Fertility with Less Fuss

By LARRY THOMPSON

Making a test-tube baby is a test of human endurance -- especially for the would-be mother. To start the process of in-vitro fertilization (IVF), she must submit to a two-week regimen of daily drug injections. They prepare her ovaries and cause perhaps half a dozen eggs to mature simultaneously, but the shots can also produce pain, bloating and sharp mood swings. Every day she undergoes tedious blood tests and ultrasound examinations: the doctors need to monitor the ovaries closely and remove the eggs at just the right time so they can be fertilized in the lab and then returned to the womb. Despite the hardships, infertile couples went through the costly, complex procedure 40,000 times last year in the U.S.

Before long, though, they may have a better way to make a baby. This week, Alan Trounson, an IVF pioneer at Monash University in Melbourne, Australia, will tell the American Fertility Society meeting in San Antonio, Texas, that he and his colleagues have devised an alternate approach that is much cheaper, simpler and easier on the mother. It removes the need for fertility drugs and daily monitoring. "There is nothing terribly complicated about ((the procedure))," Trounson claims, "so it will spread like a brush fire because the patients want it."

Trounson's method, called immature oocyte collection, is radically different from traditional IVF. Instead of priming the woman with fertility drugs so that eggs (the oocytes) will mature, doctors simply remove immature eggs. The timing is no longer crucial. Success hinges on two new techniques: locating the immature eggs and stimulating them to mature outside the ovary.

The process begins with an examination of follicles, the tiny sacs in the ovary where eggs are found. Fertility doctors ordinarily focus on large follicles -- nearly a half-inch wide -- that contain mature eggs. But Trounson's partner, Dr. Carl Wood, discovered that the latest ultrasound machines could spot follicles that are less than a tenth of an inch wide and hold immature eggs. Wood developed a way to pluck the young eggs out of the smaller follicles with a specially designed needle. Trounson, after experiments with cattle, devised a cell-culturing procedure that ripens the immature eggs in the laboratory so they can be doused with sperm and fertilized.

Robyn Hallam, 33, was a perfect candidate for the new, streamlined IVF. Unable to conceive naturally with her husband Tim, a grain farmer in Hopetoun, Australia, Robyn tried fertility drugs to no avail. As the couple prepared to undergo traditional IVF, they were offered Trounson's new approach. "We were told that there'd never been a baby born through this procedure," Robyn recalls. "We thought, 'What do we have to lose?' "

Instead of enduring drug treatments and monitoring, Robyn merely went to the Monash clinic to have immature eggs extracted. The doctors got six eggs and tried to fertilize them all, but only one developed into a viable embryo. It was implanted in Robyn's womb, and on Dec. 14, 1993, Kezia Hallam, Trounson's first bundle of success, was born.

She was actually the fourth human born from an egg matured outside the ovary. In 1991, Dr. Kwang Yul Cha and his colleagues at the Cha Woman's Hospital in Seoul removed the ovaries of a woman with fibroid tumors and isolated immature eggs, which were then ripened and fertilized in the lab. They transferred the embryos to a surrogate mother, who produced triplets. Since then Cha has not repeated his success.

Trounson and the Monash team, in contrast, have impregnated several more women. IVF America, a Greenwich, Connecticut, company associated with Monash, plans to develop the technique in the U.S.

If Trounson's approach works as well as he says, it could transform the economics of the test-tube baby business. Standard IVF can cost more than $100,000, but Trounson says he can slash that figure 80% by eliminating drugs, curtailing testing and reducing doctors' fees.

American fertility experts doubt that Trounson's method will save as much money as he claims. What's more, they question whether the treatment will be useful for the majority of infertile women. "I don't think we have data to prove that this will give the woman a better chance of success," says Dr. Suheil Muasherof the Jones Institute for Reproductive Medicine in Norfolk, Virginia. Trounson admits that he cannot predict the procedure's success rate, but in cattle, 30% of the embryos from immature eggs become calves. That's slightly better than the current 25% success rate for IVF in humans.

It's too soon to tell whether Trounson's technique will revolutionize the treatment of infertility. But the desperate couples who face the emotionally and financially draining ordeal of making a test-tube baby will be eager to find out.