In vitro fertilization: is conceiving a child worth the costs?

• Author: Kershner, Kelly

JAIME ROMANO knew something was wrong. She'd had gynecological problems since she was 18 and had seen several doctors over the last 12 years about recurrent abdominal pain and abnormal vaginal bleeding--mostly without success. This time, though, it was different. "One of my Fallopian tubes had wrapped itself around my ovary, which became cystic and burst. I had developed such a high tolerance for pain that, by the time they operated, my abdominal cavity was full of gangrene.

"Since I was in my early 20s, I'd had a feeling that pregnancy was something that would not come easily. After my surgery, I realized that in-vitro fertilization [IVF] would be my only option."

Two years later, Romano and her husband, Frank, decided to try it. Jaime began taking a series of hormone injections to boost her functioning ovary's egg production. For about a week, she endured almost-daily blood tests and ultrasounds--measures fertility specialists use to gauge when eggs are mature enough for removal. Finally, it was time. The Romanos' fertility specialist retrieved Jaime's ripe eggs and mixed them in a special solution with Frank's sperm. A day or so later, fertilization occurred; tiny embryos began to divide and grow--two cells, then four. A day later, the fertility specialist transferred four of these microscopic clusters of cells into Jaime's uterus. Everyone hoped for the best. It didn't work. About a year later, the Romanos tried IVF again, without success.

Today, Jaime Romano feels some bitterness about the costs and pitfalls of IVF. "My husband and I have spent more than $20,000 pursuing IVF. The cost has affected everything we do--our savings, our vacations, work on our house. It's always near the surface of our existence. If we are not discussing it, then one of us is thinking about it. Plus, it seems that many clinics are now emphasizing marketing. They are twisting numbers and misleading patients--patients who are vulnerable and desperate and can be easily led down the primrose path. I'll just say this--the doctor who performed our second IVF is held in very low esteem in our household."

Despite these concerns, the Romanos have not given up. "We'll be giving IVF another try.... I've wanted to have a child since I myself was a child. I feel I should pursue the options this technology gives me."

Jaime Romano's mixed feelings about IVF are not surprising. By any measure, assisted reproductive technologies are amazing medical breakthroughs. For the fortunate few, they are remedies for the heartbreak of infertility. Nevertheless, there are pitfalls, including high cost, pain, vulnerability to deception, and dashed dreams. There also are the larger societal questions about these technologies' worth: What are the true costs and benefits for individuals and society? How do these technologies affect women's and infants' health? Do they exploit women? Empower them? Are they anti-adoption? Is the possibility of conceiving a biological child worth any price?

Assisted reproductive technologies are expensive. The costs are high: a single IVF attempt runs an average of $8,000; one GIFT (gamete intrafallopian transfer, in which retrieved eggs and sperm are mixed and transferred to the Fallopian tube) attempt is even more--an average of $10,000. Moreover, the costs are not limited to a single attempt. A 1994 New England Journal of Medicine study found that the expense of a successful delivery with IVF ranges from $67,000 (if a child is conceived on the first attempt) to almost $115,000 (if it takes six attempts). For couples where...