A Tristate fertility expert says many women are wasting thousands of dollars on near-hopeless in-vitro fertilization (IVF) treatments because they aren't getting, or don't know about, a blood test.

        The test is called ovarian reserve screening and can predict whether women have low odds of fertilization. The test measures the ability of a woman to produce viable eggs. A poor score means the odds of a live birth resulting from an in-vitro fertilization attempt can be less than 5 percent.

        Dr. Glen Hofmann, director of the Bethesda Center for Reproductive Health and Fertility, recommends the test whenever women over 35 seek fertility treatment and for younger women in special situations. He said the test is especially important for couples who have failed to conceive while using fertility medications and are considering more expensive, higher-tech treatments.

WHO SHOULD BE TESTED

The American Society of Reproductive Medicine recommended in 1996 that certain women seeking fertility treatment should get the test:     • All women age 35 and up.     • Women of any age if they have recurrent miscarriages or the couple has otherwise unexplained infertility.     • Women of any age who have one ovary.     • Women of any age who have had poor response to the fertility drug Pergonol.

        “We see a lot of women who don't know about this test. There's a lack of knowledge out there, especially among general ob/gyns,” Dr. Hofmann said.

        Nationwide, the number of women seeking IVF continues to rise. More than 360 fertility clinics provided treatments that led to 28,500 births in 1998, according to the Centers for Disease Control and Prevention. That's up from 300 clinics and 20,600 babies born in 1996.

        However, some treatments are much more expensive than others and insurance frequently does not cover the bill.

        It can cost $200 to $300 per menstrual cycle for a woman taking the fertility drug Clomid. An artificial insemination service involving Pergonal, a stronger fertility drug, and a visit to the doctor's office at the peak of ovulation can cost about $3,000.

        A full-scale IVF treatment, which involves using strong fertility drugs, harvesting eggs, inseminating them in a lab dish, then returning fertilized embryos to the would-be mother, can cost about $10,000.

        Adding special services to a basic IVF treatment, such as direct sperm injection, assisted egg hatching, or using another woman's eggs can add several thousand dollars.

Test about $170

        For some couples, life plans can be affected and high expenses can be avoided by taking the $170 blood test.

        Amy is a 33-year-old Wyoming resident who says her parenting plans have been changed dramatically by the ovarian reserve test. She asked that her last name not be published because many people close to her do not know she has been seeking fertility treatments.

        She and her husband of 11 years, like many couples, decided to pursue education, careers and some of their travel interests before trying to have children.

        “I always thought I would have three or four kids and that it would be OK as long as I started in my early 30s. But there's really a risk that comes with waiting,” Amy said.

        The couple spent about a year trying on their own to conceive. Then they spent several months working with an obstetrician/gynecologist, who prescribed Clomid. Amy monitored her body temperature so she can time intercourse with the peak of ovulation.

        Then the doctor recommended that Amy see a specialist. Based on some previous blood tests, Dr. Hofmann recommended the ovarian screening test.

        Ovarian reserve screening actually is a two-step process: one blood test to measure a woman's base level of follicle stimulating hormone (FSH), a hormone crucial to egg production. A second blood test is done 10 days later after taking several doses of Clomid.

        Elevated levels of FSH mean lower odds of successful pregnancy. In most labs, an FSH level below 10 is good, 10 to 15 is considered borderline and scores above 25 are clearly abnormal. Doctors disagree whether scores from 15 to 25 are abnormal or borderline.

        The problem caused by high FSH levels can manifest itself two ways. Some women produce five or fewer eggs even when stimulated with drugs that would normally result in 10 to 20 eggs.

        For others, their ovaries produce plenty of eggs, but they are defective, and pregnancies end in miscarriage.

        “This is a test that can give couples closure, allowing them to move on to other options,” Dr. Hofmann said.

        Amy's test scores were high. For her, the problem was not enough eggs to attempt IVF, despite powerful drugs.

        “The results were devastating,” Amy said. “Part of it is, you have to let go of a dream. You have to grieve the loss of that dream. Once you're done with that, you can move on to other alternatives.”

        Such options can include the time and expense of seeking an egg donor, adopting a child or deciding not to have children.

        Amy and her husband are pursuing egg donation and adoption, she said. The test made it easier to accept these ideas.

        “I feel really fortunate to know that (diminished ovarian capacity) was my problem,” she said, “and that I didn't have to go through years of treatment to find out.”
       

Shooing away tough cases

        Amy participates in an infertility support group called Resolve.

        Dr. Sherif Awadalla, medical director for the Institute for Reproductive Medicine at Christ Hospital, said the ovarian reserve test is gaining importance, but doctors continue to debate how widely it should be used.

        “Ovarian reserve has become more of an issue because more and more women are waiting longer to have babies,” Dr. Awadalla said.

        Women generally hit peak reproductive ability during their 20s. Starting at about age 32, various studies have shown a steady decline in the quality of their eggs.

        Dr. Awadalla also is concerned that some fertility clinics may try to use the test as a way to pad their success rates by shooing away tough cases.

        The biggest complaint among doctors is that ovarian screening is not absolute. For women under 35, the test's ability to predict success appears less accurate than for women over 35.

        Meanwhile, doctors and couples struggle to decide what to do about “borderline” test results, where the hormone level is elevated but just slightly, Dr. Awadalla said.

        “If you tell a patient their chances are low, but they say they really want the (IVF) treatment, it is hard to say no,” he said. “I have treated women who have had babies despite poor test results.”

       For information about Resolve, call 800-414-OHIO. Press 4 for information about meetings in Cincinnati.

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