Health News and Information

Science now offers the gift of pregnancy to “infertile” couples wanting to have a baby – almost without exception – whatever the barrier to conception might be. Their becoming expectant parents depend on how far they may want to go to solve their problems and achieve their goals.

Solutions include these:

•   Surgery to repair damaged anatomy

•   Drugs to heal interfering infections

•   Drugs to normalize hormone levels

•   Fertilization in a glass dish

•   Frozen embryos

•   Borrowed sperm

•   Borrowed eggs

•   A “borrowed” uterus

Not every couple wants to opt for the most exotic of infertility treatments. But most of those who desperately want a baby will consider any effort at any cost.   Susanne and David Johnson of Chesapeake, Virginia, both 37, spent 40,000 dollars over the course of 14 years before their son, Richard David, was born in 1988.

Mr. Johnson, a police sergeant, was tested – inconclusively – for a low sperm count. Doctors also tried to repair Mrs. Johnson’s fallopian tubes, damaged by an infected, ruptured appendix when she was 13. The operation failed, and the surgeons had to remove her tubes, leaving no way for an egg to get from her ovary to her uterus.

So the Johnsons went to the Howard and Georgeanna Jones Institute for Reproductive Medicine at Eastern Virginia Medical School in Norfolk, Virginia. It was the first clinic in the United States to succeed with in vitro fertilization (IVF). In vitro fertilization means that sperm and egg are joined in a glass dish. (Vitro in Latin means glass.)

The doctors gave Mrs. Johnson drugs that stimulated her ovaries to produce eggs. With simple surgery, they recovered those eggs and mixed them with her husband’s sperm in a glass dish. The sperm entered and fertilized the eggs and produced several embryos. These were implanted singly into Mrs. Johnson’s uterus. After six attempts in 18 months, an implant succeeded. Nine months later, Richard David was born without a hitch.

“We’re ecstatic about our baby,” says Mrs. Johnson. “He is a dream come true. He is a picture of his father. He has our personality and our disposition. That’s why we wanted our own child.”

More than 15,000 IVF babies have been born worldwide since British doctors brought Louise Brown into the world in 1978 as the first “test-tube baby.”

Dr. Larry Grunfeld, a fertility expert at Mount Sinai Medical Center in New York City, says he sympathizes with the Johnsons: “The most difficult job I have is telling a couple to stop trying.” He adds that many fertility problems went unidentified and unsolved 20 years ago. “Today,” he says, “we have something to offer nearly every infertile couple.”

Dr. Grunfeld says science now can figure out the cause in 85 percent of infertility cases and that, with further testing, causes for infertility could be found for the rest. Forty percent of the time the problem lies with the man; 40 percent, the woman. The remaining 20 percent are man-woman difficulties – her body rejects his sperm. Her womb may create antibodies to the incoming male sperm, or her mucous may block all the sperm. A man’s problems are harder to solve. He may have no sperm or poor-quality sperm. Or he may be-impotent – incapable of sexual intercourse.

One in three infertile women may have endometriosis, an overgrowth of the lining of the uterus. That growth invades the pelvis and damages the ovaries and fallopian tubes. One woman in six may have fallopian tubes damaged by infections. Or hormone difficulties may interfere with egg production.

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Illness and nutrition

Illness has many effects on the body’s ability to use nutrients and upon the specific requirements. Lack of appetite, vomiting, and pain often prevent the intake of a sufficient amount of food. In severe diarrhea the absorption of all nutrients is poor, so that loss of weight, dehydration, and signs of malnutrition may be found. A fever increases the rate of metabolism, thus increasing the need for calories, protein, and vitamins. In metabolic diseases nutrients are not utilized fully; for example, the untreated diabetic patient will not make adequate use of carbohydrate. The patient who must remain in bed or in a wheelchair for a long time usually loses increased amounts of nitrogen and calcium from his body. As the student becomes more experienced in the care of patients, she will undoubtedly find numerous examples of the effects of illness upon nutrition.

Medications and   diet

Some drugs interfere with food intake because they produce nausea and vomiting. Others reduce the absorption of nutrients because they interfere with enzyme activity, block the absorption of some vitamins, or lead to diarrhea. On the other hand, food can also interact with the medications so that absorption is reduced. Thus, the peak of effectiveness of the drug may never be reached. The nurse, dietitian, and pharmacist must take these factors into account to assure maximum effectiveness of the drug as well as optimum food intake and utilization.

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