Fertility science has come a long way since 'test-tube babies'

Thursday, February 04, 1999

Fertility science has come a long way since 'test-tube babies'

Specialist's typical day includes thrills, heartbreak

The hallway of Dr. NeeOo Chin's fertility clinic at Christ Hospital is lined with framed photographs of children from couples he has helped overcome fertility problems.
(Michael E. Keating photo)
| ZOOM |

It was a day of thrills for a couple who saw their baby's first heartbeats flashing on the ultrasound screen.

It was a day of prayers for a woman hoping this insemination attempt would be the one that works.

It was a day of tragedy for another couple, mourning the loss of twins to premature labor.

It was just one day in the practice of Dr. NeeOo Chin, the Tristate area's best-known specialist in the fast-changing world of fertility science.

The success stories of Dr. Chin and his partners, Drs. Sherif Awadalla and Erica Behnke, could populate a small town: more than 7,000 babies born since 1987 through fertility treatments, including more than 1,500 born through in-vitro fertilization procedures.

Dr. Chin's practice, based at Christ Hospital, is one of three in-vitro fertilization (IVF) programs in Cincinnati and one of more than 300 in the United States.

IVF programs, which fertilize eggs in a laboratory and transfer them into the uterus, have come a long way since 1978, when Louise Brown — the world's first “test-tube baby” — was born in Manchester, England.

In the United States in 1996, more than 20,600 babies were born from pregnancies aided by fertility treatments, a small but growing percentage of the nearly 3.9 million babies born a year in the United States.

Today's IVF clinics offer an arsenal of technology: a variety of fertility drugs; techniques to make eggs easier for sperm to penetrate; and the ability to grow embryos to the blastocyst stage and to directly inject a single sperm into an egg.

In 1996, a California woman became a first-time mom at age 63. In 1997, America watched in fascination the births of the McCaughey septuplets in Iowa. Then in December, the Chukwu octuplets were born in Texas. This year in Ohio, a pending divorce case has a twist: a custody battle over unused frozen embryos from a previous IVF attempt.

Beyond those stories comes the sobering thought of an estimated $2 million in medical costs and the high odds of lifelong health problems.

Medical futurists, meanwhile, predict a blending of genetics, cloning and fertility science with far-reaching consequences.

On one hand, many people would welcome a day when dozens of inherited diseases, such as spina bifida, cystic fibrosis and sickle cell anemia, can be cured in the womb. On the other hand, many people shudder at the thought of parents seeking “designer babies,” genetically composed to be long-lived geniuses, athletes or supermodels.

As the ethical debates swirl, fertility treatment marches on. To get a deeper sense of how such practices work, the Enquirer recently spent a day with Dr. Chin and several of his patients. ےےے

9:58 a.m. A woman from Northern Kentucky has come for an ultrasound exam to see an image of her developing child.

Her husband and their 2-year-old daughter, who also was conceived through in-vitro fertilization, are there for moral support.

Dr. Chin — a hard-core Duke fan who dares to live in Wildcat country — teases the couple about their University of Kentucky sweat shirts. Swiftly, things get down to business.

The black-and-white ultrasound screen shows an inchlong developing fetus. The head. The outline of the spine. And most of all, the heartbeat, revealed as a flashing, pulsing light inside the chest.

The first surprise to an outsider is Dr. Chin's rapid pace. This exam lasts just six minutes, a typical length, actually slowed slightly to ask the patient if a reporter could enter the exam room.

Days later, the mother speaks with the Enquirer, but requests that her name not be used because she doesn't want to hear from people who don't approve of in-vitro fertilization.

Many fertility patients resent being second-guessed by family, friends and groups with social agendas. Why do they spend so much money? Why don't they adopt? Why don't they accept that God doesn't want them to have children?

“There's still a taboo about it,” the Northern Kentucky mother said. “People hear you're going through this and they feel they have a right to tell you things that are really none of their business.” ےےے

9:25 a.m. This patient wants to use wild yam cream to support the process. Some say the cream, applied externally, works like the hormone progesterone to support implantation of a fertilized embryo in the uterus. While researchers may debate the effectiveness of the cream, Dr. Chin agrees to work with the patient's request. ےےے

Dr. Chin's Chinese background makes him more willing to consider alternative medicines than many Western physicians.

He was born in Hong Kong in 1955 and was 3 years old when his father, Henry Chin, brought him to Cincinnati.

Henry Chin worked for nearly 14 years in Cincinnati at his uncle's restaurant. Eventually, Mr. Chin launched the Wah-Mee restaurant, now located downtown.

Dr. Chin grew up in an apartment above the Wah-Mee's original location in Wal nut Hills. By age 16, he was a naturalized citizen. ےےے

The large-yet-cramped office moves at a hectic, often noisy pace. Dr. Chin buzzes from exam room to exam room, amid a din of telephones ringing and staff talking to patients and each other.

The most striking feature of the place: a narrow hallway plastered floor to ceiling with 8-by-10 portraits of babies. Mostly singletons, with a handful of photos of twins and triplets mixed in. Every one a success story. ےےے

More than 25 nurses, clerical workers and lab personnel keep the office running seven days a week. Doctors are on-call constantly because peak ovulation times don't keep a 9-to-5 schedule. On Saturdays, Dr. Chin performs surgical procedures, such as egg retrievals and removal of endometriosis scar tissue.

He enjoys music, ballroom dancing and martial arts. But he says he has little time for hobbies. Most of his free time is spent with his family.

Dr. Chin and his wife, Shelly, were married 22 years ago. They have a 16-year-old son, Jason, and a 5-year-old daughter, Taryn.

The couple never went through fertility treatments, but they can empathize with the pain couples feel when they cannot have children. That's because Shelly had a stroke several years ago, serious enough that she was temporarily blind.

She recovered. But with Shelly's blood-clotting problem, the couple decided not to have more children because pregnancy can increase the risk of blood clots.

10:48 a.m.: Lorrie Klaserner, of White Oak, gets a checkup in preparation for transferring a frozen blastocyst left over from a previous IVF cycle, which resulted in their 9-month-old daughter, Allyson. She speaks with Dr. Chin in a rapid exchange of medical shorthand. All is going well. ےےے

Couples going through fertility treatment often gather professional-level knowledge about the process. Most are paying out-of-pocket for the treatments. All of them have a lot of homework to do: about drugs that have to be injected at home, about pills that need to be taken according to schedule, about timing sexual intercourse for peak ovulation times.

The treatments rarely focus solely on the woman. Men come in for sperm tests and to supply sperm for artificial insemination treatments.

Despite the seriousness of the work, patients quickly discover that Dr. Chin is less formal than many other doctors they've met. He tells crude jokes. He uses curse words. He laughs quite a bit. ےےے

10:42 a.m.: Dr. Chin and a patient receiving an insemination procedure talk about the recent news of the Texas octuplets. “I don't want eight babies,” the woman said. ےےے

Some experts and interest groups debate the ethics of “reducing” a pregnancy by aborting some babies in a multiple pregnancy so that the others might live. But that's not the main issue to Dr. Chin.

“The physician should never have put those women in that position in the first place,” Dr. Chin tells the patient. “If I saw seven or eight eggs in you, I wouldn't ovulate you.”

Many people outside the business don't realize that egg follicles are easy for professionals to count with an ultrasound exam, Dr. Chin said. The eggs, themselves too small to see, form a sack of liquid called a follicle, which can grow an inch long.

People having five, six, seven or eight babies at a time is the kind of thing that medical societies, insurance company policies, or state laws can help prevent, Dr. Chin said.

“It's not fair to the parents. It's not fair to the children. It's not fair to society,” Dr. Chin said.

Either fertility drugs should be prescribed only by board-certified specialists, or ultrasound testing should be a standard part of all fertility treatments involving injected fertility drugs, he said. ےےے

After lunch, Dr. Chin drives to a nearby hospital, where a couple mourns the loss of twins to premature labor after going through what had been a successful IVF treatment.

It's a scene of deep pain and a stark reminder that medicine can only do so much. Refusing a chair, Dr. Chin hugs his patient and fights back his own tears. There are no magic words. ےےے

Even in their grief, the couple says they will come back to Dr. Chin to try again.

The woman who lost her twins said: “We've known Dr. Chin for a long time. He's honest and compassionate. It's like dealing with a friend.”

Back in the car, Dr. Chin said, “This is the part I'd rather not have a lot of. This is why I didn't want to go into pediatrics.”

This from a man who says a pediatrician, Dr. John H. Hunt, ignited his boyhood desire to be a doctor.

“He wanted me to take over his practice (when he retired). That was tough to turn down,” Dr. Chin said. “But I was just not comfortable with death and dying.”

He was a first-year medical student at Ohio State University when the world learned about Louise Brown, the world's first “test-tube baby.” Fertility treatment promised to be an exciting field of medicine. Dr. Chin got in pretty close to the ground floor. ےےے

Among the photos in the hallway of babies hangs a wide-angle photo from Dr. Chin's annual family reunion for IVF families. The shot shows a hillside packed with parents and their children. ےےے

“Just think how many babies wouldn't be around if it wasn't for Dr. Chin,” Mrs. Klaserner said.

Having a baby is a woman's “biological right,”Dr. Chin said. If anybody is playing God, it would be people who would deny women access to fertility treatments.

“What if we were talking about heart disease?” Dr. Chin said. “Would people say God meant for you to have poor arteries, so you shouldn't get a bypass?” ےےے

1:45 p.m.: As Dr. Chin returns from the hospital, he meets a mother and baby who have stopped by to say hello.

The last time Dr. Chin saw Sophie Jostworth, she was an inch-long squirming blob on the ultrasound screen, just 10 weeks into pregnancy. Now, she's nearly 8 months old.



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