Four years of diligent effort, nine applications of advanced fertility technology and $60,000 finally made parents of Shelley and Robert Saffrin of Chicago last April.
Their son, Daniel, is one of probably only a few hundred U.S. children conceived through intracytoplasmic sperm injection, or ICSI for short. In it, technicians inject a single sperm directly into an egg in a delicate laboratory process.
"Obviously," Shelley Saffrin said, "Mother's and Father's days were unbelievable for us this year."
Besides helping infertile couples, ICSI and other nascent technologies could give a boost to the $1 billion and growing fertility business. ICSI, for example, treats male infertility, such as low sperm count or sperm that can't penetrate an egg. Those deficiencies lie behind about 40% of the 2.3 million current cases in which couples can't conceive naturally.
Classic assisted reproductive technology, which failed the Saffrins, mainly tackles female troubles, such as blocked fallopian tubes. Female infertility is responsible for an additional 40% of cases. In the remaining cases, physicians can't identify exactly what's gone wrong.
Another developing technology, if eventually successful, would make treating both types of infertility less costly by doing away with drugs that stimulate egg production. Such progress would be a boon to infertile couples, perhaps giving them a few more shots at pregnancy before insurance or their own funds run out.
Right now, the cost of each successful in-vitro fertilization, researchers say, is $60,000 to $110,000 because most attempts don't result in pregnancy. Many couples return for the $8,000 to $10,000 procedure again and again.
As a result, the field is growing. Some 300 in-vitro programs operated in 1994, up from 180 in 1990, the American Society for Reproductive Medicine said. But growth has come with controversy. For example, the high demand for services has left room for unscrupulous providers (July 3, p. 11).
ICSI, the latest development, is a variation on older services. In basic in-vitro, drugs spur the growth of eggs. Mature eggs are removed from the woman and fertilized in the laboratory. The fertilized egg then is implanted in the woman's uterus.
Eight years ago technicians began slitting the egg's outer membrane to make fertilization easier. ICSI, a more advanced form of "micro-manipulation," was developed four years ago.
Few U.S. centers offered the procedure until last year, said Paul Katayama, M.D., an infertility specialist at the Advanced Institute of Fertility in Arlington Heights, Ill. Since February 1994 Katayama has used the technique with 64 couples, including the Saffrins. About half the women are now pregnant.
National success rates are lower. In 905 attempts, all forms of micro-manipulation led to 94 pregnancies for a 10.4% success rate per cycle in 1993, according to the reproductive society. In comparison, 31,900 cycles of standard in-vitro resulted in 6,321 pregnancies, a 19.8% success rate per cycle.
Micro-manipulation, however, mostly aids couples who have been let down by more basic technology. With practice, clinics should get better at it.
For some couples, a technology in clinical trials also offers new hope. Women with polycystic ovarian disease produce eggs that age too quickly for fertilization. Current technology can't help them. Could more advanced science control the maturation process?
At least one U.S. firm, Purchase, N.Y.-based IVF America, is ripening young eggs in its laboratories, instead of using mature eggs for in-vitro. Since last fall, it's tried maturing young eggs from 12 women. But none became pregnant because the eggs didn't take to their wombs, said Donald Wood, IVF's senior vice president of science and technology.
Foreign clinics, however, have done better. And Wood hopes IVF can offer the process to women with polycystic ovarian disease in two years.
It would be a real triumph if the procedure proves successful enough for broader use. Fertility drugs produce unpleasant, sometimes dangerous side effects. With monitoring, they make up about one-fourth of a cycle's cost.
"What if for the same $10,000 we could give a couple three cycles?" Wood asked. "The likelihood of getting pregnant goes up and up."
That sounds good to the Saffrins, who hope to conceive again later this year-with a little help from technology.