(5 of 8)
The tension of the next two weeks, as the couple awaits the results of pregnancy tests, is agonizing. "Women have been known to break out in hives," reports Linda Bailey, nurse-coordinator at the IVF program at North Carolina Memorial Hospital in Chapel Hill. Success rates vary from clinic to clinic; some centers open and close without a single success. But even the best clinics offer little more than a 20% chance of pregnancy. Since tiny factors like water quality seem to affect results, both physicians and patients tend become almost superstitious about what else might sway the odds. Said one doctor: "If someone told us that painting the ceiling pink would make a difference, we would do it."
In recent years, IVF practitioners have discovered a more reliable way of improving results: transferring more than one embryo at a time. At the Jones' clinic, which has one of the world's highest success rates, there is a 20% chance of pregnancy if one embryo is inserted, a 28% chance if two are used and a 38% chance with three. However, transferring more than one embryo also increases the likelihood of multiple births.
For couples who have struggled for years to have a child, the phrase "you are pregnant" is magical. "We thought we would never hear those words," sighs Risa Green, 35, of Framingham, Mass., now the mother of a month-old boy. But even if the news is good, the tension continues. One-third of IVF pregnancies spontaneously miscarry in the first three months, a perplexing problem that is currently under investigation. Says one veteran of Steptoe's program: "Every week you call for test results to see if the embryo is still there. Then you wait to see if your period comes." The return of menstruation is like a death in the family; often it is mourned by the entire clinic.
Many couples have a strong compulsion to try again immediately after in vitro fails. Popela of Cleveland compares it to a gambling addiction: "Each time you get more desperate, each time you say, 'Just one more time.' " In fact, the odds do improve with each successive try, as doctors learn more about the individual patient. But the stakes are high: in the U.S., each attempt costs between $3,000 and $5,000, not including travel costs and time away from work. Lynn Kellert, 31, and her husband Mitchell, 34, of New York City, who tried seven times at Norfolk before finally achieving pregnancy, figure the total cost was $80,000. Thus far, few insurance companies have been willing to foot the bill, arguing that IVF is still experimental. But, observes Grobstein of UCSD, "it's going to be increasingly difficult for them to maintain that position."
Second and third attempts will become easier and less costly with the wider use of cryopreservation, a process in which unused embryos are frozen in liquid nitrogen. The embryos can be thawed and then transferred to the woman's uterus, eliminating the need to repeat egg retrieval and fertilization. Some 30% to 50% of embryos do not survive the deep freeze. Those that do may actually have a better chance of successful implantation than do newly fertilized embryos. This is because the recipient has not been given hormones to stimulate ovulation, a treatment that may actually interfere with implantation.