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If a Couple Can't Conceive

New technologies are making a difference for thousands

Late marriages and biological clocks are frequent factors. Environmental toxins and previous surgery may also play a role at times, but about 1 out of every 12 prospective mothers in the United States has been reported unable to conceive in at least a year of trying. This is despite the fact that more than half those women already had at least one child. For couples frustrated by such fortunes, "every menstrual period is like a funeral," in the words of one disappointed woman. While the New England Journal of Medicine reports that medically assisted reproduction can succeed in more than 80 percent of the cases where it is attempted, few couples in fertility programs succeed because of financial strain and emotional fatigue from the process.

In some cases the causes of the infertility are clear-cut. Certain women do not release enough eggs and can be treated with a fertility drug such as Clomid. (A recent scare linking Clomid to ovarian cancer turned out to be a false alarm, according to the American Society for Reproductive Medicine, but several ongoing studies are looking into its safety.) At other times couples simply need to adjust their schedules to conceive.

But many of the tests and treatments are much more expensive and demanding. For example, a post-coital test is commonly given to test the sperm's ability to make its way to the fallopian tube, where fertilization usually occurs, and requires a couple to have sex just before the woman ovulates, which may be in the middle of the work week. Before washing, the woman must quickly have a pelvic exam at her doctor's, wherever that happens to be. "When it is all over, neither you nor your doctor really has a very good idea whether or not your eggs can be fertilized by your husband's sperm," writes fertility expert Dr. Sherman Silber in his book, How to Get Pregnant with the New Technology.

A good rule of thumb in judging a treatment's efficacy, according to Joyce Zeitz of the Fertility Institute in Birmingham, Ala., is, after following a procedure for six full cycles without success - try something else.

The last resort for many couples is medically assisted fertilization procedures, which have only a one-in-seven chance of producing a baby on one try, but have success rates of over 80 percent when six or seven attempts are made. Women over 40 typically experience the most difficulty.

The techniques include in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), and zygote intrafallopian transfer (ZIFT). With GIFT, the sperm and egg are placed in the fallopian tubes, where fertilization occurs normally. For IVF and ZIFT, the fertilization of the eggs by the sperm takes place in the laboratory and the fertilized egg is placed directly into the woman's uterus for IVF, or her fallopian tubes for ZIFT.

In all cases the woman must have daily hormone injections to control her body's reaction by stimulating egg production, prompting the movement of the eggs out of the fallopian tubes and others to supply normal pregnancy hormones so that a miscarriage does not occur.

Only ten states* require insurance companies to cover such procedures, which can cost anywhere from $6,000 to $10,000 a try. Most successful treatments occur by the fourth attempt, and most clinics limit patients to a total of eight tries. Often patients only try once, however.

Arkansas, California, Connecticut, Hawai'i, Illinois, Maryland, Massachusetts, New York, Rhode Island, and Texas.

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