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Surrogacy Book

Looking for a Surrogate Mother or an egg donor?

This book is a moving real-life account of one woman's struggle with infertility and her journey through surrogacy to have the family she desperately wanted.

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By Sally Bell Boulder County Business Report  Mar. 05, 2004

BOULDER -- In her 20s and supposedly at the prime of her reproductive years, Kathleen Bernoth tried for five years to have a baby, but wasn't ovulating. Doctors in her native Australia solved the problem, but she still didn't get pregnant.

By the time Bernoth and her husband, Andy, moved to Boulder in 2000, she was heartily discouraged. Then a doctor referred her to Conceptions Women's Health and Fertility Specialists here.

One cycle of fertility injections later, "we fell pregnant," she said. "I was over the moon at the news. I was actually woozy."

Her daughter, Mykaela, turns 2 on May 29.

"She's a blue-eyed blonde. She's very outgoing and definitely a people person. She's just a bundle of laughs," Bernoth said.

The couple tried again in November. And once again, she became pregnant on the first cycle of fertility drugs. Her second child -- she's chosen not to learn its gender is due July 16.

Mykaela and her brother or sister are two of about 2,000 babies born with Conceptions' help since the Boulder clinic opened in 1993.

Unlike Mykaela, though, most are conceived through in-vitro fertilization, in which sperm and egg mix in a culturing medium, and the resulting embryo is implanted in the woman's womb.

More than 30,000 IVF babies now are conceived in the United States each year. That's a long, long way since Louise Brown, the world's first "test-tube baby," was born in 1978.

Today's overall national IVF success rate is 32.8 percent per menstrual cycle --and even better locally, where half of Conceptions' younger IVF patients conceive the first time.

Pregnancy rates are so much higher today, up from just 15 percent in the early 1990s, because of innovative new techniques and technologies.

"The real secret is in the embryology laboratory," said the clinic's lead physician, Dr. Richard Worley.

In fact, odds of conceiving through IVF now are actually far better than even the natural rate of 21 percent per cycle in couples who have no fertility problems, Worley said.

"IVF produces a much greater rate of pregnancy than natural sex. You get a distribution of egg and embryo quality and can select those most likely to remain viable," and then implant no more than two or three to boost the odds further, he explained.

Fewer embryos implanted because of better techniques mean multiple birth rates are declining.

Since 40 percent of infertility originates in the man and 40 percent in the woman (with the remaining 20 percent both partners or unknown), Conceptions starts with a thorough physical exam. His sperm is evaluated and her fallopian tubes and uterus are X-rayed.

When the fallopian tubes are blocked so the egg can't get from ovaries to uterus, Conceptions will operate to try opening them. If that succeeds, or other reproductive obstacles are solved, more than half the women will fall pregnant over the next year on their own, said Dr. Mark R. Bush, a new clinic partner who will start working at Conceptions in mid-July.

If the tubes are clear, Conceptions next will give the woman fertility drugs to induce "super ovulation," as was done with Bernoth, then inject concentrated sperm through the cervix into the uterus.

Should that not succeed after several cycles -- insemination works less than one-third of the time, but is tried first because it is less invasive and much less expensive -- the clinic moves to in-vitro fertilization, which is conducted in the clinic's Littleton office.

Here's where the science gets fancy. Conceptions can aspirate sperm directly from the man's sperm ducts, inject a single sperm directly into the egg, fertilize donor eggs, screen embryos for certain genetic defects, keep embryos longer in the culturing medium so they are larger before implantation, and help prevent miscarriage.

The clinic also will help a couple have a child of a specific gender when there are strong sex-linked disorders in the family or for family balancing when the couple already has two or more children of the same sex, Bush added.

Whatever the technique, the goal is to grow the embryo in a culturing medium for five days to the blastocyst stage of 128 cells or more, he said. Not long ago, embryos routinely died after three days in a less nourishing medium, when they had just eight cells.

The two additional days means at least four more cell divisions, enabling clinic embryologists to tell which embryos are the healthiest. Conceptions' averages 67.9 percent pregnancy for women of all ages whose embryos survive to the crucial blastocyst stage.

For women under age 35 with normal ovarian function, about 50 percent of Conceptions patients become pregnant with each menstrual cycle. After three cycles, the most Conceptions usually administers, 87.5 percent of these younger women will have conceived. With age, however, success rates plummet, so that only 11 percent of women ages 42 and older succeed the first time.

"It's an emotional roller coaster" for women who don't get pregnant right off, said Margie Mercer, Conceptions' director of public relations. "Every monthly period is another down for them. Our doctors take a lot of crying phone calls."

Just as emotional for most patients is the cost. Insurance usually pays for the initial infertility diagnosis and for about half the $913 per cycle superovulation and insemination costs, Worley said, but rarely covers the very expensive in-vitro fertilizations, which costs nearly $10,000 per cycle --plus medications.

For that reason, Conceptions recently launched a nonprofit foundation, Gift of Hope, which will donate at least four in-vitro cycles a year to couples who can't afford treatment, beginning next fall. Worley said funds will come from the pharmaceutical firms that make fertility drugs, some successful parents and businesses. Clinic staff members will donate their time.

Helping couples have children is "a wonderful feeling," Worley said. "You know that any couple willing to put forth this effort of emotion, commitment and money is also going to love this child.

The reward we see is bringing love to children in the world."

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