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IVF, fertility drugs and other techniques have, in short, revolutionized conception. And the revolution is far from over. In the R.B.A. laboratories and in a handful of other research labs around the world, scientists are pushing the technology of assisted reproduction even further, offering new hope to childless couples and new opportunity to women who want to postpone childbearing.
If egg freezing can be perfected, for example, a woman who faces the loss of her egg-bearing ovaries through radiation therapy or disease could preserve her eggs for later insemination. Or, given that aging eggs rather than aging bodies are the leading cause of female infertility, a young woman who wants a career before she starts her family--or even before she chooses a mate--could freeze her eggs in their prime, then use them later.
Egg freezing is just one of the fertility breakthroughs that are moving through the pipeline from lab to clinic. Doctors are removing and cold-storing ovarian and testicular tissue for later reimplantation, coaxing test-tube embryos to grow stronger before they are put into the womb, even performing microscopic surgery to transfer chromosomes from old, worn-out eggs into young, robust ones. All these techniques have a single purpose: to beat the odds nature has stacked against a woman's ability to bear children.
Americans will undoubtedly be the biggest consumers of these new procedures, just as they are of current treatments. However, many existing assisted-reproduction therapies were developed overseas. The world's first in-vitro baby, Louise Brown, was born in England. The first baby born from a frozen embryo is Australian. And it was in a Belgian lab that researchers found a way to inject sperm directly into an egg cell, enabling men with insufficient, slow-moving or feeble sperm to become fathers--a powerful new technique known as intracytoplasmic sperm injection, or ICSI.
Which of these or half a dozen other procedures a specialist will call upon depends largely on the reason a patient or couple is infertile. For Anita and Vincent Bielicki, both Chicago police officers, the problem was in Vincent's sperm. Before turning to more elaborate measures, the couple tried several courses of therapy, in which Anita took ovulation-stimulating drugs (a la Bobbi McCaughey) and fertilization was to occur inside the body.
After six unsuccessful tries, the Bielickis decided to go for what Anita calls "the whole banana"--in-vitro fertilization at Chicago's Center for Human Reproduction. It worked the first time, and in 1993 Anita gave birth to Andrea. Later attempts were unsuccessful, so the following year they tried ICSI. Result: their second daughter, Elizabeth, now 2.
For Sheila and Rick Burski of Rice, Minn., the outcome was equally happy. Because Sheila's fallopian tubes were blocked, a problem in about 35% of female-infertility cases, IVF was the only option. The first try at the Midwest Center for Reproductive Health in Minneapolis ended in a miscarriage, and the second, using leftover embryos that had been frozen, didn't take at all. "We had some real downer weeks, particularly after the second attempt," says Rick, an excavation contractor.