Sunday, January 25, 2004

Science of fertility growing up fast


Local centers among leaders
in producing 'miracle babies'

By Tim Bonfield
The Cincinnati Enquirer

baby tech
Kammie Kinkade, 31, of Clermont County, holds her 2-month-old daughter, Madeline, as her son, Riley, 2, sits to her left..
(Photos by Steven M. Herppich/The
Cincinnati Enquirer)
baby tech
Kammie Kinkade holds her daughter, Madeline, as her husband, Jaime (background), who is a paraplegic, plays with their son, Riley, 2.
baby tech
Kammie Kinkade puts Madeline into her bassinet as Jaime sits in his wheelchair in the foreground.
baby tech
Kammie Kinkade holds the petry dish were Madeline started out as the baby lays in her bassinet.
baby tech
Kammie Kinkade holds her daughter, Madeline, as her husband Jaime holds their son, Riley.
When Jaime Kinkade was paralyzed from the chest down in a dirt bike crash in 2000, he and his wife, Kammie, thought it would never be possible to have another child.

Now, Kammie rocks her daughter Madeline in her arms. And she and her husband marvel at the science that gave them their "miracle baby."

"I feel very blessed and lucky," says Jaime.

Madeline, nearly 2 months old, is just one success.

As many as 400 babies have been born as a result of work done in one year at Cincinnati's three fertility centers. Medical experts say fertility technology is advancing so quickly that couples who could not be helped just a few short years ago are having children today.

In Cincinnati, new technology allows a man with a spinal cord injury to father a child. It also helps embryos attach to the uterus and allows the testing of embryos of only eight cells for genetic defects.

Researchers are even experimenting with freezing women's eggs, a concept that experts say could revolutionize the fertility industry.

"There are so many advances on so many fronts," says Dr. Sherif Awadalla, the senior partner in Greater Cincinnati's biggest fertility clinic, the Institute for Reproductive Health.

"Every six months things are getting better."

Of 24 fertility clinics in Ohio, Kentucky and Indiana, three are in Greater Cincinnati.

The three centers accounted for about 400 babies born from in-vitro fertilization services performed in 2001, according to the latest data from the federal Centers for Disease Control and Prevention. Overall, the region's hospitals deliver about 30,200 babies a year.

About one in six American couples faces problems with fertility. While many find success using fertility drugs and other treatments, others turn to the higher tech - and more expensive - methods of in-vitro fertilization.

Nationwide, in-vitro services performed in 2001 resulted in more than 40,600 babies born in 2001 and 2002, according to federal health statistics.

Success rates vary a great deal. A lot depends on the woman's age and the type of services involved.

In Cincinnati, fertility centers reported live birth rates as high as 40 percent for women under 35 who were trying to get pregnant using fresh embryos from the woman's own eggs. But for women over 40, success rates dropped to as low as 12 percent.

FERTILITY DATA BANK

By the numbers

24: Fertility clinics in Ohio, Indiana and Kentucky

400: babies born from services provided in 2001 at Cincinnati's three fertility centers

1 in 6: American couples who face problems with fertility

What's it mean?  

In-vitro fertilization: When the egg and sperm are united in a petri dish, resulting in an embryo that is implanted in the mother's womb.

Hatching: Lab experts use needles, lasers and other techniques to create a small hole in the embryo membrane to make it easier for embryo to hatch and attach to the uterus.

More about local centers

Institute for Reproductive Health, 3805 Edwards Road, Norwood. (513) 924-5550. www.cincinnatifertility.com

Center for Reproductive Health at Christ Hospital, 2139 Auburn Ave., (513) 585-2355. www.ucfertility.com

Bethesda Center for Reproductive Health and Fertility, Bethesda North Hospital10506 Montgomery Road, Suite 303, (513) 745-1675. www.bethesdafertility.com

More information online

The Centers for Disease Control and Prevention report pregnancy success rates at the nation's fertility clinics at www.cdc.gov/reproductivehealth.

Cool concept: freezing human eggs

Success rates also vary depending on whether women use frozen embryos or donated eggs.

Better results for money

Costs also range widely, depending on the center and how many services are performed.

Package prices in Cincinnati for a single "cycle" - an attempt at fertilizing an egg and implanting a growing embryo - range from $5,000 to $7,000.

Fertility medications can cost another $1,500 to $2,000. Special services such as direct sperm injection, assisted hatching, embryo freezing or genetic testing can add several hundred to a few thousand dollars to the bill.

Yet, fertility experts contend that families are getting better results for their money than couples did even a few years ago.

More precise use of fertility drugs, better lab equipment, improved chemical mixes used for growing embryos, even learning the best places on the uterus to implant a fertilized embryo, have combined to steadily improve a couple's chances of getting a baby on their first attempt.

Better technology also makes it less likely for couples to get "too lucky" and wind up with twins, triplets or more after in-vitro fertilization, Dr. Awadalla says.

As fertility technology advances, couples with once untreatable problems are discovering that they, too, can become parents.

Spinal cord injuries

Clermont County resident Kammie Kinkade was about three months pregnant with her first child, Riley, when her husband Jaime was riding a motorcycle off-road in southern Indiana on Nov. 5, 2000. He collided with a four-wheel ATV, was thrown from his bike and was hit by another four-wheeler.

Jaime's back was broken and he was paralyzed from the chest down. As he recovered, the couple discovered a common result of spinal cord injuries - Jamie was unable to ejaculate. Yet Kammie very much wanted to have another child. At first, in-vitro fertilization did not occur to them. But friends who had their own baby through fertilization treatments recommended their doctors to the Kinkades. After learning there was something the doctors could do, Kammie took medications to generate a dozen eggs in a single menstrual cycle.

Meanwhile, Dr. Michael Scheiber used a needle to remove a small amount of tissue from Jaime's testes.

In that tissue, lab technicians found immature sperm cells, some of which were injected one at a time directly into Kammie's eggs. Of eight successfully fertilized embryos, two were implanted.

One of those embryos developed into a healthy baby girl. Madeline was born Nov. 20.

Kammie holds the palm-sized, clear plastic petri dish next to Madeline and describes what it took to make her life possible. The shots of medications for 17 days in a row. The procedures. The idea that a human life really can start in a lab dish.

"It's hard to believe isn't it?" she says. "(Going through the process) my thought was, 'None of this seems natural.' But here we are."

For men with fertility problems, the needle biopsy isn't particularly new. But only recently have centers started applying the technique to people with spinal cord injuries, Dr. Awadalla says.

Jamie is sharing his story, he says, in hopes of letting other men know there are options.

Genetic testing

Come February, a Greater Cincinnati couple is expecting a baby that they know will not suffer from Fanconi's anemia, a rare and serious bone marrow disease that prevents production of all types of blood cells.

The parents are carriers for the disease, which can cause numerous problems from malformed limbs to learning disabilities to organ damage and death. Few people born with the disease have lived beyond age 25.

The couple, who declined a request for an interview, is among a growing number of would-be parents who are seeking genetic testing during the in-vitro fertilization process.

If possible, parents want to avoid having a child born with cystic fibrosis, sickle cell anemia, Tay-Sachs disease or any of more than 200 conditions on a list of rare genetic diseases and chromosomal disorders.

"We're talking about couples who've already gone through the pain of having a child die from one of these diseases and they don't want to go through it again," Awadalla says.

Even when parents are carriers of a genetic disease, it is not guaranteed that their child will have the condition. Depending on whether a trait is dominant or recessive, the odds for a given child tend to be either 50 percent or 25 percent.

However, through genetic testing of embryos grown during the in-vitro process, it becomes possible to beat the odds by implanting only those embryos that are found not to have the genetic problems.

A handful of labs equipped to do such testing have been in business for several years now: in Chicago, Detroit, Dallas, Los Angeles and other cities. But until recently, Cincinnati patients had to travel to those cities - or pay for a technician to be flown here - to get the testing done.

The Institute for Reproductive Health in Norwood and the Center for Reproductive Healthat Christ Hospital in Mount Auburn already offer expanded genetic testing services.

In March, the service also will be available through the Bethesda Center for Reproductive Health, based at Bethesda North Hospital.

The centers don't do the full genetic analysis themselves, but they have added equipment and have given staff members appropriate training.

Help for older women

As women reach their late 30s and early 40s, the overall quality of their eggs - and their chance of a healthy baby - sharply declines.

Even after a successful fertilization, the membrane surrounding the embryo tends to be thicker from eggs that come from older women. That becomes a problem during implantation because the embryo needs to "hatch" to become fully attached to the uterus and continue to develop.

Enter assisted hatching, a process that has been performed for several years in some parts of the country but only recently has caught hold in Cincinnati.

Lab experts can use a variety of methods - including needles, lasers and acids - to create a small hole in the embryo membrane just before implantation.

When successful, the hole makes it easier for the embryo to hatch into its next stage. The risk: The process sometimes destroys embryos.

The frequency of assisted hatching varies among fertility centers. Doctors at the Center for Reproductive Health at Christ Hospital say they've had such success with assisted hatching that they are making it routine for more women.

Two years ago, they did the procedure only for women over 38. Then the live birth rates for those women started to outpace the birth rates for women 35-37 years old.

"We're doing a lot more assisted hatching. Within the last year or so, we've been doing this for all women over 35," says Dr. Dan Williams, director of the Center for Reproductive Health.

As technology races ahead, doctors say it is hard to predict how it will be applied.

How long will it be before the new genetic testing used to spot a dreaded disease is also used to spot a desired trait, like gender, intelligence, beauty, or athletic ability?

"Everybody worries about people seeking designer babies. But I think that's a long way off," Tucker says. "It's hard enough to do these things for valid medical reasons."

E-mail tbonfield@enquirer.com




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