Women's Health

Fertility treatments often do not begin with in vitro or its variations. In fact, only 11 percent of infertile couples ever reach the IVF stage. Before plunging into costly high-tech methods, couples first undergo diagnostic tests to learn the cause of infertility. Then they may be treated with relatively simple (and less expensive) techniques.
Women who do not shed enough eggs, for example, can be treated with clomiphene (one of a number of ovary-stimulating drugs) or hormones. They may become pregnant in 6 to 9 months, at a cost of about 4,000 dollars. If blocked fallopian tubes are the problem, surgery often can be used, at a cost of between 5,000 and 10,000 dollars. In another scenario, women may be producing harmful antibodies -chemicals that can destroy or injure sperm entering the vagina. The condition may be treated with potent steroids like cortisone.
About 40 percent of the burden of infertility lies with the man. Women account for another 40 percent; the remainder may be a result of both partners or may have unknown causes. One common cause of male infertility is a swollen vein in the testicles, called a varicocele. It can be corrected with surgery.
If these treatments do not work, doctors may try a high-tech method. In 1993, about 41,000 such procedures were performed in the United States, according to the American Society for Reproductive Medicine. Although traditional IVF was by far the most common, accounting for 81 percent of all procedures, other methods increasingly are being used. Here are some of the latest variations and their success rates:
•       GIFT and ZIFT. The letters stand for gamete or zygote intrafallopian transfer. With GIFT, doctors surgically insert an egg and sperm (or gametes) inside the fallopian tube. Once there, the sperm is supposed to fertilize the egg, forming an embryo, which then travels to the uterus. ZIFT is similar: Instead of placing the sperm and egg immediately into the fallopian tubes, the doctor places them into an incubator for 24 hours. Then the fertilized eggs are put into the fallopian tubes. The success rate for both techniques is around 24 percent, although that figure, along with the cost, can vary considerably from clinic to clinic.
•      ICSI – intracytoplasmic sperm injection. One of the most promising new treatments for male infertility is ICSI. Doctors take a single sperm and inject it into a single egg; the resulting zygote is then transferred into the uterus. About 1,000 ICSI procedures are performed each year, and the success rate is around 24 percent. ICSI costs 10,000 to 15,000 dollars.
Jeffrey and Amy Hill of Minneapolis used GIFT to help them give birth to two daughters: Kate Lynn, now 7 years old, and Julia, almost 4. The couple spent 22,000 dollars on their fertility program.
“We depleted our savings,” Amy, 41, recalls. “My husband was out of a job. [Jeffrey, 44, is now president of a water treatment company.] We had to make a major decision on whether to gamble. But it was in our plan, in our hearts, and it would have been a real sting if it had not worked.
“But we have two beautiful, healthy daughters. We never really believed we’d have a baby until we had Kate Lynn in our arms. We were in total awe of her.”
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WOMEN’S HEALTH

What starts labor at the end of nine months? I will lay my cards on the table and tell you I do not know. I do know that it is not the castor oil and quinine which so many unfortunate young women have taken. If they are ready to go into labor, this nauseous mixture will be followed by labor pains. If not, they will have only diarrhea and ringing in the ears. The common opinion (evidently shared also by obstetricians) has been that if one irritated the uterus, labor contractions would begin. It is not at all certain that quinine irritates the uterus any more than the rest of the body. Castor oil irritates the intestines because it is partly digested there and in this process the bland material breaks down into substances which cause tremendous bowel disturbances. They do not get into the uterus, however. I think the world would be just as well off if no more castor beans were grown.

A pregnant uterus may be very long suffering without being dissuaded from its original purpose to baby sit for the proper length of time. I once removed an acute appendix from a woman who was expecting to go promptly into labor. In fact she was in a lying-in hospital. Her uterus was bigger than a modern football, the appendix was behind it, and we of necessity had to be very rough with the uterus. Did all of this irritation start her promptly into labor? It did not. In fact it was two weeks before she had a normal labor.
At any rate, when the time comes, the muscular uterus begins a series of rhythmic contractions. What first happens reminds me of your morning experience with your tube of tooth paste. When you squeeze on it, there is only one place where the contents can come out. So with the uterus. There is an opening at the bottom. The baby is in a sac full of fluid. Each contraction squeezes this sac down into this opening which gradually gives way and dilates or opens. In the normal course of events when it is entirely open, the sac breaks, letting out the fluid and the baby’s head is forced downward. Mid wives say that the “waters have broke.” If the waters break early, it is called a dry labor, for the head is not so efficient a dilator. This is the first stage of labor.
In the second stage the head gradually pushes out, and after it is out the smaller body comes easily. The third stage is getting the afterbirth out. Once in a while the membranes which form the sac do not break and the baby is born with this veil of membranes covering, but not attached to, his head and face. The veil is called a caul and is supposed to bring good luck to the child. Usually it is thrown away with the afterbirth to which it is firmly attached, but sometimes it is wrapped up and kept. John of Gaunt is one of the famous characters in history who carried his on his person, like a charm, and believed that it brought him good fortune.
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WOMEN’S HEALTH

Since the birth of Louise Brown in 1978, in vitro fertilization has produced more than 300 babies around the world, and the number grows daily as new clinics open. Louise has an IVF sister, Natalie Jean, born in 1982. But the success rate of in vitro fertilization is less than 20 percent. To increase the possibility of a “take,” doctors use fertility drugs, fertilize several eggs, and then reimplant all of them. This approach also ups the chances of a multiple birth, as Todd and Nancy Tilton of Sea Cliff, New York, discovered. Mrs. Tilton underwent in vitro fertilization at the Eastern Virginia Medical School in Norfolk and gave birth to IVF twins.

In vitro fertilization can cost up to 15,000 dollars before a pregnancy is achieved, and it may be useful to fewer than 5 percent of infertile women. Nevertheless, the success of IVF has inspired doctors to pursue even bolder, more remarkable solutions to infertility.
One such answer is embryo transfer. In 1983, Australian scientists announced the birth of an IVF baby (that is, fertilization took place outside the body in a glass dish) from an egg donated by one woman to an infertile wife.

More remarkable still, Dr. John Buster and his colleagues at Harbor-UCLA Medical Center in Los Angeles, California, delivered to one mother a baby who started life inside the womb of another woman. Doctors inseminated the husband’s sperm into the other woman. Five days after the fertilization, a doctor transferred the growing fetus out of the donor’s uterus and implanted it into the wife.
“The donors love it,” Dr. Buster says. “They feel it is a big thing to give the gift of life to another person.”

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WOMEN’S HEALTH

During the nine calendar months which equal ten lunar months, or two hundred and eighty days, innumerable changes take place in the embryo, very few of which we can observe from the outside. The increase in size is, within a few months, noticeable by the change of the mother’s figure, although the amount of fluid within the membranes may have much to do with this appearance. The heart has taken shape by four weeks and begins to beat, but it is months later before it can be heard. What is remarkable is the early age at which muscular movements start. An obstetrician of great experience tells me that he has felt them at sixteen weeks and it is not unusual to get them before he hears the heart beat of the child. May not this mean that nature has not as yet caught up with the gadget age and is still working on the assumption that man will continue to make an active use of his muscles?
The head, which is very large at eight weeks, continues until some time after birth to be bigger in diameter than the body. Do not take this as evidence of man’s great brain function. The only use of a head until long after birth is as an efficient dilator of the birth canal. One other organ which is active during life in the womb is the skin. You know that your own skin is always excreting grease. I think that it is even more active before birth, when the baby is covered with a thick, greasy, cheesy material called the vernix caseosa, which is Latin for “cheesy varnish.” When you consider what a few minutes of daily dish washing may do to the skin of hands, you will realize what might happen to the skin of a baby soaking for nine months without this protection.
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WOMEN’S HEALTH

Blocked Tubes
Infections of the ovaries, fallopian tubes, and pelvis – called pelvic inflammatory disease – frequently scar or destroy the tubes, blocking the egg’s path. Today, microsurgery is overcoming the damage that infections inflict. Dr. Luigi Mastroianni, Jr., of the University of Pennsylvania in Philadelphia, a pioneer in repairing blocked or damaged tubes, says that the success rate can be as high as 80 percent if there is only light scarring.
Endometriosis
Studies show that in half of all women, pieces of the inner lining of the uterus (the endometrium) grow outside the uterus after menstruation each month. In severe cases, the tissue spreads over the ovaries and fallopian tubes. Called endometriosis, this condition can cause severe pain during menstruation and intercourse.
But worst of all, a third of the women stricken with endometriosis become infertile – exactly how is unknown. And because the risk of endometriosis increases with age, it may be a major cause of infertility in older women.
The drug Danocrine helps some women. In others, surgery removes the wandering tissue. Pregnancy practically cures the disease by stopping the growth of endometrial tissue, but the problem is to get pregnant in the first place. Likewise, treatment with birth control pills, which induce artificial pregnancy, can] clear up the condition.

“Sperm Allergy”
About 10 percent of women are infertile because their immune system attacks their husbands’ sperm. Bonnie Marangoni, 28, an attorney from East Meadow, New York, tried to conceive for years. One pregnancy ended in miscarriage. Dr. Richard Bronson of North Shore University Hospital in Manhasset, New York, discovered that Mrs. Marangoni produced antibodies that stopped her husband’s swimming sperm. He treated her with a hormone that suppressed the allergic response. In August 1983, Jillian was born. “She’s adorable,” says the proud mother. Dr. Bronson reports 40 percent success.
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WOMEN’S HEALTH