European Stars And Stripes (Newspaper) - August 5, 1988, Darmstadt, Hesse                                Help for childless Embry Logist examines egg in an incubator in 10 years in Vitro fertilization has become routine Medicine a multimillion Dollar business and a catalyst of ethical debate. By Robert Glass associated press Ince the world s first test tube baby was born in England 10 years ago the medical technique that made her life possible has spread around the world and spawned an array of treatments to help childless couples. It s been astonishing. The ideas Are coming from everywhere said physiologist Robert Edwards who with the late gynaecologist Patrick Steptoe pioneered the technique known As in Vitro fertilization. There have been some amazing advances especially in unlocking some of the mysteries of Early human growth and hereditary diseases Edwards said. Originally developed As a treatment for women with blocked fallopian tubes in Vitro fertilization has produced a Range of techniques such As embryo freezing womb leasing and egg donation to treat infertility in both men and women. Virtually every industrialized country has an established in Vitro program and Many developing countries such As China India and Egypt have entered the Field. Because few countries keep records of in Vitro births no precise estimate exists of their number worldwide. However a Survey has indicated at least 10,000 test tube babies have been born since the first Louise Joy Brown on july 25,1978. Britain Australia France the United states West Germany Belgium and Austria account for the majority of test tube babies worldwide. Fledgling programs also have been set up in Asia the Middle East and latin America often in Defiance of religious and economic objections. In the conservative islamic nations of the Middle East for example theologians initially walked at in Vitro because of the Koran s teaching against Western style adoption procedures and birth outside marriage. But clinics have sprung up in saudi Arabia and Egypt mainly catering to the wealthy and two clinics Are expected to open soon in Bahrain. Italy meanwhile has established a flourishing test tube baby program despite the roman Catholic Church s objections to artificial reproduction. China while imposing a strict one child per family regime to control its population of More than 1 billion announced the birth of its first test tube baby this year. India s first test tube baby was born two years ago. In Vitro researchers say assisted conceptions produce a statistically negligible addition to the population and Edwards says those who criticize populous countries for promoting new childbirth methods should re Analyse their own View of  a chinese woman has the same urge to have children As a British woman he said. You can t just set aside a group of patients and leave them to suffer in  despite the proliferation of clinics the Steptoe Edwards technique remains a costly hit and miss proposition available to Only about 5 percent of childless couples. Nearly 10 years after the first baby was born As a result of in Vitro fertilization this treatment is still largely unsuccessful said a report in the British medical journal. It said the latest figures show that in Britain Only 11 percent of women got pregnant and 9 percent had a live baby after a single Cycle of treatment and other countries with advanced programs had similar Success rates. The treatment has brought an awful lot of Joy and happiness for a lot of people but also a lot of disappointment said or. Peter Brinsden Deputy director of the Fertility and in Vitro fertilization unit at London s Humana Hospital Wellington. Eventually he expects the Success rate to creep up to 20 to 30 percent but noted it s a Long Way Down the  Brinsden and his colleagues Are among world leaders in the latest in Vitro spinoff known As gamete intr fallopian Transfer or gift in which doctors Transfer egg and sperm directly into the fallopian tube for fertilization in the womb. The Humana unit has reported a 31.2 percent Success rate with gift but it has the drawback of being available Only to women with at least one unblocked fallopian tube the Normal site of Conception. Although Edwards said his clinic at Bourn Hall near Cambridge has a much higher pregnancy rate than average he acknowledged that the biggest in Vitro advances have been in research into hereditary diseases rather than improving the technique s Success rate. Under the Steptoe Edwards technique ova Are removed from the Mother mixed with the prospective father s sperm in a Laboratory dish and re implanted in the Mother s uterus. To increase the chances of pregnancy doctors now routinely use drugs to stimulate ovulation and fertilize and implant three or four embryos at a time resulting in a High incidence of multiple births. Parents with babies bom As a result of in Vitro fertilization at a party in new York in March. A renewed debate Over test tube babies1 by Christopher Sullivan associated press doctors and nurses in scrub suits the colors of sherbet wheeled another patient into the operating room for a Brief procedure placing fertilized eggs in her  involved hoped the eggs would cling there and grow into a pregnancy but everyone knew they probably would not. The scene played out on a video Monitor Over the Heads of Georgeanna and Howard Jones whose in Vitro fertilization clinic gets credit for about 400 test tube babies including the first in this country. In a month the woman on the screen would receive a phone Call telling her whether or not she was pregnant. Roughly three times in four even at the Best centers like the Jones Institute for reproductive Medicine at Eastern Virginia medical school in Norfolk the answer is no. It s always hard said the 77-year-old or. Howard As colleagues Call him. But said or. Georgeanna who s 76, it More than compensates when you Call to say  it has been 10 years since in Vitro technology was proven with the birth of Louise Joy Brown in Britain the first of an estimated 10,000 such infants born to infertile couples around the world. In Vitro fertilization has become routine Medicine a multimillion Dollar business and a catalyst of new ethical debate with each research Advance. At least 169 in Vitro centers operate in 41 states in the United states alone and with the proliferation have come questions that practitioners and policy makers Are now being pressed to answer Why in t Success More common Are in Vitro clinics and their practices adequately regulated Why does in Vitro Cost so much $4,000 to $6,000 on average per attempt and should insurance companies or taxpayers help pay the Bill Why has the Federal government maintained a de Facto moratorium on financing research have some clinics taken advantage of a vulnerable patient population to make a profit some clinics Are Selling false Hope asserted Gary Ellis director of a just completed study of infertility for the congressional office of technology assessment. A clinic knows if it has had any babies born. A clinic that keeps admitting people in the front door and does not have any births i ask you what Are they Selling they re Selling false  he and others stressed that Only a minority of clinics fell into that category. But the vast Market for infertility services 2 million to 3 million american couples unable to have babies enhances the danger of charlatan by and fraud. You can charge these people More because they re More desperate said Gina de Miranda who founded a consumer Protection group in Texas for infertile people after her own years of frustration and sadness. What you be had is a whole lot of clinics opening All Over the United states with varying rates of Success. And in order to break even they be got to get More patients in and charge them As much As they can she said. Infertility treatments Cost americans $1 billion last year $66 million of that for what has become the treatment of last resort in Vitro fertilization according to the Ota study. De Miranda whose lobbying made Texas one of the five states along with Maryland Massachusetts Hawaii and Arkansas to require insurance companies to offer coverage of in Vitro advises anyone thinking of the procedure to ask questions. Patients need to know More than the basics of in Vitro the hormonal stimulation of the woman to produce More than one egg in a month the retrieval by doctors of As Many eggs As possible the mixing of those eggs with the husband s sperm in a Petri dish and the implanting of fertilized eggs or embryos in the uterus. Patients should ask among other questions suggested by de Miranda s group How Long a program has been in operation its rate of live births How Many retrieval procedures recover a mature egg and How often the procedure is cancelled before the embryo implant stage. Success rates should be spelled out she and others said stressing the need for Clear definitions for example a pregnancy defined Early in chemical terms May never produce a baby and hard numbers. A recent report by 41 . In Vitro centers claimed a combined rate of clinical pregnancy determined by detectable fetal heartbeat of 17 percent per embryo Transfer. Calculating miscarriages and other loss the Chance of having a baby after one embryo Transfer was 11 percent. The centers surveyed were among the nation s most successful scores of others still have recorded no births. The Jones Institute reported that 500 patients underwent 736 stimulation cycles last year. In 537 cases embryos were transferred. Of those 169 clinical pregnancies occurred or 23 percent per attempted stimulation 29.5 percent per embryo Transfer. The miscarriage rate was 24 percent. Noting that even Fertile couples have Only a 25 percent Chance of achieving a pregnancy in any one month of trying Howard Jones said he s pleased with his Center s total of about 400 babies to Date. It sounds so easy to do you get an egg and get some sperm you put pm together and you Transfer them nothing to it he said smiling. In fact it s not easy. It s a very demanding and exacting science and Art to interpret sometimes contradictory signals to Harvest eggs at just the right moment of maturation. It just does t seem to be a technique that s easily taught and  even so 41 states have at least one if Center. California has 22, Texas 14 and new York 11, according to the Ota report. The nine states without centers Are Alaska Arkansas Idaho Maine Montana new Hampshire North Dakota South Dakota and Wyoming. Waiting lists for the established centers can be As Long As two years. But the report also noted nearly half of All centers have yet to achieve a live  most centers Are not for profit though some Are for profit adjuncts of research hospitals and still others operate strictly As profit making concerns. Who monitors the Quality of care at these clinics asked rep. Ron Wyden d-ore., chairing a congressional committee hearing last month on the proliferation of in Vitro centers. Noting that guidelines set by a professional group the american Fertility society Are voluntary he answered his own question there Are no Federal or state requirements for accreditation or reporting. There is in fact no Public accountability at  in a step toward consumer Protection he promised the Federal government would Survey Success rates of All . In  clinics and make the results Public. Or. Richard Marrs director of the in Vitro Center at los Angeles Hospital of the Good Samaritan testified that even though regulation of reproductive Medicine is a sensitive Issue the procedures performed Are potentially dangerous without Standard licensing of the facilities and  government involvement is not something that Medicine normally seeks. But Howard Jones too chastised Washington for staying away from infertility research. The National institutes of health have never provided any funds for in Vitro fertilization or its offshoots such As Transfer of egg and sperm directly to the fallopian tubes and embryo freezing for later implant because of pressures which the politicians Are not willing to Buck he said. Federal regulations require that a special ethics advisory Board approve government funded in Vitro research but since 1980 no Secretary of health and human services has appointed the Board. A de Facto moratorium has resulted and de Miranda who says Federal funding would ensure better controlled research blames it on right to lifers within and without the government. For some ethical difficulties arise As soon As embryos Are created the Central part of the in Vitro process and of research to improve the technique. I think it s just a straight out fear of touching upon the whole Issue of abortion asserted Arthur l. Caplan director of the University of Minnesota s Center for biomedical ethics. The Vatican in its 1987 instruction on respect for human life recognized no moral distinction Between embryos at the moment of Conception and fetuses and fully developed humans they must be protected equally. Yet Many physicians and ethicist do make distinctions and consider medical research using embryos to be justifiable. Regardless of the controversy Caplan argues the government has an obligation not to evade an Issue that affects so Many americans. Reasons for infertility associated press i must have done something wrong to deserve  that diary entry from an infertility patient reported by a Washington d.c., psychologist hints at the fragile state of mind of Many unable to reproduce but doctors say there Are Well documented physical reasons for the condition. Infertility is defined As the inability of a couple to conceive after 12 months of trying without contraception. Among women the cause May be a hormonal disturbance impairing ovulation or endometriosis a disease in which cells of the uterine lining grow outside the uterus and disrupt the reproductive Cycle. Or it May be scarred or blocked fallopian tubes the Normal site of fertilization. Tubes Are most often damaged by Pelvic inflammatory disease studies have shown intrauterine devices can increase this risk. In women Fertility decreases markedly after age 35. Male infertility usually results from abnormal or insufficient numbers of sperm. Researchers cite such factors As environmental hazards drug abuse cancer and testicular blood vessel problems in 20 percent of cases of infertility sexually transmitted diseases often treatable Are blamed. In up to 20 percent More no clinically demonstrable cause is Ever found. 14 the stars and stripes Friday augusts 1988 the stars and stripes Page 15