Medical treatment helps infertile couples fulfill parenting dreams
Aug. 26, 2002

By MORGAN LYLE
Special to the Observer-Dispatch

For six years, Sussanne and Jeff Murteza tried to get pregnant on their own. Like so many couples, they yearned to have a child.

“And when you’re told you can’t, it’s very, very shattering,” said Sussanne, a 32-year-old paramedic who lives in Pulaski in Oswego County. “You tend to say, ‘Should I divorce him and let him try with someone else?’”

They turned to medicine — specifically, in-vitro fertilization by Dr. Robert Kiltz at CNY Fertility Center in Syracuse.

Twice Sussanne got pregnant but miscarried. Three more times it didn’t take. On the sixth try, it did. Nicholas, Nathaniel and Noah were born April 18, 2001, nine weeks premature but healthy.

“I do have two older children that I conceived naturally. But my now-husband did not have the experience of parenthood, and he was getting up in age,” Sussanne said. “And as a wife, there’s a certain obligation that a person feels. You want to give him that, to give him a child. ... I know that a lot of marriages have been destroyed by infertility.”

The unpredictability of procreation has changed the histories not just of families, but of nations, said Dr. Murray Nusbaum, medical director of the Ferre Institute in Utica.

“There are numerous instances of infertility and the sorrow it brought in the Bible — Sarah’s a good example — and throughout history, infertility has literally caused war and stopped war, when men couldn’t have heirs,” he said. “It’s one of the most emotionally wrenching instances a couple can have.”

At any given time, about 15 percent of couples are unable to conceive. Many turn out to have problems that can be corrected relatively easily. In fact, simple behavior modification such as quitting smoking or achieving the proper weight can often do the trick.

It’s possible to make a good guess when ovulation has occurred by tracking body temperature, and there are urine and tissue tests that can predict ovulation and therefore when is the best time to have sex.

A test called the hysterosalpingogram or HSG, which uses dye and X-rays to check the condition of the uterus, can sometimes open fallopian tubes and allow conception to occur.

Women whose ovaries do not regularly release eggs, or do not produce enough of the hormone progesterone, sometimes respond to treatment with medicines called gonadotropins, administered as a series of injections by the woman herself.

If the problem is low sperm count in the man, a common treatment is intrauterine insemination: the sperm is “washed” to concentrate the best cells, then injected into the uterus during ovulation.

Many insurance companies cover most of the costs of these treatments. But when these less-drastic measures fail and couples move on to high-tech procedures such as in-vitro fertilization, conception becomes expensive.

CNY Fertility charges $4,300 to $7,000 for one cycle of IVF, and Nusbaum said the price at many clinics runs from $12,000 to $20,000. And many insurance companies will not pay for IVF.

What’s more, the high-tech treatments don’t always work.

CNY Fertility Center’s success rate for women younger than 35 is 36 percent for the past three years. That’s a little better than the national rate, as measured by the Centers for Disease Control in 1999: 30.6 percent — 19.2 percent single-fetus pregnancies, 11.4 percent multiples.

And multiples are indeed an issue.

Though Sussanne said she was overjoyed to learn she was carrying triplets, she didn’t set out to have three children at once, and admits it’s demanding to care for them all.

She has lots of company among couples being treated for infertility. The CDC estimates 37 percent of pregnancies resulting from procedures such as IVF resulted in multiple births — more than 10 times the natural rate. Thirty-two percent were twins, and the other 5 percent were triplets or more.

All multiple-infant births carry higher risks of prematurity, low birth weight, disability and death. Multiple-fetus pregnancies also can put the couple in the terrible position of having to select one or two fetuses to abort because carrying them all would be too dangerous for the mother.

But despite the cost, despite the odds, despite the risks, the prospect of having a family leads droves of Americans to try.

In 1999, there were 86,822 menstrual cycles’ worth of assisted reproductive technology, as IVF and other high-tech treatments are known, performed in 370 clinics across the United States They led to 21,501 live-birth deliveries, with a total of 30,285 babies.

“It offers a huge, huge opportunity for couples or even single women who want to have children,” said Kiltz, founder and director of CNY Fertility Center.

Along with the longing for a baby to love, the inability to build a family the old-fashioned way often spawns feelings of guilt and inadequacy.

“Emotionally, it’s rough,” Nusbaum said. Infertile couples sometimes imagine ways they have caused their own problems. Some people are afraid they damaged their fertility by taking drugs in their youth. One woman told Nusbaum she was sure God was punishing her for changing churches. Some men equate infertility with failure and refuse to get checked — even though male factors are to blame for close to one-third of all infertility cases.

All this, of course, is often set against a backdrop of pressure from family and peers, such as parents and in-laws who say, “When are you going to give me a grandchild?”

Religious prohibitions deny medical help with fertility to a significant number of people. For example, it is against their religions for Catholic and Orthodox Jewish men to masturbate, making it more difficult to get the sperm needed to diagnose male infertility or to inseminate embryos outside the womb for IVF.

But the main thing keeping infertile couples from assisted reproductive technology is money, the experts agreed.

“Unfortunately, I suspect it’s often the people who have knowledge and money that get the treatment, while other worthy people who don’t have one or the other don’t get the treatment,” Nusbaum said.

The Murtezas had insurance that covered their medicines, but still wound up paying about $5,000 out of pocket. The cost would have been much higher had Sussanne not donated some of the embryos she produced in four of her six cycles. She was credited $3,000 per cycle, the amount the clinic pays for embryo donation. (Sussanne’s “extras” went to two friends, who went on to have babies.)

“I would say about 20 to 40 percent of couples have full insurance (coverage), and maybe 60 percent have partial insurance. But that’s people who come to us,” Kiltz said. “My bet is that there are a lot of people who don’t come.”

“Many people may find that it doesn’t cost as much as they think,” he added. “Insurance companies often make it hard to understand what you have coverage for. We spend hours on the phone trying to identify people’s coverage and getting them authorization for treatment.”

That will become somewhat easier under a law passed this year by the state Legislature. It requires most private insurance companies to cover the evaluation, diagnosis and treatment of infertility. The coverage is limited; IVF, for example, is specifically excluded.

But the new law, which takes effect Sept. 1, also creates a $10 million pool to “improve access” to infertility services including IVF.

“That’s a big step forward,” Kiltz said. “Legislation for some coverage will help a lot of people.”

It may even help Sussanne and Jeff Murteza. They want a girl.

“Believe it or not, we are embarking on another cycle with Dr. Kiltz,” Sussanne said.

GLOSSARY:

Here’s a list of some fertility treatment terms:

IN-VITRO FERTILIZATION (IVF) — Embryos (eggs) are retrieved from the woman’s ovaries, fertilized in an incubator with washed sperm from her partner, then surgically placed in the uterus to grow into a fetus. The most popular and least invasive method of assisted-reproductive technology.

GAMETE INTRA-FALLOPIAN TRANSFER (GIFT) — Embryos are retrieved, then placed in the fallopian tubes (near the uterus) along with sperm. Fertilization is allowed to occur “naturally” in the tubes; the fertilized embryo travels to the uterus to develop. Requires laparoscopic surgery (threading of a slim device into the uterus or tubes).

ZYGOTE INTRA-FALLOPIAN TRANSFER (ZIFT) — Embryos are retrieved, fertilized outside the womb, then planted in the fallopian tubes to travel to the uterus. Requires laparoscopic surgery.

INTRAUTERINE INSEMINATION — A relatively “low-tech” outpatient office procedure. Sperm is collected, washed to concentrate the best cells, placed in a catheter and placed into the woman’s uterus immediately after ovulation.

Source: CNY Fertility Center

THE FERRE INSTITUTE

The Ferre Institute was founded in Utica in 1974 as a first-of-its-kind federal pilot program. The word “ferre” comes from the Latin root of “fertility.” From offices in New Hartford, Binghamton, Buffalo and Potsdam, the institute:

• Provides professional training in adoption, infertility and medical genetics.
• Provides information and resources about family building issues to the public.
• Is committed to raising awareness about the needs of individuals who are members of underserved communities and communities of color.
• Provides clinical genetic counseling services through a unique community-based model. At present, the institute serves 1 million New York state residents in underserved and rural communities.
• Until the mid-1990s, Ferre operated a public clinic, Mid-York Fertility, which offered fertility treatment at sliding-scale rates.
• Today, the institute’s projects include study of familial cancer and infertility among African-Americans, in addition to its traditional specialties.