An Expert Sees 'a Golden Age of Fertility Medicine'

updated 08/20/1990 AT 01:00 AM EDT

originally published 08/20/1990 AT 01:00 AM EDT

When older women discover that they cannot conceive naturally, often the next step is consulting a medical specialist. One of the leading experts in the field is Dr. Robert Franklin, a clinical professor of obstetrics and gynecology at Baylor College of Medicine and director of the fertility clinic at Woman's Hospital of Texas in Houston. The co-author, with Dorothy Kay Brock-man, of In Pursuit of Fertility, Franklin, 62, has spent the last 28 years working with infertility patients and trying to help bring about the miracle of conception. He spoke with Chicago bureau chief Giovanna Breu.

Are there more women facing infertility problems today?

Infertility patients are increasing. There are more women in the over-40 age group who have waited to have a child. When I first started practicing in 1962, an estimated one out of every 20 couples had fertility problems. Now the figure is one in six.

What are the major causes of infertility in older women?

The most common problem we see is ovarian dysfunction. Often the ovaries either fail to produce an egg or do not produce enough nutrients to support the fertilized egg. Another important problem is endometriosis, a disease in which benign menstrual tissue grows outside the uterus and may disturb uterine or ovarian activity. Fibroids also cause complications because they can block the fallopian tubes or prevent a fertilized egg from implanting properly in the uterus.

What other factors make it hard for women over 40 to conceive?

Stress plays a role. Though we don't know exactly how, anxiety appears to affect the blood supply to the ovaries so that they don't function as well. There are bacterial causes such as chlamydia, a sexually transmitted disease that can damage the reproductive organs. We've noticed that chlamydia is much more likely than gonorrhea to destroy fallopian tubes because it works so slowly and quietly.

But a lot of women have only some mild malfunction, such as allergic reactions to sperm, and once we find out what it is we can treat it.

What are some of the conventional treatments available for infertility?

Medications like Pergonal and Clomid can correct ovulation problems in older women, but they are effective only when used under the right circumstances. For example, if a patient has endometriosis, such drugs can make it worse. In the case of endometriosis and fibroids, the growths can be treated with medication or surgically removed, and this should be done before giving fertility drugs. Bacterial diseases can be treated with antibiotics. If we feel stress is a major problem, we advise patients to exercise, cut down on caffeine and follow a low-sugar diet, all of which can reduce anxiety and thereby improve ovarian function.

At what point should a woman think about in vitro fertilization?

A patient is considered a candidate for IVF only after conventional methods have failed. IVF, in which a fertilized egg is placed inside the uterus, was originally aimed at women with missing or damaged fallopian tubes. The cost ranges from $3,000 to $5,000 per attempt and is successful about 20 percent of the time in most clinics. But for patients over 40, the success rate is lower, and the rate of miscarriage is as much as 30 percent higher than in younger women.

Why do older women suffer a greater number of miscarriages?

About half of the miscarriages are due to genetic problems with the developing embryo. When the male and female sets of chromosomes come together during conception, they don't always merge as well in older women, and the resulting imperfect embryo is rejected by the woman's body. But we can do something for the other 50 percent. If I have a patient who is 40 or so and has had two miscarriages, I start looking for other causes, such as uterine and ovarian dysfunction, as well as genetic problems.

At what point do you conclude that a woman is incapable of having a child?

The time varies with each couple and their problems. When you see that the situation seems hopeless and is doing emotional damage to a marriage, then the doctor should advise the couple to stop trying and perhaps consider adoption.

The people I care the most about are those that I've failed. But we are living in the golden age of fertility medicine. I had one patient who had fibroids and endometriosis, and her treatment was very slow and expensive. But she became pregnant and had a precious, gorgeous baby at 46.

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