In search of a fertility fix

Who can be trusted in the profiteering frontier of fertility treatments?

By Carol Lloyd

Published July 5, 2007 7:45PM (EDT)

More bleak news for women in the throes of fertility madness. Yesterday two separate studies presented at the European Society of Human Reproduction and Embryology in Lyon, France, suggested that some of the therapies supposedly designed to help women get pregnant may actually have a deleterious effect on baby making.

Reuters reported on a clinical trial from the University of Amsterdam of 408 women aged 35 to 41 who were attempting to conceive through in vitro fertilization. The research (published online by the New England Journal of Medicine) found that genetic screening, a process increasingly used to screen embryos implanted through IVF in older women, has been found to reduce live births by one-third.

The assumption was that the test would allow doctors to choose only the healthiest embryos and therefore give women the best chance of bearing a baby. But even a first-grader, applying age-appropriate arithmetic, might have questioned this logic. In the best-case scenario, the test removes one out of the eight cells that form the 3-day-old embryo, with the expectation that seven remaining cells will develop into a healthy infant. (The idea that some test-tube kiddies need all eight cells to burst into the world 40 weeks later doesn't seem so far-fetched.) But in a less rosy scenario, the 3-day-old embryo is composed of as few as four cells, in which case the test removes 25 percent of the embryo to test its viability.

Kathy Hudson, director of the Genetics and Public Policy Center at Johns Hopkins University, in Baltimore, told Reuters that no other "medical procedure with such profound medical and ethical consequences has been so poorly studied." But at $3,000 to $5,000 a test, who has time to stir up doubts about efficacy?

Update: It should be clarified that -- as the Reuters article notes -- it's unclear why exactly genetic screening reduces viability in the clinical trial mentioned above. But, as Sebastiaan Mastenbroek, from the Academic Medical Centre of the University of Amsterdam, told the wire service: "It is possible that the biopsy of a cell from an early embryo on day three after conception hampers the potential of an embryo to successfully implant, though the effect of biopsy alone on pregnancy rates has not been studied."

If mainstream fertility procedures seem to be failing some women, alternative therapies don't seem to be helping much either. As reported by the Associated Press, a Danish study found that women who turn to alternative therapies such as reflexology, acupuncture and herbal supplements during in vitro fertilization have lower pregnancy rates than those women who don't. Out of the 800 women in the study, the 33 percent that sought alternative therapies were 20 percent less likely to get pregnant than those who didn't.

Although it seems worthy to study the viability of such therapies, this particular study had too many design flaws to draw any coherent conclusions. The researchers acknowledged that the women who opted for alternative treatments generally had a worse prognosis from the get-go, but maintained that even after controlling for this fact, the use of alternative therapies was still linked to lower pregnancy rates.

Another weakness of the study, however, is that it lumps all alternative therapies together -- as if acupuncture and herbal remedies and kinesthesiology are somehow comparable simply because they stand outside of mainstream medical practice. In the end the study only underscores what we already knew: We don't know if alternative fertility remedies are harmful or helpful, but one shouldn't assume they work just because someone with a plaque on his or her wall is willing to sell them to you.

Of course, the same can be said for a lot of mainstream medical fertility treatments. In the profiteering frontier of high-tech spawning, preserving the bottom line sometimes means throwing the baby out with the petri dish water.

Carol Lloyd

Carol Lloyd is currently at work on a book about the gentrification wars in San Francisco's Mission District.

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