GIVING NATURE A HAND
JANUARY 27, 1997
Advances in science and a continued demand has led to an explosion in assisted reproduction. Fred de Sam Lazaro of KTCA St. Paul/Minneapolis reports on the growing concerns and criticism over the baby business.
FRED DE SAM LAZARO: Nineteen years ago, when the world's first test tube baby was born, Louise Brown was hailed as a miracle, the result of hundreds of attempts to combine egg and sperm from an infertile couple in a petri dish. The embryos formed were then implanted back in the uterus.
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DOCTOR HUGH HENSLEIGH: So here's the injecting needle going in. And it depresses against the egg shell and against the egg, itself.
FRED DE SAM LAZARO: Two decades later, in vitro fertilization has made huge strides, resulting in 26,000 babies in the U.S. alone. Instead of injecting millions of sperm into a dish with eggs to cause fertilization, doctors can now go directly into the egg with a single sperm, using sophisticated microscopic tools.
DOCTOR HUGH HENSLEIGH: So that's one egg injected.
FRED DE SAM LAZARO: St. Paul embryologist Dr. Hugh Hensleigh says men who are virtually infertile can now become fathers. It's one reason the success rate with embryos transferred to the uterus has gone up three to four-fold in the last decade.
DR. HUGH HENSLEIGH, Embryologist: Here we've been running an ongoing pregnancy rate of 30 to 40 percent per transfer, in there. So there's been a huge increase in the pregnancy rate each cycle, and it's due to better stimulations, you know, better medications used for the stimulations, better procedures in the lab, more freezing.
FRED DE SAM LAZARO: Advancements in technology, coupled with huge demand, have made assisted reproduction extremely lucrative. This fierce competition for the business of an estimated 5 million infertile couples, like Jodean Thronson and her husband, John Riemer. They often spend tens of thousands of dollars, most of it out of their own pockets, trying to have a baby.
JODEAN THRONSON: We paid Reproductive Health $15,000, and probably our drugs were probably about $750 maybe, $600 or so.
JOHN RIEMER: I got to say it's probably more than that.
JODEAN THRONSON: Yeah.
JOHN RIEMER: In vitro is not a cheap procedure.
FRED DE SAM LAZARO: Thronson and Riemer shopped around and were attracted to this clinic, Reproductive Health Associates in St. Paul. Last year, it became the first in vitro clinic in the world to offer both a fixed price and a warranty. If you don't have a baby, you get your money back.
For a flat fee, ranging depending on their age from fifteen to seventeen thousand dollars, patients are allowed three attempts at pregnancy. A la carte each of these embryo transfers costs about $7500. So the package price is about 25 percent off the pay-as-you-go plan unless, of course, a couple is successful on their first try. Dr. Jacques Stassart is a clinic partner.
DR. JACQUES STASSART, Fertility Specialist: What we tell our patients and we tell them very bluntly when we give them our orientation is that the ones who become pregnant the first time around are going to be subsidizing the ones who take three attempts to become pregnant, and, most importantly, the ones who do not become pregnant at all, even in spite of three attempts. The ones that take two attempts we can pretty much break even. It's a lottery. And how much we think we know, we never know who's going to get pregnant and who's not going to get pregnant.
FRED DE SAM LAZARO: Thronson and Riemer find it a worthwhile gamble. They say the warranty provides a sense of certainty, a beginning and end of an experience fraught with anxiety and uncertainty.
JODEAN THRONSON: We pay them the lump sum. We'll go through three tries, and really that'll be it for us because I can't imagine having to make that decision each time and having to come up with the money each time because it would, I think Dr. Stassart compared it to gambling, it would be like when are we ever going to stop? We know if it doesn't work, we will take that money then and build our family an alternative way.
FRED DE SAM LAZARO: But the money-back guarantee has drawn widespread criticism from the American Medical Association, among others. Dr. Paul Kuneck, who works for a Minneapolis clinic, does not question the integrity of his St. Paul competitors but in the free-wheeling in vitro business, Kuneck fears some clinics could use a guarantee as a marketing tool, inflating both the hopes and even the medical risks of patients.
DR. PAUL KUNECK, Fertility Specialist: There's always a concern that there will be a pressure to achieve a pregnancy faster. There's always a concern that rather than putting back three embryos, they might put back five embryos; that rather than using 3 M's of drug, they might choose to use 5 M's of drug. In a money-back program there is a greater financial inducement to potentially use poor medical judgment.
FRED DE SAM LAZARO: Critics have long maintained that the unregulated American in vitro industry, as it is, provides the wrong incentives to doctors. Dr. Robert Winston, one of Britain's leading in vitro specialists, appeared on the NewsHour in this 1994 story.
DR. ROBERT WINSTON, Fertility Specialist: There's a lot of evidence in the United States which suggests, for example, that clinics are practicing which have a very low success rate, often exploiting patients. There were large sums of money to be made, and we see a lot of American patients. They come across the Atlantic regularly for treatment. And I think there are occasions when we feel that the treatment that we have--actually are reviewing is treatment that we would be very reticent to approve.
FRED DE SAM LAZARO: But Dr. Stassart insists his clinic has not changed its guidelines, the type of patient it admits, or the number of embryos it will transfer to the womb. They remain the same for patients on the warranty program and those on the pay-as-you-go plan.
DR. JACQUES STASSART: We tried to come up with an option, which, by the way, it is. I mean, half our patients go the traditional way, they pay as they go and take their chances and the other half like the idea of having a safety net so that if they do luck out then they'll pay a little more than what they would have paid, paid as they went, but if they do not luck out, then they don't, they still maintain the option of adopting.
FRED DE SAM LAZARO: The commercial flavor of terms like "money-back guarantee" and "lottery" also add to a more fundamental criticism of the in vitro fertilization industry. It comes from some anti-abortion groups and most prominently the Catholic Church. Richard Berquist is a Professor of Philosophy at the University of St. Thomas in Minnesota.
RICHARD BERQUIST, University of St. Thomas: Every human being must be brought into the world for its own sake, as valuable in itself. And the process of in vitro fertilization doesn't recognize this. It treats the embryo as a kind of product which is made by technicians.
FRED DE SAM LAZARO: Berquist says the most egregious example of this disrespect to embryos was a law passed in Britain that resulted in the discarding of an estimated 6,000 unclaimed embryos belonging typically to couples who have not communicated with their clinic for five years, presumably having given up pregnancy attempts or completed their families.
RICHARD BERQUIST: So I suppose the first thing one has to do is to make people aware of exactly what they're dealing with. This is not just a question of disposing of biological material. This is a question of human beings in their embryonic state with a dignity and a value and rights.
FRED DE SAM LAZARO: However, the parallels the Church draws with the abortion controversy has not slowed down the thriving business of assisted reproduction. Dr. Hensleigh says a few patients in his clinic always use newly fertilized embryos to avoid the specter of discarding frozen ones. But the typical patient is likely to be like Joe McKinley and his wife, Penelope Phillips, whose in vitro attempts succeeded after two years of trying. Although her pregnancy is the result of a thawed embryo, Phillips claims no emotional attachment to embryos.
PENELOPE PHILLIPS: I'm not attached at all. That sounds so callous when you think about it now, it really does, but it was very intellectual, wasn't it? And you would always get to see them too. They'd always say, would you like to see your embryos before--come look at the kids--but you never--you know, you never--it's simply--you don't make that connection. But I don't know if that's an ethical, moral issue, or just kind of I'm a pragmatist. And this is what I wanted was a family.
FRED DE SAM LAZARO: Phillips and McKinley say they'd be willing to donate any surplus embryos to another couple; however, they speak from the luxury of just delivered a baby boy, Edward. Riemer and Thronson, whose first attempt at in vitro pregnancy failed, say they too would be willing to donate embryos, but only after they've had a baby.
JODEAN THRONSON: If were successful and end up with a baby, I think the answer of destroying our frozen embryos would be, yes, that we would have no need for them any longer.
FRED DE SAM LAZARO: Again, if you're not successful--
JODEAN THRONSON: I do like the idea of having them ask how long would you keep them frozen. I like the idea of having a finite amount of time. It would be two years after we're done with this whole process, or even a year, or just to put closure on it.
FRED DE SAM LAZARO: Emotional as such closure is for some couples, there's also strong economic pressure for it. It costs $50 per year to store each frozen embryo, the down side perhaps of an all-business in vitro system. Yet, it's the lucrative nature of the science that some experts say has advanced it so quickly and increased the chances such couples will bear children.