Baby-making at a crossroads

Jacqueline Stenson MSNBC contributor

Since the birth of the world's first "test-tube" baby nearly 30 years ago, doctors have made remarkable strides in helping infertile couples achieve their dreams of having a family.

Overall, about a third of couples who seek infertility treatment today will bring home a bundle of joy (or two or three), though that number can fluctuate dramatically depending on the reason a couple can't conceive naturally and the woman's age.

But now, improvements in the "take-home-baby rate" have slowed or even plateaued at the nation's top infertility clinics. And reproductive specialists find themselves at a crossroads, searching for new ways to boost success.

"We're better at what we do but we can't reverse the effect of aging," says Dr. Eric Surrey, medical director of the Colorado Center for Reproductive Medicine in Englewood and a past president of the Society for Assisted Reproductive Technology.

As Dr. Richard Scott, director of reproductive endocrinology at the University of Medicine and Dentistry of New Jersey, puts it, "We’re up against the glass ceiling of reproductive aging.”

A woman's fertility begins to decline in her late 20s, drops off more sharply after 35 and plummets when she hits 40. In fact, after age 30, the probability of a woman getting pregnant naturally decreases 3 percent to 5 percent per year — and even faster when she hits 40, notes the American Fertility Association. Whereas a healthy 30-year-old woman has a 20 percent chance of getting pregnant in any given month, by age 40 those odds drop to 5 percent.

Through the use of fertility drugs to induce ovulation and techniques such as in vitro fertilization (IVF) — in which an egg and sperm are combined in a lab dish and any resulting embryos are transferred to a woman's uterus — doctors worldwide have helped thousands of couples to overcome fertility problems. In the United States alone, nearly 400,000 babies were born as a result of assisted reproductive technologies since 1985, when the American Society for Reproductive Medicine began collecting data, through 2004.

But doctors have had the least success in cases where women are over 40 because their eggs are deteriorating or dramatically declining in number. In a last-ditch effort to conceive, these women often have to turn to donor eggs or embryos.

Interactive Learn more about the techniques used to help infertile couples conceive a child.

Doctors have continued to improve upon their existing techniques, with incremental improvements in their ability to induce ovulation, grow embryos longer in the lab and more safely transfer them to the womb. They're trying to find ways to improve the process even further and make it more tolerable for women using simpler hormone regimens that produce fewer side effects. And they're hopeful that new developments on the horizon — particularly embryo evaluation and egg-freezing — will allow them to boost birth rates even more.

"The success rate will never be 100 percent," says Surrey. "But there is a gap in current knowledge base that I think will be filled in the next five to 10 years."

Selecting the cream of the crop
One of the biggest challenges with IVF is figuring out which embryos to transfer to a woman's uterus. "With IVF failures, most often the embryo produced doesn't have the genetic [capability] to develop beyond a certain stage," explains Dr. Steven Ory, president of the American Society for Reproductive Medicine who is in private practice in Margate, Fla.

Currently, doctors simply look at the embryos and try to tell which ones seem most likely to fully develop based on their shape and size. So researchers are experimenting with several approaches that would allow them to evaluate embryos and transfer only the healthiest ones that are most likely to take up residence in the uterus.

A technique already in use is called preimplantation genetic diagnosis (PGD). Doctors extract a cell from an embryo and test it for chromosomal abnormalities. PGD is good for screening for specific genetic disorders such as cystic fibrosis and Tay-Sachs disease, and also can be used to select gender. But it tests fewer than half of the chromosomes in an embryo, so it's not a perfect indicator of overall embryo health and it hasn't been all that useful for most women.

"It has not been shown to consistently improve the outcome," says Ory.

To do better, scientists are experimenting with methods that assess how an embryo functions when it's in the culture solution in the lab. What chemicals and proteins does it release into the solution it's being bathed in and what does that say about its viability?

MORE FROM TODAY

Today Section Front

New treatment improving burned triplets’ scars Victims relieved ‘Ether Man’ may be in custody Rihanna says album helped recovery Dad lost his job, so this family lives on the road ‘Going Rouge’ offers roguish reply to Palin book Living on the road full-time: Is it right for you? Lupica’s latest book: ‘Million-Dollar Throw’ Grisham: Printed books are endangered species Racing to save Earth’s most endangered species Obama’s half brother: Our father was abusive Today Section Front   Add Today headlines to your news reader: