THE VIRGINIAN-PILOT
Copyright (c) 1994, Landmark Communications, Inc.
DATE: Saturday, August 13, 1994 TAG: 9408130287
SECTION: FRONT PAGE: A1 EDITION: FINAL
SOURCE: BY DIANE TENNANT, STAFF WRITER
DATELINE: NORFOLK LENGTH: Long : 163 lines
Making babies may be more fun the old-fashioned way, but injecting a single sperm directly into a human egg is more likely to produce pregnancy for couples whose infertility is a male problem.
Using a needle as thin as a hair, doctors at the Jones Institute for Reproductive Medicine at Eastern Virginia Medical School have achieved pregnancy in eight of 14 women trying the new intracytoplasmic sperm injection procedure, or ICSI, since May. One miscarried, but seven women are carrying babies, including a set of twins and a set of triplets.
Jones researchers announced their high rate of success with the new technique two weeks after the New England Journal of Medicine published a study comparing in-vitro fertilization costs for all couples against the number of babies actually born. The study concludes that expensive techniques and the low percentage of babies produced makes each child cost between $67,000 and $115,000, although individual couples may not pay that amount.
``It is great. Modern technology. It's amazing,'' said one of the expectant mothers, a 28-year-old in Connecticut who asked to remain anonymous. ``We're expecting twins. I haven't seen actual babies yet, I've only seen little black blobs (on an ultrasound). But they had heartbeats.
``We just felt like, what's money for if you can't use it to have a baby?'' she said. ``We are fortunate to be able to save enough to do this.''
ICSI (pronounced ICK-see) is the latest high-tech method of making parents out of infertile couples. The first ICSI birth in the United States was last fall. The first Jones Institute ICSI baby is due around the first of the year.
The process was tried at Jones in 1988, but no pregnancies resulted, so it was abandoned in favor of more promising techniques, said Dr. Suheil L. Muasher, director of in-vitro fertilization at the institute. A clinic in Belgium perfected the technique, however, and has produced more than 100 babies using it.
ICSI is expensive - $2,000 on top of the usual in-vitro fee of $5,000 to $7,000 for each attempt. The Connecticut couple spent about $27,000 on three attempts to get pregnant.
But, using ICSI, Jones has achieved fertilization rates of 65 percent, higher than the rates for other in-vitro methods, and implantation rates (where the embryo attaches to the uterus) of 24 percent, double the usual figure.
``We were amazed by this,'' Muasher said. ``We were extremely excited about this.''
Because ICSI is so technically challenging, few clinics can do it yet. It is used mainly for couples in which the man is infertile, meaning that he has a low sperm count, or his sperm are inactive, which reduce the chances of other in-vitro techniques working. Muasher is optimistic that ICSI will also bring more pregnancies to women older than 40, for whom the chance of in-vitro working drops to 10 percent.
Dr. Masood Khatamee, executive director of the New York-based Fertility Research Foundation, said ICSI is ``a breakthrough.'' It is too early to determine success rates for ICSI, but rates for any in-vitro technique vary widely between clinics, he noted, depending on how good they are.
Regular in-vitro involves placing an egg in a lab dish, then dropping about 100,000 sperm on top of it. Only one sperm is needed to penetrate the egg and fertilize it.
ICSI capitalizes on those odds, using a tiny needle to capture one sperm, then helping it penetrate the egg. Three fertilized eggs are placed in each woman's uterus, improving the chances that at least one will attach and grow into a baby.
None of the Jones ICSI patients is local. Three are from Chicago, one from Honduras and one from Canada. The others are scattered throughout the United States. They were drawn to Jones largely by its reputation.
Nearly half of infertility is in the male, despite society's common view that infertility is a woman's problem. Normal sperm counts are around 12 million, but the men whose sperm was used in ICSI have average counts of 8 million, Muasher said.
A control experiment trying regular in-vitro fertilization on those same couples produced no fertilized eggs, he said.
Despite its prevalence, male infertility is seldom talked about, partially because some men fear they will appear less masculine. The Connecticut woman, in a telephone interview, asked to remain anonymous so her husband's infertility would not become known to their friends.
``People think he's, like, really, really macho now because I have two babies,'' she said. ``Somebody said to me, `Oh, your husband did that to you?' and he said, `Yeah, me and a few other people.'
``I've had people come to me and say they wish they could give me their ovaries or something. And I have nothing wrong with my ovaries.''
Muasher said he believes that ICSI will make male infertility more accepted. ``It's a very common problem, and I think one of the things in-vitro has helped us to do is understand the male better,'' he said. ``This is probably the biggest single cause of infertility. . . Up to very recently, we could do very little about it.'' ILLUSTRATION: STAFF GRAPHIC
THE NEW PROCEDURE
While holding the egg firmly with a glass pipette, the technician
inserts a hollow needle into the egg and injects one sperm into the
egg's interior. Doctors have achieved a 65 percent fertilization
rate with this procedure.
SOURCE: The Jones Institute for Reproductive Medicine
STAFF GRAPHIC
TREATMENTS FOR INFERTILITY
SOURCE: Parents Magazine
PROCEDURE: Clomid: hormone drug therapy (female)
PROCESS: An oral medication is taken during each cycle to
stimulate ovary production.
RESULT: An increase in the number of follicles, resulting in a
greater chance of fertilization.
SUCCESS RATE: 30%
ESTIMATED COST: $50-$150 per cycle.
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PROCEDURE: Pergonal: hormone drug therapy (female)
PROCESS: An injection of medication is given during cycle to
stimulate ovary production.
RESULT: Same as above.
SUCCESS RATE: 20%
ESTIMATED COST: $500-$2,500 per cycle.
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PROCEDURE: Artificial insemination (female & male)
PROCESS: Sperm is inserted into woman's uterus or cervix during
ovulation.
RESULT: Increased chance of fertilization
SUCCESS RATE: 10%
ESTIMATED COST: $150-$500 per cycle
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PROCEDURE: In vitro fertilization (female & male)
PROCESS: Eggs are retrieved during ultrasound, fertilized, then
transferred to uterus.
RESULT: Fertilization in laboratory
SUCCESS RATE: 15%
ESTIMATED COST: $6,000-$10,000 per cycle
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PROCEDURE: Gamete intra-fallopian transfer (GIFT) (female &
male)
PROCESS: Eggs are retrieved, then eggs and sperm are added
separately to fallopian tubes.
RESULT: Fertilization in fallopian tubes
SUCCESS RATE: 25%
ESTIMATED COST:$6,000-$10,000 per cycle
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PROCEDURE: Zygote intra-fallopian transfer (ZIFT) (female &
male)
PROCESS: Lab fertilization, then fertilized eggs are transferred
to fallopian tubes
RESULT: Fertilization in laboratory
SUCCESS RATE: 20%
ESTIMATED COST: $6,000-$10,000 per cycle
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KEYWORDS: EVMS INFERTILITY IN-VITRO FERTILIZATION ICSI by CNB