Can Fertility Clinics Deliver On Promises?

Just as birth control has given women the freedom to delay having children, reproductive medicine has allowed many to have babies after they thought it was too late.

But in recent years, there have been more questions about whether the fertility industry can deliver on its promises.

When Miriam Zoll was in the prime of her reproductive years, she wasn't sure she wanted to be a mother. Her career was in full swing. The love of her life had married someone else. Her own childhood had been stressful and unhappy. And there was no rush to decide.

"I had certainly heard about the biological clock," Zoll said. "That conversation fell off the table in the late '90s and early 2000s and was replaced with, 'You don't have to worry about your biological clock anymore. If you have trouble getting pregnant, go to a fertility clinic and they'll get you pregnant.'"

As a women's health advocate who co-founded the Ms. Foundation's "Take Your Daughter To Work Day," Zoll didn't want to be defined by her biology.

"But when I decided I wanted to be come a mom everything began to focus on my hormones," Zoll said. "So it was like, all the years that I didn't focus on it, Mother Nature was now giving me pay back."

That pay back began at 40, after Zoll had reunited with and married her first love. They moved from New York City to a quiet farmhouse in Conway, Mass. and tried for two years to get pregnant naturally. When that didn't work, they didn't panic. They went to a fertility clinic.

"Most people in our social circle were endorsing the treatments, saying that they knew someone who got pregnant, the treatments work, so we signed up very optimistically and when our first cycle failed we were dumbstruck," Zoll said.

As she chronicles in her memoir, "Cracked Open: Liberty, Fertility and the Pursuit of High Tech Babies," Zoll and her husband spent a heartbreaking decade, and tens of thousands of dollars, going through six failed cycles of in vitro fertilization. In IVF, an egg and sperm are combined in the lab and implanted in the woman's uterus. Zoll had one miscarriage and tried twice to use donor eggs that turned out not to be viable.

"It was then that I began to really question what we were doing and why we were doing it. And it was also when I realized that there were no consumer protections in place," Zoll said.

She argues that fertility clinics take advantage of the desperation of many older, infertile couples by encouraging costly, physically demanding treatment they know have a small chance of working. The Society for Assisted Reproductive Technologies reports that about 40 percent of standard IVF treatments for women under 35 lead to babies. By the age of 42, that number goes down to 4 percent.

Zoll doesn't doubt many fertility doctors have good intentions, "But I also think because they are simultaneously wearing their doctor hats and their business hats, that when, for example, our doctor told me and my husband that my chances of having a baby through IVF were very low, he also told us that you never knew, it only took one good egg, and why not try?"

It's that enticement, Zoll says, along with news of older celebrity pregnancies and miracle births that leave women like her to become what she calls "fertility junkies."

"Couples become so obsessed and their faith in the science to overcome a medical condition is so strong that they believe it will work the next time," Zoll said. "And it's a psychological mechanism that I believe the industry understands ... It's why the websites are full of babies in pink and blue blankets, it's why you don't see pictures of couples crying in each other's arms, you don't see pictures of women injecting syringes into their bellies."

Dr. Cynthia Sites is chief of the Obstetrics-Gynecology department at Bay State Reproductive Medicine in Springfield, Mass., which performs about 500 IVF cycles a year, as well as less invasive treatments. Test tubes and long needles populate the lab where biologist Lisa Ashcraft analyzes sperm under a microscope and counts the healthy swimmers.

Although Zoll was not a patient here, Dr. Sites has sat with many a tearful couple whose treatment failed. She says Bay State is always transparent about the chances of a live birth. On a hospital bedside table, she picks up several laminated pages attached to a metal ring.

"These are the types of statistics that we have down here to show patients," Sites said. "And as you can see, as patients get older, it's anywhere from about 4 or 5 percent up here to 30 percent."

Despite Zoll's critique of industry profits, Sites says Bay State's doctors are salaried and have no incentive to encourage couples to keep at it indefinitely. After three or four failed cycles, Sites may suggest they take a break from treatments or get a second opinion.

"We don't want to waste their time. We don't want to waste our time. It's fruitless. It's nearly fruitless. As I said, I never say never. But the chances are diminishing. They may not hear it, they may not want to hear it."

Erin Chrusciel of East Longmeadow has been going through treatment for a decade, including hormonal injections, intrauterine insemination, several failed IVF cycles, and three miscarriages.

"I think our OB was very frank with us and very honest with us," Chrusciel said.

Like Miriam Zoll, Chrusciel delayed motherhood in part for her career and assumed she'd be among the women who get pregnant easily when they're older.

When she learned her ovaries would not perform on command, "It was devastating. It literally felt like someone punched me in the gut and I remember not being able to stand. And I think as we got into fertility treatments, it's a horrendous experience. It's invasive, it feels demeaning, but I don't blame the industry on that. I think that it's kind of the nature of the beast."

One key difference between Chrusciel's experience and Zoll's is the outcome. Chrusciel gave birth to a daughter three years ago using an egg donated by a distant relative. At 42, Chrusciel is now pregnant with her second child through egg donation and IVF.

"It's kind of crazy to think that someone would be doing this for 10 years. And it is crazy because it did, it took a piece of me away, you know? It's nothing I would wish on anyone. But, you know, you met my daughter. I mean, she's more than I could have ever imagined. And I spent a lot of time imagining."

Miriam Zoll and her husband eventually adopted a baby boy whom they adore. So it's hard for Zoll, now 50, to wish things had gone differently, but she does urge other women to try for children earlier than she did, which she says would be easier if employers offered better family leave policies and workplace flexibility.

"We have a right to be mothers and a right to work and we should not feel that our economic and professional status is dependent on whether we agree to subject our bodies to fertility treatments because we're delaying motherhood," said Zoll.

She recently joined the board of Our Bodies Ourselves, the women's health collective based in Boston. Her goal is to make sure women have the facts they need to be informed reproductive health consumers.