Published: November 19, 2006 01:17 am      

Seeking ‘Miracle of Life’

IVF offers hope when infertility is a problem

MORGANTOWN — One in five.

That’s a startling statistic, but doctors estimate that 20 percent of couples of child-bearing age have some sort of fertility problem.

“It makes infertility the most common malady, other than the common cold,” said Dr. Michael Vernon with the West Virginia University Center for Reproductive Medicine. “The reason it doesn’t get the attention is that you don’t die from infertility. Because of our Victorian attitudes, we aren’t willing to talk about it. People keep it to themselves.”

But it is something that couples can feel comfortable talking about at the center, Vernon said, which is located on Pineview Drive in Morgantown.

“People like to come here because it is a nice place for them to come for a problem they don’t want to have to deal with,” Vernon said. “We don’t have problems with parking. We have a lot of privacy. It’s an office that treats everyone like they are coming into a hotel.

“And with that type of environment, it is a lot friendlier for a problem that they wish would just go away.”

The center itself is generating a great deal of talk — success rates for in vitro fertilization there are within the top 5 percent in the nation.

In vitro, which means “in glass,” matches a single egg with sperm cells in a laboratory environment to produce an embryo, as opposed to the traditional method of conception where the male’s ejaculated sperm cells meet the female’s egg within her fallopian tubes.

“In our program, the success rate for IVF for all comers for the last three years has been about 50 to 60 percent,” said Dr. Kevin McGinnis, a reproductive endocrinologist at the center. “Nationally, the success rates run about 40 to 45 percent.”

IVF technology was first developed as a way to help couples trying to conceive when the woman was dealing with diseased or blocked fallopian tubes. But today, the technique can be used to deal with any number of fertility problems, including low- to no-sperm counts, the lack of ovulation and irregular ovulation cycles.

“What’s happened is we now have discovered a myriad of ways that we can help the infertile couples using IVF,” Vernon said. “And it now has reduced the total number of individuals who go childless — substantially reduced.”



When is infertility

a problem?



For couples in their 20s, infertility is defined as failure to achieve pregnancy on their own in one year, McGinnis said. For couples over the age of 35, most gynecologists would consider a period of six to eight months without success as a reason to test for infertility causes.

“What I tell patients in the office is that there are basically three things that have to happen for a woman to get pregnant,” McGinnis said. “She has to make a healthy egg, her husband has to make enough healthy sperm, and they (the egg and the sperm) have to be able get together. So we test for all of those things.”

Consider the process of conception. According to the Mayo Clinic, conception happens after a series of intricate events:

• Every month, hormones from the pituitary gland stimulate ovaries to release an egg, or ovulate. This often happens around day 14 of the menstrual cycle, although the exact timing may vary among women or even from month to month.

• Once the egg is released, it travels to the fallopian tube. The egg has about 24 hours to unite with a sperm. Since sperm cells can survive in the reproductive tract for two to three days, it’s best to have regular sex during the days leading up to ovulation.

• If the egg is fertilized, it will travel to the uterus two to four days later. There it will attach to the uterine lining.

They don’t call it the “Miracle of Life” for nothing. McGinnis says that a fertile couple only has about a 20 percent chance of conception every month.

That percentage is dramatically reduced by any number of factors, including environmental exposure to toxins, health problems or abnormalities.

“The initial evaluation for infertility is done by the local gynecologist, and even some of the initial treatments are done by them depending on how comfortable they are,” he explained. “At some point, and sooner for the older couples, the gynecologist refers them to us.”

An IVF procedure isn’t necessarily the first course of action at the WVU Center for Reproductive Medicine, McGinnis said.

“There are a series of options, and I tend to go in a step-wise fashion,” he explained. “I start at the least-expensive, least-invasive option, working up to IVF being my treatment of last choice. That is just because a lot of patients will get pregnant without IVF.”

For example, there are oral or injected medications that a woman can take to assist with ovulating every month, a regular cause of infertility.

“Normally, the chance of those working — depending exactly on what her problem is — are about 10 to 15 percent a month for the first three to four months, then it decreases,” he explained. “But even before I would start those medicines, I would start an evaluation to explain why this woman is not getting pregnant.”

A 1995 report by the Center for Disease Control estimated that:

• The number of women ages 15-44 with impaired ability to have children was 6.1 million.

• The number of women who have ever used infertility services was 9.2 million.

• The number of married couples who are infertile was 2.1 million.

• The number of women using infertility services was 9.3 million.

Male infertility



A woman is born with a fixed number of egg cells that never replenish. A man, on the other hand, produces 30 to 70 million sperm cells per day.

“If a man is exposed to an environmental toxin, say he paints a room and smells all that acetone, it hurts his current sperm production,” Vernon said. “But in two months, he bounces back as if the event doesn’t take place. If a woman does that, those fumes will kill some of her eggs, and she never gets a new group.”

But there are cases where men produce few healthy cells capable of fertilization. McGinnis said that in about 40 percent of the cases he sees, there’s some sort of male infertility cause that reduces the chances of conception.

The center has had a great deal of success with intracytoplasmic sperm injection, which means using one single sperm cell to fertilize an egg, as opposed to the conventional method where the lab takes a single egg and puts as many as 150,000 to 200,000 sperm cells around it.

“In fact, one of the things we have been able to do, which has been very exciting over the past four years, is that we actually help men who have no sperm in their semen,” Vernon said. “What we do is go in and take a little piece of testicular tissue and extract sperm for that testicular tissue and inject it into the egg. And we have had an unusually high success rate doing this.”

Since cancer treatment can cause infertility, the center can also help men plan for the future before infertility becomes a problem.

“The most common individual we see is a young, unmarried man in his mid 20s who wants to preserve his capacity to have children,” Vernon said. “When a person has cancer, all they hear is bad news. And you think the last thing they would want to deal with is the reproductive system. But to my surprise, most males look at this as planning for the future.”

An there have been many heartwarming successes in cases like that, he said.



The IVF process



When IVF becomes the option for couples facing difficult odds conceiving on their own, the WVU Center for Reproductive Medicine uses both a clinical and laboratory approach Vernon says contributes to the high success rates.

“There is a little bit of truth to the fact that the laboratory component is the secret,” said Vernon, who is the IVF lab director for the center. “If you can cultivate and culture embryos and sperm to develop in a fashion that allows them to implant, you will have a high success rate.”

But the lab’s success also strongly depends on the quality of the eggs collected, Vernon said.

“Dr. McGinnis stimulates the patient to produce high-quality eggs. We then take those, and we then cultivate them into an embryo. And then he then puts them back into the woman,” Vernon said. “The other component is the university has gone out of its way to financially support us. So we have cutting-edge equipment now. Without that equipment, there is no way that the lab component would be able to do as well as we have been doing.”

On average, about 10 eggs can be collected from the woman, and about four of those eggs are of the quality considered good for fertilization and development. In the lab, the eggs are fertilized with sperm cells, creating embryos. About three days later, the embryos will develop and divide to six to eight cells, which are then transferred to the mother’s uterus.

Vernon said the embryos are graded by appearance — either excellent, good, fair or poor.

“The excellent ones, as the name implies, have a very high chance of making a baby. We usually have one excellent per patient,” he said. “We usually average one excellent and two good. So from that group, we usually transfer an excellent and good or two good-quality embryos.”

The center will cryo-preserve the remaining embryos if they are in good condition, Vernon said, for the couple’s future use.

And because more than one embryo is transferred into the uterus, there’s a higher chance of a multiple pregnancy with an IVF procedure than traditional conception — about a 25 percent chance.

“But our multiple (pregnancy) rates are almost all twins,” Vernon said. “The real problem is when you have greater than twins — triplets and above. That is a serious obstetrical problem. That is why here we only transfer two or three (embryos).”



And then the wait



There are two kinds of pregnancy tests — a qualitative test, which is either positive or negative, and a quantitative test, which measures the amount of HCG hormone present in the woman’s body during pregnancy.

A couple can buy a qualitative urine pregnancy test kit over the counter at a pharmacy or discount store, but that will just show whether the hormone is present. A blood test administered by a doctor’s office or lab can determine exactly how much hormone is present in the blood stream.

After an IVF procedure, the blood test is an important tool in determining whether the procedure was successful.

“Twelve days after an embryo transfer, we do a quantitative test because it is more sensitive than a pregnancy test,” McGinnis said.

“Some of our patients are a little bit impatient and do a urine pregnancy test, and sometimes they turn out positive,” he said. “I tell them if it turns positive great, but if it turns negative, it doesn’t mean anything.”

If the procedure was a success, McGinnis said he sees the couple through the first 10 weeks of the pregnancy.

“When the pregnancy is about six weeks along, we can see (the baby’s) heartbeat,” he explained. “So we measure hormones until the level shows that they are far enough along that we can use a ultrasound and see a heartbeat. Once we see a heartbeat, I tell them it’s time to make an appointment with their OB/GYN.”

The heartbreak of a loss



The chances of a miscarriage aren’t necessarily higher after an IVF procedure, but because the center is so in tune with early pregnancy, a loss may be detected before a woman who conceived the traditional way would even know she was pregnant.

A loss at this stage is devastating for the couple, considering the emotional and financial investment into the pregnancy. But McGinnis said that one failed attempt usually doesn’t deter a couple from trying IVF again.

“The patients have been wanting to be pregnant for so long, then they got pregnant and had a miscarriage,” he said. “I tell them unless there’s an obvious reason for the miscarriage, then there was a chance of miscarriage from the very start whether they got pregnant the old fashioned way or with IVF. That that chance was the same.

“Once they come to understand that, they’ve been pregnant once and want to try it again,” McGinnis said. “The chance of a miscarriage is about one in seven, so there’s a six in seven chance that they won’t miscarry.”

Vernon said that couples are usually encouraged because they were able to make quality eggs, quality sperm, have fertilization, development of an embryo, implantation and early pregnancy.

“Since all those things work, they are encouraged to do it again because they got so close,” Vernon said.



The cost of IVF



There s a significant cost to an IVF procedure, which isn’t always covered by health insurance companies. At the WVU Center for Reproductive Medicine, couples can expect about a $9,000 to $10,000 investment, significantly less than the $14,000 industry average per procedure. The cost at WVU is less because of the university component, McGinnis said.

“That is what make our success rate so important,” he said. “There is a lot of variation in insurance coverage. I would say in about half the cases, there is no insurance coverage. The rest have varying degrees of coverage.”

When a new patient comes to the center, the financial counselor contacts the health insurance company. The center also offers a financing option through Capital One that has low monthly payments, low fixed rates and terms from 24 to 60 months.

E-mail Misty Poe at mpoe@timeswv.com.