There are a host of new technological options for parents who want to conceive, want peace of mind regarding their babies’ health, or just want to know more about the little one who’s on the way. Here’s a look at five of these high-tech trends and what they mean for prospective parents.
By Christina Elston
To say that Sondra Marshal sees no mystery in baby-making would be an understatement. The only mystery for the 40-year-old and her husband – who’ve been undergoing fertility treatments for about a year – is why they don’t have one yet.
“When we started this whole thing, I thought I didn’t even want to do the high-tech stuff. It’s not romantic. It’s not mystical,” says Marshal of West Los Angeles. “I’ve gotten past that.”
Married for the first time at 39, Marshal wanted to start a family right away. But when six months went by with no pregnancy, the couple decided to get help. Initial tests revealed problems with her husband’s sperm.
Several rounds of drug therapy, intrauterine insemination, and a cycle of in-vitro fertilization with their own egg and sperm failed to produce a baby. And so, after months of tests, injections, ultrasounds and gynecological exams, the Marshals are considering the use of donated sperm, eggs, or both. “You spend basically your whole teenage years and early adulthood trying not to get pregnant. You get to this age and you think it will be easy, but it’s not,” Marshal says. “My husband’s very optimistic, and that keeps me going.”
The technological options the Marshals are exploring are part of a host of new choices for parents who want to conceive, want peace of mind regarding their babies’ health, or just want to know more about the little one who’s on the way. Here’s a look at five of these high-tech trends and what they mean for prospective parents.
1. Egg Freezing
Beginning in their early 30s, women can now keep the possibility of egg freezing in mind. Officially known as oocyte (pronounced “OH-site”) cryopreservation, this technology allows women who want to delay childbearing to harvest eggs while their fertility is high and have them frozen and stored for later use.
While it’s been possible for some time to preserve sperm and fertilized embryos through freezing, doctors have only recently perfected techniques for egg freezing.
David Diaz, M.D., medical director of the West Coast Fertility Center in Orange County, Calif., and a nationally known expert on reproductive endocrinology and infertility, reminds couples that fertility doesn’t last forever. “I’ve had patients in their 40s, or even their 50s, who are stunned when I tell them that it’s probably not going to happen with their own eggs,” he says. “The best pregnancy rates are in patients who are under 32.”
For the woman who’s thinking ahead, a simple follicle stimulating hormone (FSH) blood test, available through her gynecologist or family doctor, can let her know whether her reserve of eggs is high or low. “I think it should be part of every well-woman exam,” Diaz says. In fact, he adds, women with a strong family history of premature menopause should have the FSH test sooner rather than later.
The rate of successful full-term pregnancy using frozen eggs is about 25 percent, Diaz notes. With fresh eggs, the rate is about 30 percent, according to the American Society of Reproductive Medicine (ASRM).
As of 2006, 120 babies have been born from frozen eggs worldwide, Diaz says. His own fertility center has performed seven frozen egg transfers, with four resulting pregnancies. The center’s first successful birth through the egg-freezing program occurred in October 2005.
2. Boy or Girl? Take Your Pick
For some couples, “family balancing” rather than fertility is the goal. If you just must have a girl or a boy, a new technology called MicroSort holds promise. This involves gender selection at the male gamete level, which means the technology can sort sperm to select for gender, according to Harvey Stern, M.D., Ph.D., director of prenatal and preimplantation genetic diagnosis programs at the Genetics & IVF Institute in Fairfax, Va., where MicroSort was pioneered.
Here’s how it works: Sperm that carry an XY (male) chromosome combination have 2.8 percent less DNA than sperm carrying XX (female) chromosomes. When staining a sperm sample with fluorescent dye to detect DNA, sperm with male chromosomes appear less fluorescent, a difference that can be identified through the MicroSort process with lasers.
Sperm samples can then be sorted to favor one gender or the other – up to a 75 percent male sperm sample, or a 92 percent female sample, says Stern. Once a sperm sample favors a particular gender, it can then be artificially inseminated into a woman’s uterus. The percentage of pregnancies of the desired gender basically matches the sort of the sperm, Stern says.
MicroSort isn’t for everyone, however. The clinic’s standard for performing the procedure is that only couples who have more children of one gender than the other qualify. They will not perform MicroSort for those who have no children, or for parents with equal numbers of children of each gender.
Currently in clinical trials supervised by the U.S. Food and Drug Administration (FDA), several thousand MicroSort cycles have been done, resulting in 500 to 600 births. So far, there is no detectable increase in birth defects. The trials will likely be finished within the year.
If approved, MicroSort could replace other gender selection methods, some of which are controversial or have much lower success rates. Other sperm-sorting techniques, for instance, offer a 60 percent success rate at best. The only technique with a higher success rate than MicroSort involves determining the gender of fertilized embryos during an in-vitro fertilization (IVF) procedure, and only implanting those of the desired gender. This leaves the couple with unused embryos that must be either donated to other couples or destroyed, raising ethical and moral issues.
3. Genetic Testing
There was a time when parents didn’t know whether they had a boy, a girl, or even a healthy baby, until they counted fingers, toes and other body parts. Ultrasound, amniocentesis and chorionic villus sampling (CVS) have taken away some of the mystery, but new frontiers in genetic testing are focusing on family medical history and earlier, less invasive tests.
Today, a visit to a genetic counselor before pregnancy can help prospective parents make informed decisions. “These are complicated issues,” Stern says. “The great thing about a genetic counseling appointment is that it tends to get people to call their relatives.” Family health history, he says, has a definite impact.
“There is getting to be more emphasis on people knowing their family history,” agrees Richard Olney, M.D., team leader for pediatric genetics at the Centers for Disease Control’s National Center on Birth Defects and Developmental Disabilities. Olney points to the U.S. Surgeon General’s online resource, “My Family Health Portrait” (www.hhs.gov/familyhistory), as a good way to collect the needed information even before you’ve visited a counselor.
During pregnancy, a woman’s unborn baby is assigned a risk level for certain conditions – especially chromosome abnormalities – based on the mother’s age. Risk for moms in their late 30s and older was once automatic cause for undergoing amniocentesis or CVS. But today, family history and other tests can yield a more targeted group and allow some moms to forego invasive and potentially risky tests. Among the latest advancements:
Blood tests – Performed during the first trimester, these tests can now more closely indicate the risk for chromosome abnormalities.
The nuchal translucency test – Used to screen for Down syndrome, this test involves a first-trimester ultrasound scan to measure the thickness of a flap of skin at the back of the fetal neck. A difference of a fraction of a millimeter may indicate the presence of Down syndrome. The measurement, along with testing for the presence of two specific proteins, proved more effective at detecting cases of Down syndrome than second-trimester tests, according to a recent study in the New England Journal of Medicine.
Improved evaluation of embryos before IVF implantation – Finding the healthiest embryos would allow doctors to implant just one, says Eric Surrey, M.D., past president of the Society of Assisted Reproductive Technology and a physician at the Colorado Center for Reproductive Medicine (CCRM) in Denver. Surrey and his colleagues are working to create an “embryo fingerprint” by monitoring the appearance and metabolic activity of the embryo.
Another embryo evaluation still under development is preimplantation genetic diagnosis (PGD), which Surrey says is in its infancy. Currently, experts can evaluate just nine of an embryo’s 23 chromosome pairs. But, says Surrey, with increased research, he hopes that full chromosome evaluation will be possible within the next decade.
4. The Ultimate in Ultrasound
While baby’s health screenings are beginning earlier than ever, so is the bonding process with Mom and Dad. Parents not satisfied with the meager peek into the womb, provided by black-and-white, two-dimensional ultrasound scans, have new options. 3-D and 4-D ultrasound technology allows for vivid color pictures, even video, to be viewed on big color screens.
Done primarily for the enjoyment of families, these services are not without their critics. Several medical organizations, including the American College of Radiology (ACR), strongly recommend against using ultrasound for anything other than diagnostic purposes.
Opponents cite the unnecessary risk of energy (from high-frequency sound waves) introduced during these procedures and concerns that parents will substitute these new ultrasound options for diagnostic ultrasound care. Laboratory studies have shown that even at low levels, ultrasound can produce physical effects such as jarring vibrations and a rise in tissue temperature. While there is still no evidence that this can harm a fetus, the FDA contends that the existence of these effects means that ultrasound cannot be considered harmless.
“What we recommend is that they do one OB scan at the end of the second or beginning of the third trimester, to check for any big problems,” says Carol Rumak, M.D., head of the ACR Ultrasound Commission. If the initial 15- to 30-minute 2-D scan turns up suspected problems – as it does in about 5 percent of cases – then a more extensive scan might be merited, Rumak says.
But many of those who offer 3-D and 4-D ultrasound paint a different picture of the service they provide. “I’ve been doing ultrasounds for 30 years,” says Norma Solis, a registered diagnostic sonographer who co-founded First Sight Ultrasound in San Antonio three years ago. “At first I didn’t want to go into [3-D and 4-D ultrasound services] because I thought it was just for show, but I was so mistaken. It bonds the family together. It makes it real for them.”
Susan Simieone, R.N., owner of Envision Ultrasound in Westfield, N.J., and Brooklyn, N.Y., says the more enhanced ultrasound images are especially helpful for dads who want to connect with their baby. “Most dads I know have a really hard time understanding that little black-and-white, 2-D image,” Simieone says.
Both First Sight and Envision employ certified ultrasound technicians to perform all scans; they boast top-of-the-line equipment, and require women to have had a medical diagnostic scan and their doctor’s permission before they have a 3-D or 4-D scan.
“This way we know that we have healthy moms and healthy babies,” says Simieone.
5. Banking Baby's Blood for the Future
The hotly debated “stem cell,” a “generic” cell with the potential to help cure numerous ailments, is the focus of cord-blood banking businesses, which offer new parents peace of mind. Parents have been able to “bank” cells collected from their child’s umbilical cord blood after birth since the late 1980s, and these “hematopoetic” (blood-making) stem cells are receiving ever-increasing attention.
Though the American College of Obstetrics and Gynecology and American Academy of Pediatrics (AAP) both issued opinions against private cord-blood banking in the late 1990s, the conditions that fueled their objections are changing, say banking advocates. The AAP, in its 1999 policy statement, estimated the chances a child would need to use his or her banked cord blood at one in 200,000: too slim to justify the cost of private banking.
But Frances Verter, Ph.D., founder of the Web site www.parentsguidecordblood.com, has since pointed out to the International Cord Blood Society that opinions against private banking were based on the odds of a pediatric transplant. She and colleague J.J. Nietfeld, Ph.D., a biochemist at University Medical Center in Utrecht, the Netherlands, estimate that the odds a person would require a transplant of her own cord blood by age 70 are much higher – at one in 400. A similar assessment was made at the American Society of Hematology conference in May 2005, according to Stephen Grant, co-founder of Cord Blood Registry, a private bank in San Bruno, Calif.
The number of diseases being treated through cord blood transplants is also growing, says Mary Thistle, senior vice president and general manager of ViaCell Reproductive Health, parent company of Viacord in Cambridge, Mass. She says there are now more than 40 conditions treatable through cord blood transplants, and she places the incidence rate for an individual being diagnosed with one of these conditions by age 50 at one in 100.
“That’s a very compelling piece of information,” she says, “and when you look into the future it becomes even more compelling.”
The expanding field of regenerative medicine has increased opportunities for cord blood to be used, says Grant. The FDA, for example, has approved the first clinical trials to test the efficacy of genetically related cord blood in treating traumatic brain injury.
Given the changing medical climate, and evidence in favor of genetically related blood’s effectiveness (a 1997 study in the New England Journal of Medicine found that among patients with blood disorders, the survival rate at one year was 63 percent for those receiving genetically related cord blood, versus 29 percent for those receiving unrelated cord blood), Grant and Thistle believe that private banking is well worth the cost (up to $1,800 initially, plus $75 per year). “It’s nature’s version of a limited window of opportunity,” Grant says.
Considering how technology constantly expands on what nature provides us with now, imagine what windows might open in the future – and what they will mean for our children, and theirs as well.
So, How Much Is It?
$150 - $200 – The price range for 3-D and 4-D ultrasound image packages, which can include multiple still shots of a developing fetus, ultrasound image albums and video.
$1,500 - $1,800 – The initial cost of private cord-blood banking. After this payment, cord blood storage costs about $75 per year.
$2,000 - $3,000 – The cost of using MicroSort technology to create a sperm sample favoring a particular gender – boy or girl – and then being artificially inseminated with that sample.
$10,000 – The average cost for an egg-freezing procedure, including professional and facility fees, anesthesia, medication and pre-testing.
A Parent’s Guide to Cord Blood Banks – www.parentsguidecordblood.com – Created in memory of a child who died from cancer, this site is an excellent, balanced resource, with lists of banks, medical facts and opinions on both sides of the issue, and recent news about cord-blood research.
The National Society of Genetic Counselors – www.nsgc.org/resourcelink.asp – Online search engine helps families locate genetic counseling services.
The Society for Assisted Reproductive Technology (SART) – www.sart.org – Includes a fertility clinic locator, an online handbook that answers basic questions, and data reports describing procedure success rates at member clinics.
What to Do When You Can’t Get Pregnant, by Daniel A. Potter and Jennifer S. Hanin, Marlowe & Co., 2005. A thorough exploration of options for couples who wish to conceive.
The Yale University School of Medicine Patient’s Guide to Medical Tests, Houghton Mifflin, 1997. A comprehensive resource on a variety of diagnostic tests, it also includes chapters on genetic disorders and pregnancy.
Christina Elston is Senior Editor at Dominion Parenting Media.