The Future of Infertility Treatments

Looking Ahead

Modern medicine is taking great leaps and bounds in the field of reproductive science. There are more possiblities than ever before for couples seeking fertility help. Find out what is available and how things are changing . . . in your favor.

The ART procedures will continue to be the primary focus of research and development, with IVF leading the way. Success rates with IVF are high enough in some of the more successful programs that procedures such as GIFT and ZIFT, which require a laparoscopy, are already archaic. Pregnancy rates of over 40 percent per IVF procedure, and over 50 percent per egg retrieval if cryopreservation is also performed, are possible now.

One of the primary changes in IVF will be the continued incubation of the embryos in the laboratory for a couple of extra days until they achieve the blastocyst stage of development (just prior to hatching). Allowing the embryos to develop to this more advanced stage will permit the laboratory personnel to make a more thorough assessment of the health and develop-mental potential of each embryo. This information will make it possible to transfer only one or two embryos to the uterus, thus minimizing the risk of triplet pregnancies while maintaining or even improving upon current success rates.

Micromanipulation techniques in the IVF laboratory will continue to have a large impact on this procedure. ICSI has already all but eliminated male infertility except for those rare individuals with complete absence of sperm. Preimplantation genetic techniques will continue to develop. These procedures allow the removal of a single cell from an embryo prior to transferring it to the uterus. This cell can then be analyzed for certain inherited genetic diseases and only those embryos that are proven healthy are subsequently transferred to the uterus.

Gene therapy, introducing a healthy gene in place of a defective one, is also a possibility. Dolly the sheep has demonstrated to the world that cloning is now possible. Monitoring and controlling these developments are the most crucial issues facing fertility experts. These developments and procedures are occurring at a rate that far exceeds the ability to evaluate and develop guidelines and regulations concerning this new arena of human reproduction.

It would be foolish of anyone to suggest that the possibility for abuse does not exist. Human cloning certainly shouldn't occur, but it is theoretically very possible. It is incumbent upon every individual dealing with this area of medicine to have a real reverence for life as posed by Albert Schweitzer, which commands that we be in full and deep awareness of the results of our actions, and that we take responsibility for those actions. We must police ourselves. Every couple should investigate, and be certain they are comfortable with, the ethics of any ART program they are considering when it comes to issues such as these.

New gonadotropins have been recently released. Rather than being purified from urine, as all the gonadotropins in the past have been, these new gonadotropins are produced as the result of recombinant technology in the laboratory. (Bacteria are induced to produce very pure preparations of the gonadotropins.) They are of even greater purity and are administered subcutaneously. But there is some hope that we may not even need to use the gonadotropins someday. A lot of work is being directed toward just removing very immature eggs from the ovaries with a needle, and then maturing them in the laboratory, thus obviating the need for gonadotropin administration altogether.

Finally, there is the issue of insurance coverage for issues relating to fertility. A few states have mandated that insurance must cover fertility-related costs. But this is not the case in the vast majority of states, and in those states, couples are often left to cover all charges out of their own pocket.

It is a shame that many couples find themselves unable to pursue attempts to conceive simply because they are unable to afford it-reproduction seems like it should be a more basic right than that. But the insurance companies contend that, first of all, infertility is not a disease, and that, secondly, the treatment of infertility is not cost-effective.

Whether or not infertility should be considered: It may not be a life-threatening process, but it surely is one of the greatest stresses any couple will ever face. In the past, there is no question that the treatment of infertility was very cost-ineffective. Multiple surgical procedures, prolonged treatment with fertility medications, poor ART success rates, and the risk of higher-order multiple pregnancies all contributed to this. However, the treatment of infertility can already be cost-effective and it will continue to become more and more so with further developments.

We can only hope that by presenting this data to the payers that we can convince them of this fact and someday make it possible for everyone to avail themselves of these advances and this wonderful technology in their efforts to have a child and a family.

As you progress through evaluation and treatment for impaired fertility, a great deal of information will be gathered. You will find that keeping track of the information is invaluable. It will help you monitor your course and you will be better able to participate in your treatment decisions. If you ever change physicians, or seek a second opinion, having this information in one place will be immensely helpful.

We suggest you photocopy and enlarge the following forms for ease of use. Eight copies of the ovulation induction form and four copies of the ART form are suggested.