The couple went through the usual tests, which for a man include a sperm analysis, and if abnormalities are found, a physical exam, hormone evaluation, and possibly other tests. Jocelyn had a test called a hysterosalpingogram, in which fluid is injected into the uterus so doctors can note its progression into the fallopian tubes with a series of x-ray images, making sure there are no blockages. “It hurt like hell,” she says. “That was one of the more painful things I had to go through.”
Doctors usually test a woman’s hormones to determine that she’s ovulating, what her cycle is, and how many eggs she may have left. The condition of her ovaries might be examined with ultrasound imaging or in an outpatient laparoscopy, a minimally invasive surgery in which a scope is inserted into the abdomen to look for problems like scarring in the fallopian tubes, ovaries, and uterus.
Many times, as for the Abbotts, tests don’t uncover a specific problem. Couples then decide if they will forge ahead with treatments like artificial insemination and in vitro fertilization.
Turkey Basters, Centrifuges, Petri Dishes
The first treatment the Abbotts tried—and the only one covered by their insurance—was artificial insemination. For about three weeks beforehand, Jocelyn took gonadotropins, injected drugs that stimulate the ovaries. “That was harder on my husband than on me,” she says, “because you have to get stabbed in the butt or the stomach.”
At the clinic, Steven produced a sperm sample, which doctors “washed”—that is, they spun it through a centrifuge to isolate the healthiest sperm and separate them from white blood cells and fatty acids in the semen that could hinder motility. Then they inserted the sperm into Jocelyn’s vagina with a device “like a turkey baster,” she says. But five rounds of artificial insemination yielded nothing.
So the Abbotts tried in vitro fertilization, where eggs and sperm are swirled in a petri dish to produce viable embryos, which are inserted into the uterus. Jocelyn had to be injected with a new round of ovary-stimulating drugs. At the clinic, she was put under anesthesia while doctors removed eggs from her ovaries using an ultrasound-guided needle inserted through her vagina. Three days later, none of the eggs had fertilized correctly. For the second round of in vitro, doctors injected a single sperm directly into an egg, a process called “intracytoplasmic sperm injection.”
That produced Nicholas, the Abbotts’ seven-month old boy. As a result, they didn’t have to consider other treatments, such as laparoscopic surgery to open blocked fallopian tubes, or “assisted hatching,” where doctors use suction and a weak acid solution to release the barrier surrounding an embryo so it can implant in the uterus. They also didn’t need donor eggs or sperm.
Still, the process took an emotional toll. While the Abbotts are thankful for their baby, Jocelyn says they are unlikely to go through it all again. “It’s stressful on your sex life and stressful on your marriage,” she says. “I know people who have divorced specifically because of this.”
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Not-Quite-Million-Dollar Babies It’s easy to spend $15,000 or more on fertility treatments, says Dr. Theodore Nagel of the Reproductive Medicine Center in Minneapolis. Nagel says each cycle of in vitro fertilization costs about $7,500. Drugs to support the process run another $2,000 to $5,000. Add $400 to $2,000 for additional procedures, such as “assisted hatching” to help an embryo implant itself in the uterus or “intracytoplasmic” injection of a single sperm directly into an egg. Because of the high cost, 13 states mandate that medical insurance cover some procedures; Minnesota does not. Some clinics also guarantee part of their patients’ money back if fertility treatments fail. Nagel’s clinic offers three different refund programs, with terms based on patients’ age and health. This gives couples “the means to pursue adoption if we couldn’t make it work for them,” Nagel says. What are the success rates like? It depends on how “success” is defined. Even for couples who conceive, there’s an increased risk of miscarriage the older the woman is. In 2004, among the 287 couples who underwent in vitro fertilization at Nagel’s clinic, 51 percent of women under age 35 had babies, and 50 percent of women ages 35 to 37 did. But only 23 percent of women ages 38 to 40 achieved that goal. And of the seven women over age 40, only one had a baby. Donor eggs from a younger woman—at an additional cost of probably $3,000 to $5,000—can boost a woman’s chances of having a baby. But like nature, fertility clinics impose age limits. The cutoff at Nagel’s clinic for women using their own eggs is 45. “We’ll do 45, but I try to talk people out of it because their likelihood of success is very low,” he says. Using donor eggs, the cutoff age is 50, he says, because pregnancy is too hard on a woman’s body beyond that point.
Sperm are sensitive to temperature. That’s why they’re manufactured in the scrotum, outside of the body’s core with its high temperature. According to the Mayo Clinic, sperm counts are highest in winter and in the morning, and saunas and hot baths can adversely affect sperm count. So can hard, narrow bicycle seats, which can damage nerves and arteries and raise scrotal temperatures. But if you’re not a boxers guy, rest easy. So far, tighty-whities still get the green light. Even under the best conditions, only half to 70 percent of your sperm are capable of fertilizing an egg. “Sometimes, I’ll see a sperm analysis that says 95 percent are moving normally and 98 percent have a normal appearance,” says Dr. Theodore Nagel, who treats couples for infertility at the Reproductive Medicine Center in Minneapolis. “But Clark Kent is the only guy who’s got that.” |
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