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« Back to How Fertile Are Today's Infertility Treatments? main page    Transcript for: How Fertile Are Today's Infertility Treatments?transcript.723.html ANNOUNCER: Brought to you in part by ADM, feeding the world is thebiggest challenge of the new century. Outside the U.S., you'll find96 percent of the world's population. Inside, you'll find the meansto feed them. ADM, supermarket to the world. Additional funding isprovided by the John M. Olin Foundation, the Lilly Endowment, theLynde and Harry Bradley Foundation, and the Smith RichardsonFoundation. (Musical break.) MR. WATTENBERG: Hello, I'm Ben Wattenberg. The number ofAmerican couples seeking medical treatment for infertility has morethan doubled in recent decades. Why the dramatic increase? What arethe options open to infertile couples? Is the likelihood ofsuccessful treatment increasing, and are there ethical problemslinked some forms of infertility treatment? Joining Think Tank todiscuss these and other questions are Dr. Robert Stillman, MedicalDirector of the Shady Grove Fertility Centers; Elizabeth Stephen,Chair of Georgetown University's Department of Demography; Dr. KellyMorrow, Clinical Psychologist at the Pope Paul VI Institute for theStudy of Human Reproduction in Omaha, Nebraska; and Robert Blank,professor of political science at the University of Canterbury in NewZealand, and author of Regulating Reproduction. The topic before thehouse, fertility at any cost, this week on Think Tank. (Musical break.) MR. WATTENBERG: Over one million couples a year seek medicaltreatment for infertility problems in the United States. That's asharp increase from a few decades ago. Infertility has been calledthe yuppie plague, but the age specific incidence of infertility hasrisen only slightly. What accounts for the rapid growth intreatment? By some estimates, a woman in her late 30s is about 30percent less fertile than she was in her early 20s. And today manymore couples seek to have children later, well into their 30s andeven their 40s. Accordingly, many are having trouble conceiving. Byno means is infertility just a woman's problem. Male fertilityimpairment is a factor in up to 40 of all infertility cases. Thereare now over 300 clinics available to patients in America. Advancesin medical technology have helped meet increased demand, bringingsatisfaction to thousands of couples. But serious questions remain. What about cost, what about the ethical concerns, and perhaps mostimportant, do we really know how successful is the treatment ofinfertility? Ladies and gentlemen, thank you for joining us. Respectively, a doctor, a demographer, psychologist, and a politicalscientist, so we should really be able to solve this thing within theallotted time. Just very briefly, starting with you, Dr. RobertStillman, how goes the revolution. We have heard of this fertilityrevolution or infertility revolution. Let's just go around the roomonce. DR. STILLMAN: Well, with revolutions there is enormous change,enormous benefit to groups of couples in this circumstance, and withit come issues and questions, and complications, medical andotherwise, that need to be addressed. But the revolution goes verywell for thousands of couples who can fulfill their reproductivepotential, reproductive biology. MR. WATTENBERG: Kelly Morrow? MS. MORROW: The revolution has helped a lot of couples, and madeit a variable for them to have their own biological children. At thesame time, it has raised a lot of ethnical, moral and politicalquestions that have not been addressed sufficiently up to this point. MR. WATTENBERG: Okay. Elizabeth Stephen, the demographer's pointof view? MS. STEPHEN: Perhaps the revolution has been a little bitoverblown. We tend to hear the most dramatic cases in the newspaper. There are more people seeking treatment, as you said, but for themost part the treatment goes well and is not a part of any major newsevent. MR. WATTENBERG: Okay. MR. BLANK: I think the changes have been dramatic and beneficial. I think there's a lot to balance, though, between assistedreproduction and trying to find the causes of infertility as well asto prevent infertility from happening. And we know some of thecauses, and I think prevention is an area that's been neglected. MR. WATTENBERG: Okay. Let's try to first look at the situationas it is on the ground today. Elizabeth Stephen, how common isinfertility in America? MS. STEPHEN: In the United States, as of 1995, about 10 percentof women aged 15 to 44 had experienced what call impaired fecundity. Now, it's a bit of an awkward phrase, but it basically means a womanwho has had difficulty or for whom it's impossible to conceive or tocarry a child to term. If she's married, that definition alsoincludes her husband, that he is unable or finds it difficult tofather a child. And if she's co-habiting, that her partner finds itdifficult or impossible to father a child. MR. WATTENBERG: So, the situation involves about one in tenAmerican couples? MS. STEPHEN: That's right. Which translates to about 6.1 millionwomen. MR. WATTENBERG: Okay. The incidence of infertility, is thatgetting worse? MS. STEPHEN: It actually did increase in '95. Our results arebased on a survey that was done also in 1982 and 1988, and itincreased -- MR. WATTENBERG: The rate increased? MS. STEPHEN: I'm sorry? MR. WATTENBERG: The rate increased? MS. STEPHEN: The rate increased and the number as well. MR. WATTENBERG: From what to what, and the rate? MS. STEPHEN: The rate increased from about 8.2 percent to alittle over 10 percent. There are several reasons we think this isso. I'll just cover them very briefly. One is that infertility isin the press more, and these are self-reports. So, we believe thatwomen are being more aware of their reproductive health, and perhapsthere's a little bit of stigma with infertility that may bedecreasing, so people are more willing to admit they haveinfertility. Secondly, although the incidence of sexuallytransmitted diseases have decreased -- MR. WATTENBERG: Have decreased or increased? MS. STEPHEN: Decreased. MR. WATTENBERG: Decreased. MS. STEPHEN: That there's more of a masked effect, that women arehaving more problems later on with this. MR. WATTENBERG: Why would that be? MS. STEPHEN: That perhaps, in particular, chlamydia, and Dr.Stillman might address this when he speaks, too, often goesundetected, so the person doesn't even know they've had a sexuallytransmitted disease until they try to then have a child. MR. WATTENBERG: Now, it's also correct, as we said in the set-uppiece, that as a woman gets older it becomes more difficult toconceive? MS. STEPHEN: That's right. MR. WATTENBERG: And as the social patterns have changed, womenseeking to have children later, that also increases the infertilityincidence. MS. STEPHEN: Absolutely. There's more delayed childbearing,although still the bulk of babies being born are being born to womenin their 20s and early 30s if you look in the United States. MR. WATTENBERG: Dr. Stillman, let me ask you, is the rate ofsuccess for couples seeking treatment, is that going up? DR. STILLMAN: Yes. As the options increase from assistedreproductive technologies all the way to the most simple therapiesare becoming more effective overall, surgical therapies included,medication therapies included, and particularly where the data ismost well-known, assisted reproductive technology such as in vitrofertilization, all of those are increasing in their success rate. MR. WATTENBERG: Now, your clinic or clinics do, as I understand,something very unusual, because there so much talk about, well, itdoesn't work very well. You offer a money back guarantee. DR. STILLMAN: It's referred to as a shared risk program. Andwhat it does is, couples' insurance coverage for infertility isextremely limited, and for those couples who don't have insurancecoverage, if they wish to participate, can have the opportunity tohave -- and this refers to in vitro fertilization, three in vitrofertilization cycles, and if they haven't had a baby at the end ofthose three cycles, they get almost all of their money back. MR. WATTENBERG: For a woman, say, in her late 30s and early 40swho comes into one of your clinics, says, Doctor, I can't conceive,is it more likely today than it was five years ago? DR. STILLMAN: Absolutely. It depends on the cause of theirdifficulty in conceiving. But the newer technologies have allowed usto treat thousands of couples who had completely irremediableinfertility years ago, including in particular the 40 percent of malefactor infertility, where little was available to a couple has achoice. They can seek childlessness, or donor sperm, or adoption, orhigher technological procedures which can be successful for almostall men, even with the very lowest sperm counts. So that provides -- MR. WATTENBERG: And in the last -- okay, so it's better for men. In the last five years, has it become better for women as well? DR. STILLMAN: Yes. MR. WATTENBERG: In what particular realm? DR. STILLMAN: Well, in the overall delivery rates for thesetechnologies. MR. WATTENBERG: Due to what? DR. STILLMAN: Well, newer research, newer capabilities, most ofit coming from Europe, originally, I might add, because of lack offunding in the United States for embryo research or for infertilityresearch, which is a separate subject we may cover later. Butresearch that has been done allows us to provide both safer and moreeffective therapies. Blastocyst culture is an example where embryosare transferred for in vitro fertilization later on in theirdevelopment, allowing us to transfer just one or two blastocysts,greatly minimizing the risk of multiple pregnancy, as well as have ahigher rate of pregnancy for those one or two embryos that aretransferred. So, for those couples seeking conception and needing invitro fertilization, the opportunity for conception and saferconception, avoiding multiple pregnancies is an enormous benefit. MR. WATTENBERG: Okay. Elizabeth Stephen, that's Dr. Stillman'sview from the clinic. I mean, patient by patient, reading themedical research. You are a demographer, you look at populationsplural, or the population rather than individual people. He says thesuccess rate is going up. Can you measure that, is that right? MS. STEPHEN: If you look at the statistics that come out of theART clinics, you can see that. And by ART I mean the assistedreproductive technologies. That's very true. What we don't knowquite as much about are the lower end of technologies. We've had alot of multiclinic studies, but the vast majority of women who go fortreatment, which is only about 44 percent of all women withinfertility, seek advice, diagnostic testing, and help withmiscarriage. Almost all of the medical work really is at the lowend. It's just maybe about 1 percent who end up in clinics such asDr. Stillman's. MR. WATTENBERG: Again, just to pick up the same question, in thelast five years, has there been a noticeable change and increasetoward greater success as a general matter. MS. STEPHEN: I don't think we know that. I think the jury isstill out. DR. STILLMAN: Other than the ART. MS. STEPHEN: The ART we know very well. MR. WATTENBERG: And ART is assisted reproductive technology, thathas increased? MS. STEPHEN: Yes. But those -- MR. BLANK: It's increased, but it should be pointed out that mostwomen who undergo the technique do not go home with a baby. MR. WATTENBERG: Okay. We're coming right now to -- now we aregoing to talk about the problem with all of this, and your court. MR. BLANK: Well, as I said, there are many couples that gothrough this, and most couples that go through this will not go homewith a baby. Now, that has psychological problems, I suppose, tiedto that, and others. But also the cost involved. The problems thatI see basically are a lack of consistency, a lack of data that we canactually compare across clinics. And I think that might get toregulation questions later. MR. WATTENBERG: It is a complicated thing to measure, very, verycomplicated. MR. BLANK: It is very complicated but different clinics, some ofthe more substantial clinics, such as Shady Grove, use one set ofstatistics that I think are more honest, but other clinics usedifferent statistics to show success. So, when you say success, it'squestionable what that means. MR. WATTENBERG: You have another problem. I've read parts of oneof your papers. Basically, you're saying, it's not fair. Somepeople have access to this, some people don't have access to it. Isthat a correct characterization? MR. BLANK: Well, I think certainly there are biases. I assume,again, just because something is unfair doesn't mean that weshouldn't proceed to help the people that we can help. I do think,though, there are issues in terms of, say, race. We mentioned theyuppie question before, that's changed in terms of age. But this isstill basically a middle to middle/upper class white benefit that'soccurring. And I think there are concerns there as to a vast numberof women who simply, even if we extended insurance, and we still havemany uninsured people in this country that would not have access. MR. WATTENBERG: Isn't the answer to that to try to get suchrelief available to more women rather than as I gleaned from yourpaper to restrict it and use that monies for other purposes? MR. BLANK: I think we need a balance. And I think what we don'thave now is a balance, as I mentioned in my opening comment. Wehave, as Dr. Stillman pointed out, and it goes back to funding, about15-20 years ago, 1978, funding was drastically cut, or a moratoriumon certain types of funding -- MR. WATTENBERG: Government funding. MR. BLANK: Government funding. MR. WATTENBERG: Not private funding. MR. BLANK: Right. And that has had a tremendous impact becausemost of the research now has been more of the applied as compared tobasic research. And what that's meant is, we haven't looked at thecauses of infertility because that's not where the money is to bemade in the private sector. What we, instead, have seen is aproliferation of clinics from one in 1980 to over 300 today, many ofwhich or none of which are licensed in a regulatory sense. MR. WATTENBERG: Okay. Kelly Morrow, you have a particularproblem, I guess, with some of the techniques that are in use now; isthat correct? You are coming from a particularly Catholicperspective on this. MS. MORROW: Yes. MR. WATTENBERG: Why don't you just very briefly try to addressthat. MS. MORROW: I practice psychology, and the institute practicesmedically consistent with the Catholic Church teachings, which findsthe assisted reproductive technologies as -- MR. WATTENBERG: This is in vitro fertilization? MS. MORROW: In vitro fertilization, GIFT, ZIFT, the alphabet. MR. WATTENBERG: There are a lot of them. Yes, go ahead, right. Unacceptable. MS. MORROW: As unacceptable because it separates the love and thelife, the sexual intercourse act and the life. It also treats theembryos, the fetuses, the babies, as products. MR. WATTENBERG: Let me just as a question, if it's appropriate,if it's not skip it. Let's just go around the room. Do you all havechildren? DR. STILLMAN: Yes. I have three children, two adopted, and thena surprise natural later. So, yes, and they're all over 20. MS. STEPHEN: I have a daughter, I went clear through IVF, nothingworked, and we have a surprise five year old. MS. STEPHEN: We have two adopted children. MR. BLANK: I have two biologic children. MR. WATTENBERG: You're a pretty full range here. Do peoplefrequently who think they can't have children and have triedeverything end up having children? MS. STEPHEN: It happens, there's an argument that ART doesn'tnecessarily help people have babies, it helps them have them sooner. There's a certain percentage of people who are never going to havechildren, no matter what they do. But that assisted reproductivetechnologies will shorten that gap. MR. WATTENBERG: But your experiences would seem to say, keeptrying. MS. STEPHEN: Yes. At a certain point. You need to know thediagnosis. MR. BLANK: On the adoption issue, it's the 'old wives' tale,' touse that common colloquial term, that people will conceive more afterthey adopt. And, in fact, there is no greater statistical likelihoodof conceiving after you adopt or if you do not adopt. MR. WATTENBERG: I mean, we're learning so much about thepsychological roots of physiological problems, one would notautomatically say that's an old wives' tale. I mean, a woman or aman who has adopted and feels wonderful about it because it's aremarkable human experience, would be more at ease, more whatever. MR. BLANK: It's an old wives' tale only because it doesn't seemto be more statistically true. MS. MORROW: That's giving more credence to the power of stress onimpacting fertility than actually exists. Like you hear a lot ofcouples get the advice, oh, you know, for woman, quit work. Youknow, you're trying to do too much, and you'll get pregnant. Go on avacation, just have a romantic vacation, and that will work. MR. WATTENBERG: That's fun anyway. MS. MORROW: Those are good excuses for getting away. But,although stress, psychological problems, some studies suggest, reallyhave a significant impact on infertility only about 5 percent of thetime that can be documented. Now, with the mind-body connection, ofcourse, whenever there's stress, whenever there's depression/anxiety,which is almost inevitable when you're dealing with infertility, isgoing to set off a chain reaction with the hormones, let's say. Andso that's one reason to address the psychological issues involved ininfertility. MR. WATTENBERG: What are the major ethnical concerns? I mean,there is this woman who had, what, eight children? That's not good. DR. STILLMAN: That is not good, and we all -- MR. WATTENBERG: What is the life expectancy of those children? DR. STILLMAN: To view that, as it was sometimes portrayed in thepress, as being either common, which it's not, that's the only timeit's ever happened, or a good thing, because some of those or most ofthose children if they live, is unfortunate. That has to be lookedat as a serious consequence and side effect of therapy. Andeverything needs to be done to limit it. MR. WATTENBERG: Are you saying that's true with quads andtriplets, the same thing? DR. STILLMAN: Absolutely. What it does is, it raises theconcerns, and problems that occur with even twins, but certainlytriplets and quadruplets, and there are many steps being taken, butmore steps need to be taken to minimize -- MR. WATTENBERG: Was that an in vitro fertilization? DR. STILLMAN: No. That is, to coin a phrase, misconception aswell in that those are not related to assisted reproduction and invitro fertilization because you're limiting the number of embryosyou're transferring, including the blastocysts, limiting it to two. The insurance will help because people wouldn't be as hard pressed totake better risks when they're not paying out pocket, better researchwould help through funding from the federal government which has beenrecently brought yet once again from the NIH ethics committee. Thosethings will play an important role in allowing couples to limit risksand physicians to -- MR. WATTENBERG: Why, just to throw up a softball here, which Ithink I know the answer to, why has the federal government, which ispouring billions and billions of dollars into medical researchresisted going down the road of fertility research? MR. BLANK: Most of it has been tied either to abortion politics,research on the embryo, or it's been tied to questions relating tothe division between public and private. MR. WATTENBERG: You have some other ethical problems with this,don't you? MR. BLANK: Well, I have some problems in terms of the linebetween therapy and experimentation. I think much of what we've seenover the last 20 years has basically been experimentation on women,on couples, under the guise of therapy. And, again, I put the blameback on the lack of funding for basic research before we got into theapplied research area. And I do know that it varies from clinic toclinic as to how much this is pointed out to the woman that what, infact, she is going through is not a proven therapy in any way, orsomething that is seen to be a treatment in a traditional sense, butrather it is experimentation to get data. And I think that line isvery clear. MR. WATTENBERG: But, you have couples who, I'll use an overusedword, I guess, who are desperate to have children, and who aresaying, I don't want to wait 10 years, because 10 years it's reallygoing to be impossible, so why shouldn't I go to Dr. Stillman andgive it a shot. You tell them what the chances of success are andthe potential side effects. DR. STILLMAN: We try to be very specific regarding informationand informed consent, and risks and benefits. We try very hard to dothat. Now, I think what you're referring to, Bob, is experimentationnot as a research project, if you will, but utilizing a therapy whichwe hope will be a help and effective, that there haven't been 10years, 15 years of research behind it. MR. BLANK: There's no data. DR. STILLMAN: Right, and you generate data, if you will, bytaking couples from across the country in a network, and so on, andadding to that. But, the idea is that with informed consent thetherapeutic trials, and the therapeutic modalities that are used maynot have as much basis as some other fields of medicine. And you'reright, the blame for that in large part is that it needs to befunded. MR. WATTENBERG: My general understanding, and you all correct meif I'm wrong, is that the treatments themselves can sometimes beuncomfortable, or even painful, but are not generally speakingunsafe, in terms of anything cataclysmic. Is that a correct -- DR. STILLMAN: With very, very rare exception from what we knowtoday that's absolutely true. MS. STEPHEN: But, there are two important caveats. One is thatwe don't know necessarily the long term effects of the drugs, and howmany times a woman goes through it, a particular cancer risk. MR. BLANK: So far, so good, but -- MS. STEPHEN: Right, but we don't know much about the children,and when there's no databases following these children, to me that'sa fascinating topic, and that's something that the federal governmentmay want to turn to. MS. MORROW: I want to say one thing about informed consent, froma psychological point of view, and you raised it, these couples areoften very desperate. A lot of times it's the first time theyhaven't been able to just achieve a goal by their own efforts. They're willing to do anything to try to achieve a pregnancy, and alot of times they have selective hearing and processing about what isbeing told to them in the clinics. They want to hear that, okay,there is no reason why you can't fit into this 10 or 15 percent ofcouples who walk home with a baby. They want to hear that, and it'shard for them to really process the risks. MR. WATTENBERG: Okay. Thank you, Dr. Robert Stillman, ElizabethSteven, Dr. Kelly Morrow, and Robert Blank. And thank you. Weencourage feedback from our viewers of Think Tank via email. It'svery important to us. For Think Tank, I'm Ben Wattenberg. ANNOUNCER: We at Think Tank depend on your views to make our showbetter. Please send your questions and comments to New River Media,1150 Seventeenth Street, Northwest, Washington, D.C. 20036, or emailus at thinktank@pbs.org. To learn more about Think Tank, visit PBSOnline at www.pbs.org. And please let us know where you watch ThinkTank. This has been a production of BJW, Incorporated, inassociation with New River Media, which are solely responsible forits content. Brought to you in part by ADM, feeding the world is thebiggest challenge of the new century. Outside the U.S. you'll find96 percent of the world's population, inside you'll find the means tofeed them. ADM, supermarket to the world. Additional funding isprovided by the John M. Olin Foundation, the Lilly Endowment, theLynde and Harry Bradley Foundation, and the Smith RichardsonFoundation. (End of program.) Back to top  Think Tank is made possible by generous support from the Smith Richardson Foundation, the Bernard and Irene Schwartz Foundation, the Lynde and Harry Bradley Foundation, the John M. Olin Foundation, the Donner Canadian Foundation, the Dodge Jones Foundation, and Pfizer, Inc. ©Copyright Think Tank. All rights reserved. 
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