The turn of the century saw a huge burst of babies, worldwide, conceived with assisted reproductive technologies, such as in vitro fertilization, according to a new study. But, in the United States, infertility treatments are down due to the recession, according to some reports.
A study published today in the journal Human Reproduction found that assisted reproductive technologies, or ART, increased 25% worldwide between 2000 and 2002. An estimated 219,000 to 246,000 babies are born each year worldwide from ART procedures. The study also found a large increase in the use of intracytoplasmic sperm injection, a procedure where a sperm is injected into an egg in the lab to create an embryo, in all countries, ranging from 61% of IVF procedures in the United States to 92% in the Middle East.
The authors of the report, from the International Committee for Monitoring Assisted Reproductive Technology, noted that access to IVF varies widely among nations and that low-cost procedures should be more available to couples in poor countries.
Cost issues, however, are not limited to poor nations. A recent story in the New York Post found that a number of infertility clinics in the United States are experiencing a decline in patients and some may be struggling to stay afloat. ART procedures were expected to decline this decade as the last of the baby boomers exit their reproductive years, according to a blog post from the Center for Human Reproduction, a New York City clinic. The loss of jobs, and health insurance, has further reduced patients seeking IVF. And, the blog notes, in a recession, fewer families consider having a baby.
The octuplet births last month in Bellflower brought much-needed attention to a little-known guideline that is supposed to apply to in vitro fertilization treatment. Studies now show that in healthy women, especially those under age 35, doctors should transfer only one or two embryos to the uterus. Research has shown that, in those women, the chances of giving birth to one child are substantial even if just one embryo is transferred. There are provisions allowing for transfer of a greater number of embryos, but that depends on the mother's age and other medical criteria.
Statistics released today show that efforts to reduce multiple births appear to be working -- at least outside of Los Angeles. According to the American Society for Reproductive Medicine, the percentage of live triplet births to mothers under 35 fell from 6.4% in 2003 to 1.8% in 2007.
Moreover, in 2003 in women under 35, only 0.7% of patients opted for a single embryo transfer and the average number of embryos transferred was 2.6. But in 2007, 4.5% had a single embryo transfer and the average number of embryos transferred was 2.2.
Multiple births from elective reproductive medical services should be avoided, experts say, because such babies are often premature or low birth weight and are at higher risk for other complications. Still, fewer than 5% of women under 35 elected for a single-embryo transfer in 2007, showing there is a long way to go to convince doctors and women that it's not always necessary to risk multiple births.
"Our latest numbers show our progress in decreasing the incidence of multiple pregnancies," said Dr. Elizabeth Ginsburg, Society for Assisted Reproductive Technology president, in a news release. "As our members continue their efforts in implementing ASRM-SART guidelines, we should see future improvements in patient care and outcomes."
Egg donation is loosely regulated in the United States, making it difficult to know how many women donate eggs, why they do it and what their experiences are like. A study published in the current issue of the journal Fertility and Sterility shows that two-thirds of egg donors are satisfied with the process but the other third expressed some difficulties.
The study, from the University of Washington, examined 80 women from 20 states who had donated eggs from two to 15 years earlier. Participants, whose average age was 30, completed a detailed questionnaire. The researchers found that 16% of women complained of subsequent physical symptoms and 20% reported lasting psychological effects after donation. The physical complaints included bloating, pain, cramping, ovarian hyperstimulation, mood changes, weight gain or weight loss. Several women claimed the process damaged their ovaries, leading to a decrease or loss of fertility.
Psychological repercussions were feelings of attachment to the eggs or to the potential or resulting offspring, concern that a resulting child may want to have a relationship with them and stress resulting from the process. Some complained of being treated callously by clinic staff.
Egg donors are often college students, and they are paid an average of almost $4,000 for their services. The study showed that women who said they were motivated to donate for the money had less satisfying experiences compared with women who said they donated for altruistic reasons. About 19% said their motivations were purely financial and 32% said they just wanted to help others. The remainder of the women said both factors motivated them to donate.
"We were asking these women years later and a feeling of helping may last longer than money," said the study's lead author, psychologist Nancy Kenney, in a news release. "We know if clinics don't offer money, most women won't donate. Great Britain, where there is no paid egg donation program, for example, has a tremendous shortage of donors. But, as one of our donors said, 'If you do this just for money, you'll be sorry.' "
The study also found that a large number of women were not aware of the possible physical risks related to donation. Twenty percent said they did not recall being made aware of the physical risks at the time of their first donation. Young women, in particular, may not fully comprehend the risks, Kenney says. "Risks don't mean much to young women . . . If you are 25 and are told that something may cause cancer when you are 45 that may seem to be forever." More of the women reported being aware of the potential psychological risks.
The study seems particularly relevant during the current economic downturn, as more women might be considering egg donation as a way to make money. One Los Angeles infertility clinic employee I spoke with recently said the number of women enlisting as egg donors has quadrupled in recent months.
-- Shari Roan
Photo: Follicula fluid containing an egg. Credit: Francine Orr / Los Angeles Times
As many as 500,000 frozen embryos are in storage in the United States. While some will be used for in vitro fertilization, many others belong to couples who have completed their families or have abandoned infertility treatment. A study from the foremost researcher on frozen embryos published today reveals the anguish many of these couples have about disposition of their embryos.
Dr. Anne Drapkin Lyerly, an obstetrician/gynecologist and bioethicist at Duke University, has studied the problem of leftover frozen embryos for several years. The study published online today in the journal Fertility and Sterility is her largest survey of infertility patients -- more than 1,000. The survey found that these women feel responsible for the fate of their embryos but are dissatisfied with the choices they have. More than half are opposed to donating their embryos to other women for implantation. Twenty percent said they would likely leave their embryos frozen "forever."
"Parents care very much about what happens to their embryos," said Lyerly in a news release. "But that doesn't mean they want them to become children. Our study shows that many feel they have to do what they can to prevent their embryo from becoming a child."
The study comes at a time when several states have introduced measures that would designate frozen embryos as "persons" with legal rights or allow abandoned embryos to be adopted by another couple. The issues were described in a package of stories published earlier this year in the Los Angeles Times. Lyerly notes in her study that many families would like to have more options for disposition of their embryos. Two such options that are rarely discussed or offered involve implanting the leftover embryos in the woman's uterus during a time when she is unlikely to become pregnant or allowing a couple to have a ritual disposal ceremony of the embryos. "These may be the answers to many patients' desires as they allow the embryos to pass in a way that seems more respectful to them," she said.
Infertility clinics should develop detailed guidelines for informing couples of the likelihood of having leftover, frozen embryos, the options for disposition and how patients' feelings about disposition may change over time.
-- Shari Roan
Photo: A petri dish containing embryos. Credit: Mark Boster / Los Angeles Times
Adopted children often want to learn the identities of their biological parents. The same is true in the infertility world, where egg or sperm donors are frequently used to help a couple conceive. In a study presented today at the annual meeting of the American Society for Reproductive Medicine in San Francisco, researchers found that about 30% of eligible offspring chose to get information on their sperm donor.
The study examined the open-identity Sperm Bank of Davis. Researchers from UC Davis found that women were more likely to ask for information about the man whose sperm was used to father them. Family structure also seemed to influence the desire to know one's biological parentage. About 44% of offspring raised by single women requested information compared with 34% raised by lesbian couples and 20% raised by heterosexual couples.
In other studies about sperm donation presented at the meeting:
Researchers from Houston found that among a group of adult offspring of sperm donors, most feel "neutral" to "good" about their means of conception but thought that identifying information about the donor should be made available to the adult offspring.
A UC San Francisco study explored the psychological effect of using donor sperm or eggs on couples suffering from infertility. Both men and women said using donor gametes would raise their stress levels. They often cited fears that using donor sperm could decrease the strength of the bond between the father and child and might lead to marital problems.
University of Wisconsin researchers looked at the websites of infertility clinics and found that fewer than 60% mentioned male infertility and only 7% listed a urologist as part of the treatment team even though male reproductive problems are a common cause of infertility.
-- Shari Roan
Photo: Vials containing sperm stored in freezing tanks. Credit: Robert Gauthier / Los Angeles Times
Almost 500,000 embryos are in frozen storage in the United States, according to the stories in today's Los Angeles Times. Some of the embryos are still destined for use to help individuals or couples with infertility problems in their desire to have children. But many others are simply in limbo while their creators grapple with their options for disposition. In today's Health section, I described some of the barriers to disposition of leftover embryos via adoption or research.
Several good resources are available for people who are struggling with these issues.
Resolve: The National Infertility Assn., Southwest Region, will hold its annual Fall Family Building Symposium on Oct. 18, 8:30 a.m. until 4 p.m., at California State University, Long Beach, The Point at the Pyramid. The symposium will include a session entitled "Embryo Donation Workshops for Donors and Recipients," from 10:30 a.m. to 5:30 p.m.
A three-part series on choices regarding the disposition of leftover, frozen embryos can be accessed from the archives of the online radio program, "Creating A Family," hosted by infertility expert and author Dawn Davenport. The shows aired on May 21, May 28 and June 4.
The national headquarters of Resolve will sponsor several events during National Infertility Awareness Week, Oct. 19-25, including a series of Web chats entitled "Take Charge!"
- Shari Roan
Photo: A magnification view of human embryos. Credit: Courtesy of Dr. David Diaz
Advances in treating infertility over the last three decades have also yielded a wealth of fascinating scientific information about the basics of human biology. Today, another mystery was explained by Oxford University scientists who showed just how a fertilized egg attaches to the womb and implants itself, thus beginning the pregnancy.
When an embryo comes in contact with the lining of the womb, chemical signals are exchanged that allows the cells of the embryo to invade the womb and, eventually, connect with the mother's blood supply to form the placenta. In lab experiments, the Oxford scientists discovered that two specific proteins are involved in this process.
"We have shown that two proteins, called Rac1 and RhoA, control the invasion," said Helen J. Mardon of Oxford University. "The first stimulates cells in the womb lining to move and allow the embryo to invade and implant properly while the second inhibits this. We believe this controlled balance of the two proteins is critical for successful implantation of the embryo."
If the balance between these two proteins is altered, the cells of the womb lining won't move aside to allow for implantation, the researchers said. The failure of implantation is a major cause of infertility. Understanding the process could lead to the development of medications that help embryos implant properly. The study is published today in Proceedings of the National Academy of Sciences.
Tami Dennis, who takes the word "skeptic" to previously uncharted territory, is the Times' Health and Science editor. She's adamant that pitches promoting awareness days, weeks or months are, by their nature, non-stories. And, because she's an adult, she refuses to use words like "veggies," "tummy" and "yummy."
Rosie Mestel, deputy Health and Science editor, studied genetics before abandoning flies, fungi and DNA for health/medical writing. Her hero is the biologist Ernst Haeckel, whose jellyfish paintings inspired snazzy chandeliers. Her favorite toast-spread is Marmite, a British delicacy made of yeast extract. Her least-favorite word is "millenniums."
Melissa Healy is a staff writer for the Health section reporting from Washington D.C. Healy's a veteran of The Times' National staff, having covered the Pentagon, Congress, poverty and social welfare, the environment, and the White House before shifting to Health in 2003. She writes frequently about mental health and human behavior, about federal health policy, prescription medication and ethics in medicine. More wonk than wellness freak, Healy chooses to believe in the health benefits of coffee and wine, and considers water a better work-out medium than beverage.
Karen Kaplan covers genetics, stem cells and cloning. She and colleague Thomas H. Maugh II comprise about 25% of the unofficial MIT-Alumni-in-Journalism Club, and she is proud to have taken more math (5) than English (0) courses in college. Her contributions to Booster Shots will, she hopes, appear more frequently than postings to her mommy blog.
Thomas H. Maugh II has been a science and medical writer at the Times for 23 years. Before that, he was on the staff of the journal Science for 13 years.
He has bachelor's degrees in English and chemistry from MIT and a doctorate in chemistry from UC Santa Barbara.
After a brief stint as a sports writer, Shari Roan turned to health journalism and has covered the topic for The Times for 18 years. She is the author of three books and the mother of two daughters, both teenagers who refer to her as a "health freak." She likes to jog, watch baseball and is very happy that dark chocolate contains some health benefit.
Jeannine Stein writes about fitness, sports medicine and obesity for the Health section. She’s a gym rat from way back and never met an elliptical trainer she didn’t like. Well, maybe one or two. She tempers exercise with a steady diet of reality television because she believes it’s all about balance.
Egg donation is loosely regulated in the United States, making it difficult to know how many women donate eggs, why they do it and what their experiences are like. A study published in the current issue of the journal 
As many as 500,000 frozen embryos are in storage in the United States. While some will be used for in vitro fertilization, many others belong to couples who have completed their families or have abandoned infertility treatment. A study from the foremost researcher on frozen embryos published today reveals the anguish many of these couples have about disposition of their embryos.
Adopted children often want to learn the identities of their biological parents. The same is true in the infertility world, where egg or sperm donors are frequently used to help a couple conceive. In a study presented today at the annual meeting of the 
Almost 500,000 embryos are in frozen storage in the United States, according to the 
Advances in treating infertility over the last three decades have also yielded a wealth of fascinating scientific information about the basics of human biology. Today, another mystery was explained by Oxford University scientists who showed just how a fertilized egg attaches to the womb and implants itself, thus beginning the pregnancy.