in
a laboratory dish, allowed to develop into embryos and then
inserted into the uterus. The technique has produced 20,000
offspring since 1978.

    But even at well-run clinics, the original IVF procedure
fails 75% to 85% of the time. The biggest snag comes when the
embryo is inserted in the uterus, an operation that can be very
disruptive to the womb. As a result, such embryos often fail
to take root, or implant. To increase the chances of
implantation, many doctors are now inserting egg and sperm into
the Fallopian tube, a procedure known as GIFT (for gamete
intra-Fallopian transfer). Fertilization takes place not in a
laboratory dish but in the Fallopian tube, as it would
naturally, and the resulting embryo drifts gently into the
uterus, where it is much more likely to be successfully
received. In yet another variation, called ZIFT (for zygote
intra-Fallopian transfer), the sperm are allowed to fertilize
the eggs before transfer to the Fallopian tube. The advantage:
only those eggs that are successfully fertilized need be
transferred.

    GIFT and ZIFT have turned out to be breakthrough procedures.
Some doctors who have switched from standard IVF to the new
techniques have doubled their success rates, which now approach
50%. As the odds have improved, the demand for IVF has surged,
despite the high cost (up to $8,000 a try) and the uneven
quality of the clinics offering the service.

    The proliferation of new IVF methods has produced a crop of
books to help infertile couples, from Gay Becker's
psychologically oriented Healing the Infertile Family (Bantam;
$12.95) to how-to manuals like  The Couple's Guide to Fertility
by Dr. Gary Berger, Dr. Marc Goldstein and Mark Fuerst
(Doubleday; $14.95). One book sure to cause a stir  when it
appears next January is the new edition of Dr. Sherman Silber's
classic 1980 primer How to Get Pregnant. In the revised
version, titled How to Get Pregnant with the New Technology
(Warner; $21.95),  the author repudiates much of the advice he
gave 10 years ago.

    At that time, Silber recommended that couples exhaust every
other means before turning to IVF. Now Silber maintains that
the chances of success with state-of-the-art techniques like
GIFT are so good that almost anything else is a waste of money
and time. Among the practices he attacks are some of today's
most widely performed infertility treatments, including
operations to remove varicose veins from the testicles of
infertile men and procedures to excise tiny lesions in women
suffering from endometriosis. Such techniques may be good for
financing summer homes for doctors, says Silber, but they are
no longer the best way to give infertile couples what they
really want: a healthy baby.