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Opinion is sharply divided as to how age affects the results of IVF. Although most clinics once rejected women over age 35, many now accept them. While one faction maintains that older women have a greater tendency to miscarry, Quigley, for one, insists that "age should not affect the success rate." Curiously, the Joneses in Norfolk have achieved their best results with women age 35 to 40. This year one of their patients, Barbara Brooks of Springfield, Va., had a test-tube son at age 41; she can hardly wait to try again.
Doctors are also beginning to use IVF as a solution to male infertility. Ordinarily, about 30 million sperm must be produced to give one a chance of penetrating and fertilizing the egg. In the laboratory, the chances for fertilization are good with only 50,000 sperm. "In vitro may be one of the most effective ways of treating men with a low sperm count or low sperm motility, problems that affect as many as 10 million American men," says Andrologist Wylie Hembree of Columbia-Presbyterian Medical Center in New York City.
While most clinics originally restricted IVF to couples who produced normal sperm and eggs, this too is changing. Today, when the husband cannot supply adequate sperm, most clinics are willing to use sperm from a donor, usually obtained from one of the nation's more than 20 sperm banks. An even more radical departure is the use of donor eggs, pioneered two years ago by Dr. Alan Trounson and Dr. Carl Wood of Melbourne's Monash University. The method can be used to bring about pregnancy in women who lack functioning ovaries. It is also being sought by women who are known carriers of genetic diseases. The donated eggs may come from a woman in the Monash IVF program who has produced more ova than she can use. Alternately, they could come from a relative or acquaintance of the recipient, providing that she is willing to go through the elaborate egg-retrieval process.
At Harbor Hospital in Torrance, Calif., which is affiliated with the UCLA School of Medicine, a team headed by Obstetrician John Buster has devised a variant method of egg donation. Instead of fertilizing the ova in a dish, doctors simply inseminate the donor with the husband's sperm. About five days later, the fertilized egg is washed out of the donor's uterus in a painless procedure called lavage. It is then placed in the recipient's womb. The process, which has to date produced two children, "has an advantage over IVF," says Buster, "because it is nonsurgical and can be easily repeated until it works." But the technique also has its perils. If lavage fails to flush out the embryo, the donor faces an unwanted pregnancy.