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CNN Sunday Morning

Weekend House Call

Aired March 14, 2004 - 08:30   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.


HOLLY FIRFER, CNN MEDICAL CORRESPONDENT: Good morning, welcome to WEEKEND HOUSE CALL. One in six couples struggle with fertility at some point in their lives and about 3 percent of those couples end up choosing in vitro fertilization, the ultimate in approved fertility treatment. But for some, that technology does not work and the emotional toll of infertility makes them take, what some consider very extreme measures. Here's the story of one couple, Sharon and Paul Saarinen.
(BEGIN VIDEOTAPE)

PAUL SAARINEN, FATHER: We went through some tough times back then. I mean it was really -- really tearing our marriage apart.

SHARON SAARINEN, MOTHER: I was going to do whatever it took. It didn't matter, as long as I had -- I had to have a baby. I just didn't feel complete.

FIRFER (voice-over): Sharon was told she was pre-menopausal and her eggs were not vital enough to create a healthy embryo. Her doctor said there was nothing more she could do.

S. SAARINEN: There had to be another option. I wouldn't accept no.

FIRFER: That option was with Dr. Michael Fikah a fertility expert who was willing to try an experimental treatment called cytoplasmic transfer using Sharon's own eggs. Taking the cytoplasm from a healthy donor egg he implanted it into Sharon's weaker egg to help it survive.

Once it was fertilized it was impaled in her uterus and she was pregnant.

S. SAARINEN: I was at home alone, I got the call and I just broke down and started crying on the bed. It was the best feeling. I waited ten years to hear her say that.

FIRFER: The donor cytoplasm contains mitochondrial DNA which gives the egg that energy to survive, but it's not trait related DNA.

DR. MICHAEL FIKAH, REPROD. ENDOCRINOLOGIST: Ninety-nine percent of the genetic material from the embryo, basically, is from the patient herself and then maybe one percent is from the third person.

FIRFER: Yet, some doctors say the potential for birth defects still remains. If you have three people's DNA in one embryo, the concern is possible chromosomal abnormalities in the child.

(on camera): When the Saarinens decided they wanted to try to have another child, they returned to Dr, Fikah's fertility center here in suburban Detroit only to be told in July of 2001 the FDA had sent letters to doctors informing them that the cytoplasmic transfer and other so-called experimental procedures had been banned.

(voice-over): The FDA said in order to proceed rigorous testing would need to be done to get the agency's approval.

FIKAH: Most of these women are in their late 30s and they don't really have time, their time is very precious.

So Dr. Fikah agreed to do the procedure in his clinic in Lebanon where it's legal. The Saarinen's decided the risk was worth it. They spent another $10,000 and traveled halfway across the world to try that procedure again, but this time it didn't work.

SAARINEN: I finally, in the last few months, just reconciled with the fact that in my heart I have one child, I have to be happy with that.

(END VIDEOTAPE)

FIRFER: A couple is considered infertile if they've failed to conceive after a year of unprotected sex. If they are 35 or over, make that six months. Now, 25 years ago, when the first test tube baby was born, in vitro fertilization was cutting edge and controversial. In fact, it would be another three years before an IVF baby was born in the U.S. and now some people are getting frustrated by what they see as lack of new procedures here, and are seeking fertility treatments elsewhere.

Dr. Carlene Elsner joins us now, to help answer your questions. She's a reproductive endocrinologist who practices here in Atlanta at Reproductive Biology Associates, and she's worked in the field of infertility for more than 20 years.

Welcome, we're glad to have you here, Doctor.

DR.CARLENE ELSNER, INFERTILITY SPECIALIST: Thank you so much, Holly.

FIRFER: We have a lot of questions lined up, a lot of e-mails. So, let's start right away with Jennifer in New Hampshire. She asks:

"Is a fertility treatment considered extreme, if it is the only way a couple can get pregnant? For example, cytoplasmic transfer, because the mother's eggs failed to divide correctly?"

So would you consider something like cytoplasmic transfer extreme or cutting edge, on the edge of the future? What would you say?

ELSNER: Well, you know, Holly, 25 years ago IVF was considered extreme. So, it's hard to talk about extreme, these days. I think what we have to be concerned about is safety, and I think there's still some questions about the safety of this procedure. But certainly it's worked wonderfully for this couple and I think we're going to see a lot of improvements it in the future. So is it off the wall? No, I don't think so.

FIRFER: Right. OK. And, if people are asked how far is too far for couples to go to get pregnant, obviously the couple we saw traveled to Lebanon to try it again, how far is too far?

ELSNER: Gee, that's a personal decision. And I think each couple has to define that for themselves. But, there's more and more technology coming about every day and there are more and more opportunities and there are more and more things we can do. And I think each couple has to decide for themselves how far they want to go.

FIRFER: What they are willing to do. How much they're willing to spend because it can be expensive?

ELSNER: Well, it is very expense. You are correct.

FIRFER: OK, another procedure some would consider extreme, which has raised some ethical questions is sex selection.

Varda from Tel Aviv, Israel wants to know:

"For a couple age 50 and needing medical help to get pregnant, can they choose the sex of their next and perhaps their last child? What is a good recourse for names of hospitals and clinics with -- which specialize in these treatments?"

A lot of question there is. But, we're talking about pretty much designer babies, so to speak.

ELSNER: Well, what we're talking about for a 50-year-old lady, her chances of becoming pregnant on her own are very, very slim, you know. The technology that's going to work best for her is to use donated eggs from a younger woman. Now, that involves IVF technology.

FIRFER: Right.

ELSNER: And, of course, PGD or pre-implantation genetic diagnosis is possible, but most centers, worldwide, do that for medical reasons and not just for family balancing, although there are a few centers that do.

FIRFER: So, to be able to pick the sex of your child girl or boy most people will not do that?

ELSNER: Most IVF centers worldwide will not do that. Now, if there's a medical reason for it. If there's an inherited medical disorder that maybe prefers one sex versus another, it's a very simple technology to do, it certainly can be done.

FIRFER: OK. We have another question. Dee from Indiana and she asks: "What are the odds of a woman over the age of 43 becoming pregnant without any medical intervention?" Now, we no, Doctor, at age 35 the numbers dramatically decrease about your chances of getting pregnant. So, what about 43 and in that range?

ELSNER: Well, your chances of getting pregnant at 43 about five percent, without help. By 35, you will have lost about half your fertility. Women are most fertile in teens and early 20s, but we still see a lot of people that are interested in getting pregnant at 43 and we still work with them. We, certainly do.

FIRFER: Is there a way that women would be able to find out how fertile they are and maybe what their individual reproductive life might be?

ELSNER: Well, you know, I think the best thing to do for someone who is questioning that is to have some blood work done very early in their menstrual period, because there are certain hormone can be tested, particularly FSH and estradiol and this can give you an index of how many eggs, if you will, are left on those ovaries to respond. Then, of course, fertility drugs can help make those eggs ovulate and enhance the chance of a pregnancy.

FIRFER: Very interesting. OK. A lot more questions and e-mails coming up. Plus:

(BEGIN VIDEOTAPE)

FIRFER (voice-over): In vitro fertilization still considered extreme baby making by some. Who's a candidate and how successful is it? And, what about birth defects? Is your child at higher risk when you choose IVF. We're going to give you all the facts.

First try and answer our quiz. This week we're asking: What does the term "in vitro" mean? Think fast, we'll be back after the break with that answer.

(END VIDEOTAPE)

(COMMERCIAL BREAK)

(BEGIN VIDEOTAPE)

FIRFER (voice-over): Checking the "Daily Dose Quiz" we asked: What does the term "in vitro" mean?

The answer is in vitro is Latin for "in glass." During one part of in vitro fertilization the egg is fertilized in a Petri dish.

(END VIDEOTAPE)

FIRFER: Welcome back to WEEKEND HOUSE CALL. IVF and similar procedures account for less than five percent of infertility treatments in the U.S. Now, during in vitro fertilization eggs are taken from a woman's ovaries and mixed in a Petri dish with washed sperm. Those eggs eventually are examined and see if they've been fertilized and are dividing into cells. Those embryos are then implanted into the woman's uterus. Now, the average cost of an IVF procedure, in the United States, is $12,400 with a success rate of just over 29 percent. And if you're wondering about insurance, 14 states have laws that require insurers to cover some form of fertility diagnosis and treatment but beware, though, these laws vary greatly in what they require. Now, we're talking with infertility specialist Dr. Carlene Elsner.

Doctor, we've got a lot of questions lined up still, so let's get to the first on here. Rashmi in Chicago wants to know:

"How high is the risk of encountering birth defects through IVF?"

I know that a lot of people are concerned. There have been hundreds of studies involving children born through IVF. One Australian study I believe followed a two crease in fold in birth defects in IVF children. So, what would you tell your patients who are concerned about that?

ELSNER: Well, it may be a slightly increased risk of birth defects with IBV, but it's not dramatically increased. You have to understand that the chance of a birth defect in the normal population is maybe five percent. So we are looking at maybe an increase of maybe as high as 10 percent, but the flip side of that is 90 percent of the couple -- of the children are normal. And the other thing that you have to think about is that a lot of the people that are coming to us from in vitro fertilization have underlying problems with the eggs or with the sperm, and if there's a problem already with the DNA then of course that DNA is going to be past on to any future child. So, I think that puts us at more risk than the technical its.

FIRFER: And with IVF could you defect maybe a problem with an embryo that would not make it to term so, therefore you might be able to catch a problem ahead of time?

ELSNER: Of course. You can do pre-implantation genetic diagnosis, which is embryo biopsy.

You take a cell out of the embryo when it's three-day old and has maybe eight cells and put the embryo back in the incubator and the embryo does fine, but then you test that single cell and you can pick up all sorts of things like Down's Syndrome. You can pick up a lot of chromosomal abnormality in this way, and then you just don't replace those embryos, you replace the normal one.

FIRFER: OK. Let's get to another question. Lori from North Carolina writes: "With the advent of fertility treatment comes the risk of multiple pregnancies. Are parents counseled on these risks and is there any way to avoid it?"

And, I believe that more than half of infants born using assisted reproductive technology, like IVF, were multiple births. So, obviously this is a concern for people to beware you may end up with two, three, even four children.

ELSNER: This is one of the biggest problems we have, you know. And I think the answer to that is as we can put fewer embryos back, replace fewer embryos with IVF, you have perfect control over this. You know, you can replace only two embryos or only one, if you want to. The problem is the fewer embryos you replace, the lower the pregnancy rates are. So, of course, this -- because the technology is expensive and everyone wants to be pregnant, multiple embryos get replaced and with that you have increasing risk of multiple pregnancies.

FIRFER: Some people don't -- might consider that a blessing, I'm sure.

ELSNER: Right.

FIRFER: OK. Eli in Florida asks: "Are there any new treatments now, or coming up, that will have a higher success rate than IVF?"

What looks down the road?

ELSNER: Well, you know, a lot of the new things that are coming down the road are offshoots of IVF, they are things like pre- implantation genetic diagnosis, they are things like preserving ovarian tissue for people with cancer. They are things like even preserving eggs for women who maybe haven't met the right fellow and are getting just a little bit older. I think all of these things are going to be possible and I think it's where the direction is going right now. What can we do to preserve fertility for women? We already know what we can do to preserve it for men. You just freeze the sperm.

FIRFER: Which is easier to do than helping preserve the female...

ELSNER: Simple, yeah, absolutely.

FIRFER: Wonderful. OK. Coming up, New hope is on the horizon for some previously infertile couples.

(BEGIN VIDEOTAPE)

FIRFER (voice-over): Infertility and cancer.

DR. KUTLUK OKTAY, CORNELL UNIVERSITY: It made them more upset to find out that they won't be ale to have babies than they may die of their cancer.

FIRFER: New treatments give hope to women diagnosed with cancer and what about men? Infertility is not just a woman's disease. But first here's a tip to help you keep feeling fit.

UNIDENTIFIED FEMALE: Lift and curl the chest and then you can release the hands

FIRFER: For most people pregnancy is filled with joy and some anxiety.

UNIDENTIFIED FEMALE: I was more concerned -- I heard so many things about what you can and cannot eat or drink. FIRFER: While drinking up to two cups coffee is usually OK, doctors strongly advise against any alcohol.

DR. MICHAEL RANDELL, OBSTETRICS/GYNECOLOGY: We don't know what is safe in pregnancy. It's the best principle is to avoid all alcohol during pregnancy.

FIRFER: Some medications are safe during pregnancy but others can cross the placenta and get into the baby's circulation. So, always check first with our doctor. Watch sleeping and exercising on your back.

RANDELL: It's preferable you do not sleep on your back and that's because of the way the venacava is and it's very easily collapsible.

FIRFER: The venacava is a large vein that returns blood to the heart. The weight of the uterus can compress the vein when a pregnant woman is on her back. So, women are advised to sleep on their left side and minimize exercise on the back. Regular prenatal care, a helpful diet and exercise will all help you feel better and help prepare you for the marathon called labor and delivery.

(END VIDEOTAPE)

(COMMERCIAL BREAK)

FIRFER: Welcome back. We've been talking primarily about women, but infertility is a couple's disease, in fact, about one-third of cases is caused by male factors, about one-third female and the final third is a combination in both partners.

Now, for men the most common causes of infertility are either no sperm cells are produced or too few. And sometimes sperm cells are malformed or they die before they reach the egg. Also in rare cases, infertility could be caused by a genetic disease.

Now we're talking with Dr. Carlene Elsner, a reproductive endocrinologist, here in Atlanta.

And, let's get to some more e-mails. First, Kristy from Texas, she wants to know:

"How important is sperm count and motility in advanced fertility treatments? Are there any medicines or herbs that a man can take that are clinically proven to improve his count and motility to better the odds?"

ELSNER: Well, firstly, if you are doing in vitro fertilization you don't need the same count and motility that you need in just natural conception. Because if the sperm count is low, what we can do is do a procedure called Ixy, which is where you pick up single sperm in a micropipette and actually inject it into the egg to get fertilization. And, when do you that you can work with very, very low sperm numbers. But, in answer to the second question, is there something that can be done to help improve a man's sperm count? A number of things. Lose weight, stop smoking, and it's even been discovered that antioxidant vitamins may improve men's sperm counts, as well. So there are certain environmental things you can do.

FIRFER: Great. OK. Well, cancer treatments can often leave men and women infertile. Men have an option to freeze their sperm before cancer treatments, for instance, but most women are not so lucky. The time it takes to produce eggs can be valuable when battling cancer, but a new treatment is giving women new hope.

(BEGIN VIDEOTAPE)

FIRFER (voice-over): Dr. Kutluk Oktay is pioneering an experimental procedure of help women preserve the dream of becoming mothers.

DR. KUTLUK OKTAY, CORNELL UNIVERSITY: Many of these patients actually told me that it made them more upset to find out they won't be have -- they won't be able to have babies than they may die of their cancer. This, in effect, helps them cope better with the cancer.

FIRFER: Dr. Oktay removed part of a 30-year-old breast cancer's patient's ovary and preserved it cryogenically. Six years later it was removed from the liquid nitrogen and implanted just below the skin on her abdomen. The ovary began to make eggs which were harvested and fertilized. One egg split into four cells and this embryo was implanted into the woman's uterus.

Although the woman's pregnancy was not successful, doctors say the fact her ovarian function was restored and menopause reversed give them great hope. Some express concern that the potential for reintroducing cancerous tissue into the body still exists and warn even if a viable pregnancy results the child will need meticulous follow-up to ensure he or she is healthy.

(END VIDEOTAPE)

FIRFER: Now, these treatments are not yet available, but in the meantime, what can women do? Well Jessica from Indiana asks: "What about fertility issues for young women who've had breast cancer? In the past we were told not to have children, but what are the recommendations today? Has it changed?"

ELSNER: Well, I think it depends on the kind of breast cancer that a woman has. There's certain types of breast cancer that it may be OK to go ahead and have a child, thereafter, depending, of course, on whether or not she still has her ovarian functions or whether the chemotherapy or treatment that she's had has destroyed that. But, I think there certainly are certain cases in which it's OK.

FIRFER: Great, some good hope for women.

ELSNER: Yes. FIRFER: Well, coming up on WEEKEND HOUSE CALL:

(BEGIN VIDEOTAPE)

FIRFER (voice-over): Grab a pen, we'll give you Web sites to browse and numbers to call so you can get more information about infertility and its treatments. Plus, check out some of this week's medical headlines in today's "For Your Health."

New hope for heart attack patients: A study published in the "New England Journal of Medicine" finds acute heart attach patients who use an intensive regimen of cholesterol lowering statin drugs can reduce their risk of having another heart attack and even death.

Also this week, the CDC announced that poor diet and physical inactivity could soon top tobacco as the No. 1 killer of Americans. This study appearing in the "Journal of American Medical Association" showed the number of obesity related deaths has dramatically increased over the last decade.

(END VIDEOTAPE)

(COMMERCIAL BREAK)

FIRFER: For more information about infertility, click on www.asrn.org. That's the American Society for Reproductive Medicine, a great resource for couples. Also try the national infertility organization at www.resolve.org. You'll find information ranging from how to get started with treatment to coping, plus a special section just for men. And you can also call their helpline at 888-623-0744 or join their chat rooms to find online support.

Now, both of those Web sites can also help you locate reputable physicians and clinics in your area. And remember, when you're choosing your doctor, first make sure, like our guest, they're a certified reproductive endocrinologist. This means they've completed years of extra training in this field. Plus, interview several doctors before choosing just one. This can be a stressful time for couples and it's important that you click with your doctor. And also ask about insurance. What insurance do they take? What treatments cost, and if they have a payment plan.

And, Dr. Elsner, do you have a final thought for couples out there who might be dealing with infertility?

ELSNER: Well, I think the most important thing is, don't stick your head in the sand. If you think you have a problem, don't wait too long, go to the doctor, talk to somebody, and there are always new things out there. So, if it's not there this year, it may be there next.

FIRFER: Great, we appreciate it very much. Thanks for your time today, Dr. Carlene Elsner.

ELSNER: Thank you very much Holly. FIRFER: Well, that's all we have time for today on WEEKEND HOUSE CALL. Thanks to the Dr. Elsner and -- for answering all of our questions and thank you for all of your e-mails.

I'm Holly Firfer. Stay tuned for more news, right here, on CNN.

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 March 14, 2004 - 08:30   ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
HOLLY FIRFER, CNN MEDICAL CORRESPONDENT: Good morning, welcome to WEEKEND HOUSE CALL. One in six couples struggle with fertility at some point in their lives and about 3 percent of those couples end up choosing in vitro fertilization, the ultimate in approved fertility treatment. But for some, that technology does not work and the emotional toll of infertility makes them take, what some consider very extreme measures. Here's the story of one couple, Sharon and Paul Saarinen.
(BEGIN VIDEOTAPE)

PAUL SAARINEN, FATHER: We went through some tough times back then. I mean it was really -- really tearing our marriage apart.

SHARON SAARINEN, MOTHER: I was going to do whatever it took. It didn't matter, as long as I had -- I had to have a baby. I just didn't feel complete.

FIRFER (voice-over): Sharon was told she was pre-menopausal and her eggs were not vital enough to create a healthy embryo. Her doctor said there was nothing more she could do.

S. SAARINEN: There had to be another option. I wouldn't accept no.

FIRFER: That option was with Dr. Michael Fikah a fertility expert who was willing to try an experimental treatment called cytoplasmic transfer using Sharon's own eggs. Taking the cytoplasm from a healthy donor egg he implanted it into Sharon's weaker egg to help it survive.

Once it was fertilized it was impaled in her uterus and she was pregnant.

S. SAARINEN: I was at home alone, I got the call and I just broke down and started crying on the bed. It was the best feeling. I waited ten years to hear her say that.

FIRFER: The donor cytoplasm contains mitochondrial DNA which gives the egg that energy to survive, but it's not trait related DNA.

DR. MICHAEL FIKAH, REPROD. ENDOCRINOLOGIST: Ninety-nine percent of the genetic material from the embryo, basically, is from the patient herself and then maybe one percent is from the third person.

FIRFER: Yet, some doctors say the potential for birth defects still remains. If you have three people's DNA in one embryo, the concern is possible chromosomal abnormalities in the child.

(on camera): When the Saarinens decided they wanted to try to have another child, they returned to Dr, Fikah's fertility center here in suburban Detroit only to be told in July of 2001 the FDA had sent letters to doctors informing them that the cytoplasmic transfer and other so-called experimental procedures had been banned.

(voice-over): The FDA said in order to proceed rigorous testing would need to be done to get the agency's approval.

FIKAH: Most of these women are in their late 30s and they don't really have time, their time is very precious.

So Dr. Fikah agreed to do the procedure in his clinic in Lebanon where it's legal. The Saarinen's decided the risk was worth it. They spent another $10,000 and traveled halfway across the world to try that procedure again, but this time it didn't work.

SAARINEN: I finally, in the last few months, just reconciled with the fact that in my heart I have one child, I have to be happy with that.

(END VIDEOTAPE)

FIRFER: A couple is considered infertile if they've failed to conceive after a year of unprotected sex. If they are 35 or over, make that six months. Now, 25 years ago, when the first test tube baby was born, in vitro fertilization was cutting edge and controversial. In fact, it would be another three years before an IVF baby was born in the U.S. and now some people are getting frustrated by what they see as lack of new procedures here, and are seeking fertility treatments elsewhere.

Dr. Carlene Elsner joins us now, to help answer your questions. She's a reproductive endocrinologist who practices here in Atlanta at Reproductive Biology Associates, and she's worked in the field of infertility for more than 20 years.

Welcome, we're glad to have you here, Doctor.

DR.CARLENE ELSNER, INFERTILITY SPECIALIST: Thank you so much, Holly.

FIRFER: We have a lot of questions lined up, a lot of e-mails. So, let's start right away with Jennifer in New Hampshire. She asks:

"Is a fertility treatment considered extreme, if it is the only way a couple can get pregnant? For example, cytoplasmic transfer, because the mother's eggs failed to divide correctly?"

So would you consider something like cytoplasmic transfer extreme or cutting edge, on the edge of the future? What would you say?

ELSNER: Well, you know, Holly, 25 years ago IVF was considered extreme. So, it's hard to talk about extreme, these days. I think what we have to be concerned about is safety, and I think there's still some questions about the safety of this procedure. But certainly it's worked wonderfully for this couple and I think we're going to see a lot of improvements it in the future. So is it off the wall? No, I don't think so.

FIRFER: Right. OK. And, if people are asked how far is too far for couples to go to get pregnant, obviously the couple we saw traveled to Lebanon to try it again, how far is too far?

ELSNER: Gee, that's a personal decision. And I think each couple has to define that for themselves. But, there's more and more technology coming about every day and there are more and more opportunities and there are more and more things we can do. And I think each couple has to decide for themselves how far they want to go.

FIRFER: What they are willing to do. How much they're willing to spend because it can be expensive?

ELSNER: Well, it is very expense. You are correct.

FIRFER: OK, another procedure some would consider extreme, which has raised some ethical questions is sex selection.

Varda from Tel Aviv, Israel wants to know:

"For a couple age 50 and needing medical help to get pregnant, can they choose the sex of their next and perhaps their last child? What is a good recourse for names of hospitals and clinics with -- which specialize in these treatments?"

A lot of question there is. But, we're talking about pretty much designer babies, so to speak.

ELSNER: Well, what we're talking about for a 50-year-old lady, her chances of becoming pregnant on her own are very, very slim, you know. The technology that's going to work best for her is to use donated eggs from a younger woman. Now, that involves IVF technology.

FIRFER: Right.

ELSNER: And, of course, PGD or pre-implantation genetic diagnosis is possible, but most centers, worldwide, do that for medical reasons and not just for family balancing, although there are a few centers that do.

FIRFER: So, to be able to pick the sex of your child girl or boy most people will not do that?

ELSNER: Most IVF centers worldwide will not do that. Now, if there's a medical reason for it. If there's an inherited medical disorder that maybe prefers one sex versus another, it's a very simple technology to do, it certainly can be done.

FIRFER: OK. We have another question. Dee from Indiana and she asks: "What are the odds of a woman over the age of 43 becoming pregnant without any medical intervention?" Now, we no, Doctor, at age 35 the numbers dramatically decrease about your chances of getting pregnant. So, what about 43 and in that range?

ELSNER: Well, your chances of getting pregnant at 43 about five percent, without help. By 35, you will have lost about half your fertility. Women are most fertile in teens and early 20s, but we still see a lot of people that are interested in getting pregnant at 43 and we still work with them. We, certainly do.

FIRFER: Is there a way that women would be able to find out how fertile they are and maybe what their individual reproductive life might be?

ELSNER: Well, you know, I think the best thing to do for someone who is questioning that is to have some blood work done very early in their menstrual period, because there are certain hormone can be tested, particularly FSH and estradiol and this can give you an index of how many eggs, if you will, are left on those ovaries to respond. Then, of course, fertility drugs can help make those eggs ovulate and enhance the chance of a pregnancy.

FIRFER: Very interesting. OK. A lot more questions and e-mails coming up. Plus:

(BEGIN VIDEOTAPE)

FIRFER (voice-over): In vitro fertilization still considered extreme baby making by some. Who's a candidate and how successful is it? And, what about birth defects? Is your child at higher risk when you choose IVF. We're going to give you all the facts.

First try and answer our quiz. This week we're asking: What does the term "in vitro" mean? Think fast, we'll be back after the break with that answer.

(END VIDEOTAPE)

(COMMERCIAL BREAK)

(BEGIN VIDEOTAPE)

FIRFER (voice-over): Checking the "Daily Dose Quiz" we asked: What does the term "in vitro" mean?

The answer is in vitro is Latin for "in glass." During one part of in vitro fertilization the egg is fertilized in a Petri dish.

(END VIDEOTAPE)

FIRFER: Welcome back to WEEKEND HOUSE CALL. IVF and similar procedures account for less than five percent of infertility treatments in the U.S. Now, during in vitro fertilization eggs are taken from a woman's ovaries and mixed in a Petri dish with washed sperm. Those eggs eventually are examined and see if they've been fertilized and are dividing into cells. Those embryos are then implanted into the woman's uterus. Now, the average cost of an IVF procedure, in the United States, is $12,400 with a success rate of just over 29 percent. And if you're wondering about insurance, 14 states have laws that require insurers to cover some form of fertility diagnosis and treatment but beware, though, these laws vary greatly in what they require. Now, we're talking with infertility specialist Dr. Carlene Elsner.

Doctor, we've got a lot of questions lined up still, so let's get to the first on here. Rashmi in Chicago wants to know:

"How high is the risk of encountering birth defects through IVF?"

I know that a lot of people are concerned. There have been hundreds of studies involving children born through IVF. One Australian study I believe followed a two crease in fold in birth defects in IVF children. So, what would you tell your patients who are concerned about that?

ELSNER: Well, it may be a slightly increased risk of birth defects with IBV, but it's not dramatically increased. You have to understand that the chance of a birth defect in the normal population is maybe five percent. So we are looking at maybe an increase of maybe as high as 10 percent, but the flip side of that is 90 percent of the couple -- of the children are normal. And the other thing that you have to think about is that a lot of the people that are coming to us from in vitro fertilization have underlying problems with the eggs or with the sperm, and if there's a problem already with the DNA then of course that DNA is going to be past on to any future child. So, I think that puts us at more risk than the technical its.

FIRFER: And with IVF could you defect maybe a problem with an embryo that would not make it to term so, therefore you might be able to catch a problem ahead of time?

ELSNER: Of course. You can do pre-implantation genetic diagnosis, which is embryo biopsy.

You take a cell out of the embryo when it's three-day old and has maybe eight cells and put the embryo back in the incubator and the embryo does fine, but then you test that single cell and you can pick up all sorts of things like Down's Syndrome. You can pick up a lot of chromosomal abnormality in this way, and then you just don't replace those embryos, you replace the normal one.

FIRFER: OK. Let's get to another question. Lori from North Carolina writes: "With the advent of fertility treatment comes the risk of multiple pregnancies. Are parents counseled on these risks and is there any way to avoid it?"

And, I believe that more than half of infants born using assisted reproductive technology, like IVF, were multiple births. So, obviously this is a concern for people to beware you may end up with two, three, even four children.

ELSNER: This is one of the biggest problems we have, you know. And I think the answer to that is as we can put fewer embryos back, replace fewer embryos with IVF, you have perfect control over this. You know, you can replace only two embryos or only one, if you want to. The problem is the fewer embryos you replace, the lower the pregnancy rates are. So, of course, this -- because the technology is expensive and everyone wants to be pregnant, multiple embryos get replaced and with that you have increasing risk of multiple pregnancies.

FIRFER: Some people don't -- might consider that a blessing, I'm sure.

ELSNER: Right.

FIRFER: OK. Eli in Florida asks: "Are there any new treatments now, or coming up, that will have a higher success rate than IVF?"

What looks down the road?

ELSNER: Well, you know, a lot of the new things that are coming down the road are offshoots of IVF, they are things like pre- implantation genetic diagnosis, they are things like preserving ovarian tissue for people with cancer. They are things like even preserving eggs for women who maybe haven't met the right fellow and are getting just a little bit older. I think all of these things are going to be possible and I think it's where the direction is going right now. What can we do to preserve fertility for women? We already know what we can do to preserve it for men. You just freeze the sperm.

FIRFER: Which is easier to do than helping preserve the female...

ELSNER: Simple, yeah, absolutely.

FIRFER: Wonderful. OK. Coming up, New hope is on the horizon for some previously infertile couples.

(BEGIN VIDEOTAPE)

FIRFER (voice-over): Infertility and cancer.

DR. KUTLUK OKTAY, CORNELL UNIVERSITY: It made them more upset to find out that they won't be ale to have babies than they may die of their cancer.

FIRFER: New treatments give hope to women diagnosed with cancer and what about men? Infertility is not just a woman's disease. But first here's a tip to help you keep feeling fit.

UNIDENTIFIED FEMALE: Lift and curl the chest and then you can release the hands

FIRFER: For most people pregnancy is filled with joy and some anxiety.

UNIDENTIFIED FEMALE: I was more concerned -- I heard so many things about what you can and cannot eat or drink. FIRFER: While drinking up to two cups coffee is usually OK, doctors strongly advise against any alcohol.

DR. MICHAEL RANDELL, OBSTETRICS/GYNECOLOGY: We don't know what is safe in pregnancy. It's the best principle is to avoid all alcohol during pregnancy.

FIRFER: Some medications are safe during pregnancy but others can cross the placenta and get into the baby's circulation. So, always check first with our doctor. Watch sleeping and exercising on your back.

RANDELL: It's preferable you do not sleep on your back and that's because of the way the venacava is and it's very easily collapsible.

FIRFER: The venacava is a large vein that returns blood to the heart. The weight of the uterus can compress the vein when a pregnant woman is on her back. So, women are advised to sleep on their left side and minimize exercise on the back. Regular prenatal care, a helpful diet and exercise will all help you feel better and help prepare you for the marathon called labor and delivery.

(END VIDEOTAPE)

(COMMERCIAL BREAK)

FIRFER: Welcome back. We've been talking primarily about women, but infertility is a couple's disease, in fact, about one-third of cases is caused by male factors, about one-third female and the final third is a combination in both partners.

Now, for men the most common causes of infertility are either no sperm cells are produced or too few. And sometimes sperm cells are malformed or they die before they reach the egg. Also in rare cases, infertility could be caused by a genetic disease.

Now we're talking with Dr. Carlene Elsner, a reproductive endocrinologist, here in Atlanta.

And, let's get to some more e-mails. First, Kristy from Texas, she wants to know:

"How important is sperm count and motility in advanced fertility treatments? Are there any medicines or herbs that a man can take that are clinically proven to improve his count and motility to better the odds?"

ELSNER: Well, firstly, if you are doing in vitro fertilization you don't need the same count and motility that you need in just natural conception. Because if the sperm count is low, what we can do is do a procedure called Ixy, which is where you pick up single sperm in a micropipette and actually inject it into the egg to get fertilization. And, when do you that you can work with very, very low sperm numbers. But, in answer to the second question, is there something that can be done to help improve a man's sperm count? A number of things. Lose weight, stop smoking, and it's even been discovered that antioxidant vitamins may improve men's sperm counts, as well. So there are certain environmental things you can do.

FIRFER: Great. OK. Well, cancer treatments can often leave men and women infertile. Men have an option to freeze their sperm before cancer treatments, for instance, but most women are not so lucky. The time it takes to produce eggs can be valuable when battling cancer, but a new treatment is giving women new hope.

(BEGIN VIDEOTAPE)

FIRFER (voice-over): Dr. Kutluk Oktay is pioneering an experimental procedure of help women preserve the dream of becoming mothers.

DR. KUTLUK OKTAY, CORNELL UNIVERSITY: Many of these patients actually told me that it made them more upset to find out they won't be have -- they won't be able to have babies than they may die of their cancer. This, in effect, helps them cope better with the cancer.

FIRFER: Dr. Oktay removed part of a 30-year-old breast cancer's patient's ovary and preserved it cryogenically. Six years later it was removed from the liquid nitrogen and implanted just below the skin on her abdomen. The ovary began to make eggs which were harvested and fertilized. One egg split into four cells and this embryo was implanted into the woman's uterus.

Although the woman's pregnancy was not successful, doctors say the fact her ovarian function was restored and menopause reversed give them great hope. Some express concern that the potential for reintroducing cancerous tissue into the body still exists and warn even if a viable pregnancy results the child will need meticulous follow-up to ensure he or she is healthy.

(END VIDEOTAPE)

FIRFER: Now, these treatments are not yet available, but in the meantime, what can women do? Well Jessica from Indiana asks: "What about fertility issues for young women who've had breast cancer? In the past we were told not to have children, but what are the recommendations today? Has it changed?"

ELSNER: Well, I think it depends on the kind of breast cancer that a woman has. There's certain types of breast cancer that it may be OK to go ahead and have a child, thereafter, depending, of course, on whether or not she still has her ovarian functions or whether the chemotherapy or treatment that she's had has destroyed that. But, I think there certainly are certain cases in which it's OK.

FIRFER: Great, some good hope for women.

ELSNER: Yes. FIRFER: Well, coming up on WEEKEND HOUSE CALL:

(BEGIN VIDEOTAPE)

FIRFER (voice-over): Grab a pen, we'll give you Web sites to browse and numbers to call so you can get more information about infertility and its treatments. Plus, check out some of this week's medical headlines in today's "For Your Health."

New hope for heart attack patients: A study published in the "New England Journal of Medicine" finds acute heart attach patients who use an intensive regimen of cholesterol lowering statin drugs can reduce their risk of having another heart attack and even death.

Also this week, the CDC announced that poor diet and physical inactivity could soon top tobacco as the No. 1 killer of Americans. This study appearing in the "Journal of American Medical Association" showed the number of obesity related deaths has dramatically increased over the last decade.

(END VIDEOTAPE)

(COMMERCIAL BREAK)

FIRFER: For more information about infertility, click on www.asrn.org. That's the American Society for Reproductive Medicine, a great resource for couples. Also try the national infertility organization at www.resolve.org. You'll find information ranging from how to get started with treatment to coping, plus a special section just for men. And you can also call their helpline at 888-623-0744 or join their chat rooms to find online support.

Now, both of those Web sites can also help you locate reputable physicians and clinics in your area. And remember, when you're choosing your doctor, first make sure, like our guest, they're a certified reproductive endocrinologist. This means they've completed years of extra training in this field. Plus, interview several doctors before choosing just one. This can be a stressful time for couples and it's important that you click with your doctor. And also ask about insurance. What insurance do they take? What treatments cost, and if they have a payment plan.

And, Dr. Elsner, do you have a final thought for couples out there who might be dealing with infertility?

ELSNER: Well, I think the most important thing is, don't stick your head in the sand. If you think you have a problem, don't wait too long, go to the doctor, talk to somebody, and there are always new things out there. So, if it's not there this year, it may be there next.

FIRFER: Great, we appreciate it very much. Thanks for your time today, Dr. Carlene Elsner.

ELSNER: Thank you very much Holly. FIRFER: Well, that's all we have time for today on WEEKEND HOUSE CALL. Thanks to the Dr. Elsner and -- for answering all of our questions and thank you for all of your e-mails.

I'm Holly Firfer. Stay tuned for more news, right here, on CNN.

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