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CNN Saturday Morning News

Weekend House Call: In Vitro Fertilization

Aired July 26, 2003 - 08:28   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


ELIZABETH COHEN, CNN MEDICAL CORRESPONDENT: Today on Weekend House Call, in vitro fertilization. Twenty-five years ago, the first so-called test tube baby was born. Back then, in vitro fertilization seemed like something out of the pages of science fiction. But the procedure has come a long way, baby.
Our medical correspondent Dr. Sanjay Gupta reports.

(BEGIN VIDEOTAPE)

DR. SANJAY GUPTA, CNN CORRESPONDENT (voice-over): On July 25, 1978, in Bristol, England, a baby conceived in a Petri dish was born.

ARTHUR CAPLAN, BIOETHICIST: It's hard to look back and remember how surprising and shocking it was that human beings could actually be made outside the body.

GUPTA: When Louise Brown was born, she was called a test tube baby resulting from a now common procedure called in vitro fertilization, or IVF. Louise's parents were unable to conceive, so an egg was retrieved from her mother and mixed in a Petri dish with sperm from her father. The resulting embryo was placed back into her mother's uterus to develop until Louise was born, the old-fashioned way.

DR. SANDRA ANN CARSON, REPRODUCTIVE MEDICINE: Almost overnight, the question changed how we were providing regular medical care.

GUPTA: And providing hope for the countless infertile couples around the world who had resolved to adopt or lead a childless life without the possibility of ever conceiving their own children. But that hope was small, initially offering only a three to six percent chance of pregnancy.

CARSON: The general medical community was unsure and a bit skeptical about exactly what this meant and whether it would be a viable procedure.

GUPTA: But it worked. And over the last 25 years, medical advances in technology have made IVF even easier. In the U.S. alone, where doctors began using the procedure in 1981, there have more than 114,000 IVF babies. And the technology continues to grow. Sperm donors, egg donors and surrogates have all become common.

CAPLAN: You can't buy a baby in the United States if you're infertile, but you can buy the sperm, you can buy the egg and you can rent the uterus.

GUPTA: Today, IVF is less invasive. Leslie Brown's abdomen was opened for her egg retrieval and women used hormone therapy before the egg removal, so they produced more than one egg, increasing their chances of becoming pregnant.

CARSON: The challenge, major challenge of IVF right now is maintaining that high pregnancy rate but decreasing the multiple pregnancy rate.

GUPTA: In fact, many IVF pregnancies result in twins, triplets and even more. Statistically, there's about a 90 percent chance of having a healthy child. But some studies have shown these babies have a higher risk of birth defects and low birth weight. But researchers aren't sure why.

Even so, many infertile couples hoping to have a family are still finding it well worth the risk.

Dr. Sanjay Gupta, CNN, reporting.

(END VIDEOTAPE)

COHEN: Since Louise Brown's birth, over one million babies have been born worldwide through IVF and there's no sign that baby boom will be slowing down because over 10 percent of the couples in the U.S. are infertile.

But it's an expensive process. One cycle of IVF costs about $12,400, and the success rate, while growing every year, still hovers around 30 percent.

We want to answer your questions. Call us at 1-800-807-2620 or send us an e-mail at housecall@cnn.com.

Now, to help us with some of these answers, we have with us Dr. Joe Massey. He's an infertility specialist and co-founder of Reproductive Biology Associates here in Atlanta.

Thanks for joining us.

I want to jump right in with an e-mail.

This one is from Mary in Silver Springs, Maryland, and she asks, "On average, how many IVF attempts does it take for a couple to conceive?"

DR. JOE MASSEY, IN VITRO INFERTILITY SPECIALIST: Well, it's hard to answer the question exactly, but if it -- if the success rate is about 30 or 40 percent, most people, over 50 percent of the people will have to try this around twice in order to succeed.

COHEN: Thank you.

And we also have a call now from Greg in New York.

Greg, go ahead with your question.

GREG: Hi. How are you?

It's been two years we've been trying every other day. And is there any advice you can give us?

MASSEY: Two years? It's time to go to the doctor. You need to begin infertility evaluation, diagnostic testing. Hopefully some kind of conventional treatment will be available for you and in vitro fertilization would be your last resort.

COHEN: Now, if it's the last resort, what are some things that people try before IVF?

MASSEY: Well, it depends on what's wrong. For example, women with endometriosis can be cured with surgery, laparoscopic surgery. Women who are not ovulating can be given drugs which can induce ovulation and success can come in that way. Husbands whose sperm counts are low can be treated with husband insemination, artificial insemination.

So there are a number of treatments. And most people who need infertility treatment really are successful with less than in vitro fertilization.

COHEN: OK. Well, we have another e-mail now. Bev from Georgia asks, "I would like to know more about how the eggs are harvested and how the embryo is deposited? It is painful?"

MASSEY: Well, egg retrieval would be painful, but it's done under anesthesia. A needle is placed into the ovary and this is done under anesthesia, as I said. The replacement of the embryos is done with a simple little catheter and that's not painful.

COHEN: OK, we have another e-mail now. Robin from California writes, "I'm 33 and I've been trying to conceive for four years. I recently found out that I have premature ovarian failure, putting me through menopause early. I'm currently undergoing my first IVF this month. Has progress been made for women with older eggs?"

Dr. Massey?

MASSEY: There's been very little progress in this group. Most people in that category will require egg donation, and that's a highly successful procedure using the eggs from a younger woman.

COHEN: And we have a similar question from Charlene (ph) in South Carolina. Charlene, go ahead with your question for Dr. Massey.

CHARLENE: Yes, I was calling about what is your FSH level? Like what do you guys look at? What's your cut off number?

MASSEY: Well, a woman's FSH level should be under 10. That's a kind of a technical question and people who are knowledgeable will understand this. But it has to do with how many eggs a woman has in her ovary and it has to do with the possible success for advanced reproductive techniques.

COHEN: Are there some women where you say we've looked at you and you're just not a candidate for IVF for various reasons?

MASSEY: Yes. And those are some women who are in this menopausal age group, or actually they're women who are in premature menopause or in the menopausal group, 40, 42 or older. And they can't have in vitro fertilization with their own eggs. But egg donation opens the door for them. And I think about 10 or 20 percent of our in vitro fertilization procedures in this country are now being done with eggs from young women, just like years ago we used to use sperm and sperm donation, now we're using egg donation.

COHEN: Now, there are many causes of infertility. Is stress, either for a man or a woman, one of the causes?

MASSEY: Really, that's very unlikely. It's being an infertility patient or a couple is stressful, but those couples didn't start off with stress. They started off relaxed and now they've become stressed. We don't really think it's the cause.

COHEN: So people don't have to worry that they're infertile because they're stressed? It's...

MASSEY: Very unlikely.

COHEN: They're stressed because they're infertile is more likely the answer?

MASSEY: That's exactly right. That's exactly right.

COHEN: OK, well, thank you.

We're going to have to take a break.

And when we come back, we'll talk about the risk of multiple births with in vitro fertilization. How often does it happen?

Call us with your questions. Our number is 1-800-807-2620. Or send us an e-mail at housecall@cnn.com.

And we'll be right back.

(COMMERCIAL BREAK)

COHEN: Did you know that there are about 400,000 frozen human embryos in the U.S.? That's according to a recent survey by the Society for Assisted Reproductive Technology. U.S. fertility clinic freezers hold the largest number of embryos in the world. Most are being held for use by the couples who wanted them, but a large proportion will never be needed.

We're talking about in vitro fertilization. It's come a long way in the past 25 years.

Call us with your questions at 1-800-807-2620 or send us an e- mail at housecall@cnn.com.

While we're lining up your phone calls, let's check today's health quiz.

When was the first test tube baby born in the United States?

We'll have that answer in 15 seconds.

Stay with us.

(COMMERCIAL BREAK)

COHEN: Checking our health quiz, we asked, "When was the first test tube baby born in the United States?" On December 28, 1981, Elizabeth Jordan Carr (ph) was born in Norfolk, Virginia. Elizabeth was actually conceived in a Petri dish, not a test tube. But she was always known as America's first test tube baby. She's been in the spotlight all her life. She's now 21 years old and is going to college in Boston. She wants to be, of all things, a journalist.

Good for you, Elizabeth.

We're back and we're talking about in vitro fertilization.

Infertility is a difficult problem for couples to contend with, but what does infertility actually mean? The definition, according to most fertility experts, is a couple's inability to conceive after a year of unprotected sex.

As we said earlier, IVF is expensive and is usually a last option for most couples.

We have an e-mail from Carey (ph) in Ohio, who writes, "I've been battling stage four endometriosis for 10 years now and I've been struggling for the last six years to bear a child. The only option left to me is IVF and yet I can't afford it, nor does my insurance cover it. I'm wondering why the cost of IVF is largely out of reach for the average person and what is being done to make the procedure more accessible to everyone?"

Infertility specialist Joe Massey is here to answer that question.

It does seem out of reach for many people at about, what, $12,000 a try?

MASSEY: Yes, a lot of people have to finance this. There are companies set up to finance in vitro fertilization and other infertility treatments. It's unfortunate that this is considered an elective procedure. It's certainly not elective for those couples who require it. We're trying to pressure insurance companies to offer infertility coverage to more of their patients and more and more people are seeing this as a wise option.

COHEN: That's great.

MASSEY: Companies have to deal with this with their insurance companies.

COHEN: We have a question now on the phone from Kimberly.

Kimberly, you can go ahead with your question for Dr. Massey.

KIMBERLY: Yes, my husband and I would like to have a child. However, he had a vasectomy before we got married. Is it possible to use IVF in that case?

MASSEY: Yes. The way this would be done would be a needle would be used to aspirate sperm from his testicle and only one sperm would be required per egg. So after an egg retrieval, a procedure called ICSI (ph) is done to inject the sperm into the egg and the success rate should be very good and it would depend more on your age than anything else.

COHEN: We have another phone call from Camila (ph) in Illinois.

Camila, go ahead, please.

CAMILA: Hi. My husband and I currently are pregnant with twins through IVF. However, we did our research and we looked on the Web for somebody who had a high success rate. We did find somebody. And upon asking the person, you know, why his success rate was much higher than others, he stated that it was because of placement of the embryos.

Is this true?

MASSEY: You mean the method of placing the embryos?

CAMILA: Yes. He said that it's a very delicate procedure and that anybody can get embryos through Petri dishes, however, the actual placement is where the success rate lies.

MASSEY: Well, let's put it this way, that's, it's important to do it right, but generally speaking, that's not a variable that is particularly important.

COHEN: But there are various places to put the embryo?

MASSEY: Yes. It's a technical kind of a small technical refinement. But it's not the most important thing in the procedure. We think the most important thing is the people in the lab, the people in the lab who make great embryos, who allow us to work with great embryos.

COHEN: OK, thank you.

All right, we have an e-mail now from Steve in Georgia, who asks, "Are researchers working on ways to eliminate the risk of twins or triplets while still maintaining high odds of success?"

Because as we heard from our story earlier...

MASSEY: Yes. COHEN: You're trying to cut down on the number of multiples.

MASSEY: Yes. When possible, we only put two embryos back. Older women have or require three or four embryos and in those cases the likelihood of multiple pregnancies can be as high as five percent for triplets, one percent for quadruplets. And it's one of our biggest problems. We're always trying to be conservative, but we're sort of walking on a tightrope. If you don't put enough embryos in, you don't succeed. If you put back too few -- if you put back too many, you're going to get multiples.

COHEN: And is there research to try to prevent the multiples while still ensuring success?

MASSEY: Yes, we're trying to identify the embryos that are the healthiest. So that way you can cut down on the multiple embryo replacement.

COHEN: OK, we have a phone call now from Rhonda in Indiana.

Rhonda, go ahead.

RHONDA: Hi. I had a tubal ligation when I was 21 and I'm 36 now and my physician told me I'm too old to even think about in vitro.

MASSEY: Well, you're not. You can go to an infertility specialist and find out another, find another answer to that question.

COHEN: That's right, there's always...

MASSEY: Goodness sakes, because the average age of our patients is about 36.

COHEN: Wow.

MASSEY: So...

COHEN: I think that's probably an important message to get across is that it's always probably worth asking more than one person your question.

MASSEY: Yes.

COHEN: Because you might get different answers with different specialists, different people.

MASSEY: Definitely. You need a specialist.

COHEN: OK. All right, great.

Well, we're going to take a quick break now.

When we come back, finding the right doctor, speaking of doctors, and clinic for in vitro is important. We'll have some tips for you when Weekend House Call continues.

(COMMERCIAL BREAK)

COHEN: This is Weekend House Call and we're talking about infertility and in vitro fertilization.

We've had so many e-mails on this topic. Here's one. Rahmi (ph) from Chicago asks, "How high is the risk of encountering birth defects through this procedure?"

Is a couple more likely to have a child with birth defects if the child was conceived through IVF?

MASSEY: This is a controversial topic. There are studies which say there's no increased risk. There is some new information which indicates that there could be higher birth defect rates and it's very hard to sort out whether it's due to the procedure or the population of patients who enter.

COHEN: We have a phone call now from Lucretia (ph) in Texas.

Lucretia, go right ahead.

LUCRETIA: Yes, I wanted to ask a question. Is it safer to do the tubal reversal versus in vitro?

MASSEY: Is it safer? I would say it's easier on the patient to do in vitro fertilization than to go through a major operation for tubal reversal. So the trend is towards in vitro and away from tubal reversal.

COHEN: In other words, if a woman's had a tubal ligation, she's got a choice between reversing that tying of the tubes and having IVF? Those are her two choices?

MASSEY: Right.

COHEN: OK.

MASSEY: In vitro seems to be winning.

COHEN: OK.

We have an e-mail now from Jennifer in New York. She asks, "Are there publicly available statistics that can help in choosing the clinic with the highest success rate and lowest multiple birth rate?"

In other words, you set off to go through this process. Are there statistics available that help you figure out those two things?

MASSEY: There are. The American Society for Reproductive Medicine, it's asrm.org, can give you statistics. It's kick -- you do, I think people do need to shop the statistics, but it's also they need to know that they can't compare directly clinic to clinic. exact comparisons are not really possible because the patient populations may be different.

But the trends are important. Some success rates are much higher than some others.

COHEN: OK, we have a phone call now from Kelly (ph) in Georgia.

Kelly, go ahead with your question for Dr. Massey.

KELLY: Hi. I actually underwent fertility treatments for seven years and did in vitro five times. And now, at 36, I was diagnosed as being perimenopausal, and I wondered if the two are related.

MASSEY: Well, yes. If you tried six times and now they finally realize you're menopausal, the problem has been that you're sort of, your egg health has been the problem and people like you, we typically advise to have an egg donor, be an egg recipient. And then all of a sudden your chance for success would become the best possible, 50 percent or so.

COHEN: So you think even though she's tried it so many times, it would be worth it again?

MASSEY: Yes.

COHEN: But use someone else's eggs?

MASSEY: With an egg donor, all of a sudden her chances would improve dramatically.

COHEN: Wow. OK.

All right, we have an e-mail now. Julie from New York has written us. She wants to know, "Have there been any conclusive studies linking IVF and the associated hormone injection therapy with any increased health problems like cancer and stroke?"

Now, I assume she's meaning for the mother here.

MASSEY: Yes, and that's been looked at very carefully and no, there are no, there seem to be no long-term side effects. And cancer has been looked at extensively because there was a scare about this. But it's been excluded by careful study.

COHEN: And there have now been 20 years of data to go on.

MASSEY: Yes.

COHEN: We have a phone call now from Amy in Illinois.

Amy, go right ahead.

AMY: Yes, I'm currently with a fertility center now and I've been diagnosed with polycystic ovaries. And I'm now 31 years old. And I've been on clomofine (ph) and ganol (ph) and that was not successful. Now, my doctor has started me on a birth control called yasmin (ph) and hopefully, she says, it will trigger my body to where I could ovulate.

So now my question is a person with polycystic ovaries, are they capable of conceiving?

MASSEY: Yes. Your prognosis should be good, but it's, as you've indicated, it's sometimes a long haul. But if you just keep persisting, you should be successful. This is a treatment, this is one -- you should never get, hopefully never get to in vitro fertilization.

COHEN: Try other things before?

MASSEY: Get the right drugs and hopefully make it work.

COHEN: OK, all right, well, when we come back, we're going to have final thoughts on this 25th anniversary of the birth of the first so-called test tube baby.

Stay with us.

(COMMERCIAL BREAK)

COHEN: If you'd like to read more about in vitro fertilization or infertility, check out our Web site at cnn.com/health. You'll find links to other information sites about reproduction, also.

We've been talking with Dr. Joe Massey, who's an infertility specialist here in Atlanta.

Dr. Massey, what would you say to a couple who realizes that they're infertile and they're just starting out on this process of trying to have a baby?

MASSEY: If they're looking at in vitro fertilization, they need to expect some challenges. It's rather grueling, particularly for the woman to go through. She's in the office every day for a week and she's going to have a lot of shots and a lot of procedures. But it's opening a door that wasn't open 25 years ago and it's really helped, promises to help her if she's persistent.

COHEN: OK, well, thank you, Dr. Massey.

Thanks for joining us.

I know it's been an exciting 25 years.

MASSEY: It certainly was.

COHEN: A lot has happened. A lot has happened. A lot has improved.

Well, thank you so much, all of you, for joining us.

That's all the time we have for today.

I hope you can join me tomorrow when we'll be talking about the new science of dyslexia. Researchers have a much better understanding of how dyslexia affects the brain and they think they might know how to solve the problem. We'll have that exciting news tomorrow on Weekend House Call.

Thanks for watching.

I'm Elizabeth Cohen.

TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com







Aired July 26, 2003 - 08:28   ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
ELIZABETH COHEN, CNN MEDICAL CORRESPONDENT: Today on Weekend House Call, in vitro fertilization. Twenty-five years ago, the first so-called test tube baby was born. Back then, in vitro fertilization seemed like something out of the pages of science fiction. But the procedure has come a long way, baby.
Our medical correspondent Dr. Sanjay Gupta reports.

(BEGIN VIDEOTAPE)

DR. SANJAY GUPTA, CNN CORRESPONDENT (voice-over): On July 25, 1978, in Bristol, England, a baby conceived in a Petri dish was born.

ARTHUR CAPLAN, BIOETHICIST: It's hard to look back and remember how surprising and shocking it was that human beings could actually be made outside the body.

GUPTA: When Louise Brown was born, she was called a test tube baby resulting from a now common procedure called in vitro fertilization, or IVF. Louise's parents were unable to conceive, so an egg was retrieved from her mother and mixed in a Petri dish with sperm from her father. The resulting embryo was placed back into her mother's uterus to develop until Louise was born, the old-fashioned way.

DR. SANDRA ANN CARSON, REPRODUCTIVE MEDICINE: Almost overnight, the question changed how we were providing regular medical care.

GUPTA: And providing hope for the countless infertile couples around the world who had resolved to adopt or lead a childless life without the possibility of ever conceiving their own children. But that hope was small, initially offering only a three to six percent chance of pregnancy.

CARSON: The general medical community was unsure and a bit skeptical about exactly what this meant and whether it would be a viable procedure.

GUPTA: But it worked. And over the last 25 years, medical advances in technology have made IVF even easier. In the U.S. alone, where doctors began using the procedure in 1981, there have more than 114,000 IVF babies. And the technology continues to grow. Sperm donors, egg donors and surrogates have all become common.

CAPLAN: You can't buy a baby in the United States if you're infertile, but you can buy the sperm, you can buy the egg and you can rent the uterus.

GUPTA: Today, IVF is less invasive. Leslie Brown's abdomen was opened for her egg retrieval and women used hormone therapy before the egg removal, so they produced more than one egg, increasing their chances of becoming pregnant.

CARSON: The challenge, major challenge of IVF right now is maintaining that high pregnancy rate but decreasing the multiple pregnancy rate.

GUPTA: In fact, many IVF pregnancies result in twins, triplets and even more. Statistically, there's about a 90 percent chance of having a healthy child. But some studies have shown these babies have a higher risk of birth defects and low birth weight. But researchers aren't sure why.

Even so, many infertile couples hoping to have a family are still finding it well worth the risk.

Dr. Sanjay Gupta, CNN, reporting.

(END VIDEOTAPE)

COHEN: Since Louise Brown's birth, over one million babies have been born worldwide through IVF and there's no sign that baby boom will be slowing down because over 10 percent of the couples in the U.S. are infertile.

But it's an expensive process. One cycle of IVF costs about $12,400, and the success rate, while growing every year, still hovers around 30 percent.

We want to answer your questions. Call us at 1-800-807-2620 or send us an e-mail at housecall@cnn.com.

Now, to help us with some of these answers, we have with us Dr. Joe Massey. He's an infertility specialist and co-founder of Reproductive Biology Associates here in Atlanta.

Thanks for joining us.

I want to jump right in with an e-mail.

This one is from Mary in Silver Springs, Maryland, and she asks, "On average, how many IVF attempts does it take for a couple to conceive?"

DR. JOE MASSEY, IN VITRO INFERTILITY SPECIALIST: Well, it's hard to answer the question exactly, but if it -- if the success rate is about 30 or 40 percent, most people, over 50 percent of the people will have to try this around twice in order to succeed.

COHEN: Thank you.

And we also have a call now from Greg in New York.

Greg, go ahead with your question.

GREG: Hi. How are you?

It's been two years we've been trying every other day. And is there any advice you can give us?

MASSEY: Two years? It's time to go to the doctor. You need to begin infertility evaluation, diagnostic testing. Hopefully some kind of conventional treatment will be available for you and in vitro fertilization would be your last resort.

COHEN: Now, if it's the last resort, what are some things that people try before IVF?

MASSEY: Well, it depends on what's wrong. For example, women with endometriosis can be cured with surgery, laparoscopic surgery. Women who are not ovulating can be given drugs which can induce ovulation and success can come in that way. Husbands whose sperm counts are low can be treated with husband insemination, artificial insemination.

So there are a number of treatments. And most people who need infertility treatment really are successful with less than in vitro fertilization.

COHEN: OK. Well, we have another e-mail now. Bev from Georgia asks, "I would like to know more about how the eggs are harvested and how the embryo is deposited? It is painful?"

MASSEY: Well, egg retrieval would be painful, but it's done under anesthesia. A needle is placed into the ovary and this is done under anesthesia, as I said. The replacement of the embryos is done with a simple little catheter and that's not painful.

COHEN: OK, we have another e-mail now. Robin from California writes, "I'm 33 and I've been trying to conceive for four years. I recently found out that I have premature ovarian failure, putting me through menopause early. I'm currently undergoing my first IVF this month. Has progress been made for women with older eggs?"

Dr. Massey?

MASSEY: There's been very little progress in this group. Most people in that category will require egg donation, and that's a highly successful procedure using the eggs from a younger woman.

COHEN: And we have a similar question from Charlene (ph) in South Carolina. Charlene, go ahead with your question for Dr. Massey.

CHARLENE: Yes, I was calling about what is your FSH level? Like what do you guys look at? What's your cut off number?

MASSEY: Well, a woman's FSH level should be under 10. That's a kind of a technical question and people who are knowledgeable will understand this. But it has to do with how many eggs a woman has in her ovary and it has to do with the possible success for advanced reproductive techniques.

COHEN: Are there some women where you say we've looked at you and you're just not a candidate for IVF for various reasons?

MASSEY: Yes. And those are some women who are in this menopausal age group, or actually they're women who are in premature menopause or in the menopausal group, 40, 42 or older. And they can't have in vitro fertilization with their own eggs. But egg donation opens the door for them. And I think about 10 or 20 percent of our in vitro fertilization procedures in this country are now being done with eggs from young women, just like years ago we used to use sperm and sperm donation, now we're using egg donation.

COHEN: Now, there are many causes of infertility. Is stress, either for a man or a woman, one of the causes?

MASSEY: Really, that's very unlikely. It's being an infertility patient or a couple is stressful, but those couples didn't start off with stress. They started off relaxed and now they've become stressed. We don't really think it's the cause.

COHEN: So people don't have to worry that they're infertile because they're stressed? It's...

MASSEY: Very unlikely.

COHEN: They're stressed because they're infertile is more likely the answer?

MASSEY: That's exactly right. That's exactly right.

COHEN: OK, well, thank you.

We're going to have to take a break.

And when we come back, we'll talk about the risk of multiple births with in vitro fertilization. How often does it happen?

Call us with your questions. Our number is 1-800-807-2620. Or send us an e-mail at housecall@cnn.com.

And we'll be right back.

(COMMERCIAL BREAK)

COHEN: Did you know that there are about 400,000 frozen human embryos in the U.S.? That's according to a recent survey by the Society for Assisted Reproductive Technology. U.S. fertility clinic freezers hold the largest number of embryos in the world. Most are being held for use by the couples who wanted them, but a large proportion will never be needed.

We're talking about in vitro fertilization. It's come a long way in the past 25 years.

Call us with your questions at 1-800-807-2620 or send us an e- mail at housecall@cnn.com.

While we're lining up your phone calls, let's check today's health quiz.

When was the first test tube baby born in the United States?

We'll have that answer in 15 seconds.

Stay with us.

(COMMERCIAL BREAK)

COHEN: Checking our health quiz, we asked, "When was the first test tube baby born in the United States?" On December 28, 1981, Elizabeth Jordan Carr (ph) was born in Norfolk, Virginia. Elizabeth was actually conceived in a Petri dish, not a test tube. But she was always known as America's first test tube baby. She's been in the spotlight all her life. She's now 21 years old and is going to college in Boston. She wants to be, of all things, a journalist.

Good for you, Elizabeth.

We're back and we're talking about in vitro fertilization.

Infertility is a difficult problem for couples to contend with, but what does infertility actually mean? The definition, according to most fertility experts, is a couple's inability to conceive after a year of unprotected sex.

As we said earlier, IVF is expensive and is usually a last option for most couples.

We have an e-mail from Carey (ph) in Ohio, who writes, "I've been battling stage four endometriosis for 10 years now and I've been struggling for the last six years to bear a child. The only option left to me is IVF and yet I can't afford it, nor does my insurance cover it. I'm wondering why the cost of IVF is largely out of reach for the average person and what is being done to make the procedure more accessible to everyone?"

Infertility specialist Joe Massey is here to answer that question.

It does seem out of reach for many people at about, what, $12,000 a try?

MASSEY: Yes, a lot of people have to finance this. There are companies set up to finance in vitro fertilization and other infertility treatments. It's unfortunate that this is considered an elective procedure. It's certainly not elective for those couples who require it. We're trying to pressure insurance companies to offer infertility coverage to more of their patients and more and more people are seeing this as a wise option.

COHEN: That's great.

MASSEY: Companies have to deal with this with their insurance companies.

COHEN: We have a question now on the phone from Kimberly.

Kimberly, you can go ahead with your question for Dr. Massey.

KIMBERLY: Yes, my husband and I would like to have a child. However, he had a vasectomy before we got married. Is it possible to use IVF in that case?

MASSEY: Yes. The way this would be done would be a needle would be used to aspirate sperm from his testicle and only one sperm would be required per egg. So after an egg retrieval, a procedure called ICSI (ph) is done to inject the sperm into the egg and the success rate should be very good and it would depend more on your age than anything else.

COHEN: We have another phone call from Camila (ph) in Illinois.

Camila, go ahead, please.

CAMILA: Hi. My husband and I currently are pregnant with twins through IVF. However, we did our research and we looked on the Web for somebody who had a high success rate. We did find somebody. And upon asking the person, you know, why his success rate was much higher than others, he stated that it was because of placement of the embryos.

Is this true?

MASSEY: You mean the method of placing the embryos?

CAMILA: Yes. He said that it's a very delicate procedure and that anybody can get embryos through Petri dishes, however, the actual placement is where the success rate lies.

MASSEY: Well, let's put it this way, that's, it's important to do it right, but generally speaking, that's not a variable that is particularly important.

COHEN: But there are various places to put the embryo?

MASSEY: Yes. It's a technical kind of a small technical refinement. But it's not the most important thing in the procedure. We think the most important thing is the people in the lab, the people in the lab who make great embryos, who allow us to work with great embryos.

COHEN: OK, thank you.

All right, we have an e-mail now from Steve in Georgia, who asks, "Are researchers working on ways to eliminate the risk of twins or triplets while still maintaining high odds of success?"

Because as we heard from our story earlier...

MASSEY: Yes. COHEN: You're trying to cut down on the number of multiples.

MASSEY: Yes. When possible, we only put two embryos back. Older women have or require three or four embryos and in those cases the likelihood of multiple pregnancies can be as high as five percent for triplets, one percent for quadruplets. And it's one of our biggest problems. We're always trying to be conservative, but we're sort of walking on a tightrope. If you don't put enough embryos in, you don't succeed. If you put back too few -- if you put back too many, you're going to get multiples.

COHEN: And is there research to try to prevent the multiples while still ensuring success?

MASSEY: Yes, we're trying to identify the embryos that are the healthiest. So that way you can cut down on the multiple embryo replacement.

COHEN: OK, we have a phone call now from Rhonda in Indiana.

Rhonda, go ahead.

RHONDA: Hi. I had a tubal ligation when I was 21 and I'm 36 now and my physician told me I'm too old to even think about in vitro.

MASSEY: Well, you're not. You can go to an infertility specialist and find out another, find another answer to that question.

COHEN: That's right, there's always...

MASSEY: Goodness sakes, because the average age of our patients is about 36.

COHEN: Wow.

MASSEY: So...

COHEN: I think that's probably an important message to get across is that it's always probably worth asking more than one person your question.

MASSEY: Yes.

COHEN: Because you might get different answers with different specialists, different people.

MASSEY: Definitely. You need a specialist.

COHEN: OK. All right, great.

Well, we're going to take a quick break now.

When we come back, finding the right doctor, speaking of doctors, and clinic for in vitro is important. We'll have some tips for you when Weekend House Call continues.

(COMMERCIAL BREAK)

COHEN: This is Weekend House Call and we're talking about infertility and in vitro fertilization.

We've had so many e-mails on this topic. Here's one. Rahmi (ph) from Chicago asks, "How high is the risk of encountering birth defects through this procedure?"

Is a couple more likely to have a child with birth defects if the child was conceived through IVF?

MASSEY: This is a controversial topic. There are studies which say there's no increased risk. There is some new information which indicates that there could be higher birth defect rates and it's very hard to sort out whether it's due to the procedure or the population of patients who enter.

COHEN: We have a phone call now from Lucretia (ph) in Texas.

Lucretia, go right ahead.

LUCRETIA: Yes, I wanted to ask a question. Is it safer to do the tubal reversal versus in vitro?

MASSEY: Is it safer? I would say it's easier on the patient to do in vitro fertilization than to go through a major operation for tubal reversal. So the trend is towards in vitro and away from tubal reversal.

COHEN: In other words, if a woman's had a tubal ligation, she's got a choice between reversing that tying of the tubes and having IVF? Those are her two choices?

MASSEY: Right.

COHEN: OK.

MASSEY: In vitro seems to be winning.

COHEN: OK.

We have an e-mail now from Jennifer in New York. She asks, "Are there publicly available statistics that can help in choosing the clinic with the highest success rate and lowest multiple birth rate?"

In other words, you set off to go through this process. Are there statistics available that help you figure out those two things?

MASSEY: There are. The American Society for Reproductive Medicine, it's asrm.org, can give you statistics. It's kick -- you do, I think people do need to shop the statistics, but it's also they need to know that they can't compare directly clinic to clinic. exact comparisons are not really possible because the patient populations may be different.

But the trends are important. Some success rates are much higher than some others.

COHEN: OK, we have a phone call now from Kelly (ph) in Georgia.

Kelly, go ahead with your question for Dr. Massey.

KELLY: Hi. I actually underwent fertility treatments for seven years and did in vitro five times. And now, at 36, I was diagnosed as being perimenopausal, and I wondered if the two are related.

MASSEY: Well, yes. If you tried six times and now they finally realize you're menopausal, the problem has been that you're sort of, your egg health has been the problem and people like you, we typically advise to have an egg donor, be an egg recipient. And then all of a sudden your chance for success would become the best possible, 50 percent or so.

COHEN: So you think even though she's tried it so many times, it would be worth it again?

MASSEY: Yes.

COHEN: But use someone else's eggs?

MASSEY: With an egg donor, all of a sudden her chances would improve dramatically.

COHEN: Wow. OK.

All right, we have an e-mail now. Julie from New York has written us. She wants to know, "Have there been any conclusive studies linking IVF and the associated hormone injection therapy with any increased health problems like cancer and stroke?"

Now, I assume she's meaning for the mother here.

MASSEY: Yes, and that's been looked at very carefully and no, there are no, there seem to be no long-term side effects. And cancer has been looked at extensively because there was a scare about this. But it's been excluded by careful study.

COHEN: And there have now been 20 years of data to go on.

MASSEY: Yes.

COHEN: We have a phone call now from Amy in Illinois.

Amy, go right ahead.

AMY: Yes, I'm currently with a fertility center now and I've been diagnosed with polycystic ovaries. And I'm now 31 years old. And I've been on clomofine (ph) and ganol (ph) and that was not successful. Now, my doctor has started me on a birth control called yasmin (ph) and hopefully, she says, it will trigger my body to where I could ovulate.

So now my question is a person with polycystic ovaries, are they capable of conceiving?

MASSEY: Yes. Your prognosis should be good, but it's, as you've indicated, it's sometimes a long haul. But if you just keep persisting, you should be successful. This is a treatment, this is one -- you should never get, hopefully never get to in vitro fertilization.

COHEN: Try other things before?

MASSEY: Get the right drugs and hopefully make it work.

COHEN: OK, all right, well, when we come back, we're going to have final thoughts on this 25th anniversary of the birth of the first so-called test tube baby.

Stay with us.

(COMMERCIAL BREAK)

COHEN: If you'd like to read more about in vitro fertilization or infertility, check out our Web site at cnn.com/health. You'll find links to other information sites about reproduction, also.

We've been talking with Dr. Joe Massey, who's an infertility specialist here in Atlanta.

Dr. Massey, what would you say to a couple who realizes that they're infertile and they're just starting out on this process of trying to have a baby?

MASSEY: If they're looking at in vitro fertilization, they need to expect some challenges. It's rather grueling, particularly for the woman to go through. She's in the office every day for a week and she's going to have a lot of shots and a lot of procedures. But it's opening a door that wasn't open 25 years ago and it's really helped, promises to help her if she's persistent.

COHEN: OK, well, thank you, Dr. Massey.

Thanks for joining us.

I know it's been an exciting 25 years.

MASSEY: It certainly was.

COHEN: A lot has happened. A lot has happened. A lot has improved.

Well, thank you so much, all of you, for joining us.

That's all the time we have for today.

I hope you can join me tomorrow when we'll be talking about the new science of dyslexia. Researchers have a much better understanding of how dyslexia affects the brain and they think they might know how to solve the problem. We'll have that exciting news tomorrow on Weekend House Call.

Thanks for watching.

I'm Elizabeth Cohen.

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